Superior Ophthalmic Vein Congestion in Thyroid Eye Disease: Assessment With 3D T1 ‐Weighted Imaging and Association With Intravenous Glucocorticoid Therapy Outcomes

ABSTRACT Background 3D T1 may assess the superior ophthalmic vein (SOV) congestion, yet its role in the intravenous glucocorticoid (IVGC) therapy remains unclear. Purpose To evaluate SOV congestion by 3D T1 in thyroid eye disease (TED) and explore its correlation with IVGC therapeutic response. Study Type Retrospective. Subjects One hundred thirty‐three TED patients, classified as 80 IVGC responders (45.7 ± 10.9 years, 32 males) and 53 non‐responders (47.6 ± 9.7 years, 23 males); 290 healthy controls (HCs) (47.9 ± 16.4 years, 145 males). Field Strength/Sequence 3 T; 3D T1‐weighted spoiled gradient‐recalled echo, T2 iterative decomposition of water and fat with echo asymmetric and least‐squares estimation, and fat‐suppressed (FS) T2 mapping. Assessment The SOV diameter (mm), along with the volume ratio, FS T2 relaxation time (T2RT [ms]), and water fraction (WF [%]) of the extraocular muscles (EOMs) and orbital fat (OF) were manually measured. Statistical Tests Student's t ‐test, Mann–Whitney U test, one‐way analysis of variance, interclass correlation coefficient, and correlation analysis. p < 0.05 defined statistical significance. Results TED patients presented significantly larger SOV diameters than HCs (2.21 ± 0.45 vs. 1.72 ± 0.26). Among them, the responsive group had significantly larger baseline SOV diameters (2.26 ± 0.49 vs. 2.15 ± 0.39), along with higher FS T2RT (71.30 ± 14.32 vs. 67.65 ± 13.33) and WF (79.31 ± 13.68 vs. 75.17 ± 14.47) in the EOMs compared to the nonresponsive group. The SOV diameter demonstrated moderate‐to‐good positive correlations with FS T2RT ( r = 0.59) and WF ( r = 0.67) in responders. Following IVGC therapy, a significant reduction in SOV diameter was observed exclusively in the responsive group (2.26 ± 0.49 vs. 1.98 ± 0.47). Data Conclusion Patients exhibiting more severe SOV congestion showed a better response to IVGC therapy, potentially due to an enhanced inflammatory state in the EOMs. Evidence Level 4. Technical Efficacy Stage 4.