AUTHOR=Yao Jiaqi , Lu Xinjian , Ma Jingxu , Hao Lu , Liu Ying , Huang Xiaopan , Liu Jun , Tong Boding 

TITLE=White matter structural changes in the visual pathway of thyroid-associated ophthalmopathy patients: a free water and multi-shell diffusion imaging study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1598510

DOI=10.3389/fneur.2025.1598510

ISSN=1664-2295

ABSTRACT=BackgroundCompared to single-shell diffusion tensor imaging (DTI), free water (FW) and neurite orientation dispersion and density imaging (NODDI) offer a more comprehensive evaluation of microstructural alterations in cerebral white matter (WM), particularly in detecting crossing fibers. However, research utilizing multi-shell diffusion imaging to investigate thyroid-associated ophthalmopathy (TAO) remains limited. This study employs FW and NODDI to investigate microstructural changes in the white matter of the visual pathways in patients with TAO.MethodsMulti-shell diffusion magnetic resonance imaging (dMRI) scans were performed on 45 patients with TAO and 31 age- and sex-matched healthy controls (HC). Tract-based spatial statistics (TBSS) analysis was conducted using eight FW and NODDI-derived metrics to identify group differences in white matter microstructure. Furthermore, correlations between these microstructural changes and clinical measures were examined.ResultsTBSS analysis revealed that, compared to HC, patients with TAO exhibited lower free-water corrected fractional anisotropy (fwFA) and free-water corrected axial diffusivity (fwAD), while free-water corrected mean diffusivity (fwMD), free-water corrected radial diffusivity (fwRD), and orientation dispersion index (ODI) were significantly increased (p < 0.05, FWE). Notably, ODI demonstrated the highest area under the curve (AUC) among these metrics. Furthermore, fwFA, fwAD, fwMD, fwRD, and ODI showed significant correlations with the Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and the Graves’ Orbitopathy Quality of Life Questionnaire (GO-QOL2) scores.ConclusionThis study suggests that abnormalities in the white matter microstructure of TAO patients can be detected through the complementary use of FW and NODDI metrics, and it is revealed that these changes may have an impact on mental health.