Advancements and challenges of ultrasound imaging in the management of thyroid-associated ophthalmopathy

Table 1 Multidisciplinary clinical applications of the Adler-Doppler blood flow grading system¹

Classification	Application	Implications in TAO
Origin research	Evaluating tumor vascularity in breast cancer[43]	Basis for grading orbital inflammation
Cross-disease validation	Hemodynamic assessment in oncology (liver, cervical, renal cancers)[44-53]	Adapted for TAO microcirculation monitoring
Cardiovascular surgery	Microcirculation evaluation in CVD post-revascularization[54]	Potential for assessing TAO-related ischemia
TAO specific validation	Detection of inflammatory-driven blood flow changes in extraocular muscles[69]	Correlates with disease activity and fibrosis

¹The Adler-Doppler blood flow grading system demonstrates extensive clinical utility across multiple disciplines. Originally developed for evaluating tumor vascularity in breast cancer, this imaging modality has been validated in hemodynamic assessments of hepatic, cervical, cardiovascular interventions and renal malignancies. Recent thyroid-associated ophthalmopathy-specific investigations reveal its capability to detect inflammatory-driven blood flow augmentation in extraocular muscles.

TAO: Thyroid-associated ophthalmopathy; CVD: Cardiovascular disease.

Table 2 Comparison of clinical applications of ultrasound and computed tomography/magnetic resonance imaging in the diagnosis of thyroid-associated orbitopathy

Technical dimension	Ultrasound	CT/MRI	Ref.
Spatial resolution	Moderate (can distinguish muscle/fat layers)	High (MRI provides superior muscle texture detail)	[1,76]
Hemodynamic assessment	Superior (real-time Doppler quantification)	Limited (requires contrast-enhanced scanning)	[46,77]
Disease activity staging	Based on hemodynamic + structural dynamics	MRI T2 signal indicates edema	[1]
Bony structure assessment	Cannot visualize bony walls	Essential (preoperative surgical decompression planning)	[76]
Cost and accessibility	Superior (portable equipment)	Higher (especially MRI)	[46,76]
Safety	Superior (non-ionizing, repeatable)	CT radiation risk; MRI metallic contraindications	[46,76]

CT: Computed tomography; MRI: Magnetic resonance imaging.