Measurement of proptosis using computed tomography based three-dimensional reconstruction software in patients with Graves’ orbitopathy

The evaluation of proptosis is essential for the diagnosis of orbital disease. We have developed a computed tomography (CT)-based three-dimensional (3D) reconstruction software to measure the degree of proptosis. To verify clinical usefulness and reliability, the degree of proptosis was measured in 126 patients with Graves’ orbitopathy (GO) with 3D reconstruction software and compared with those obtained with Hertel exophthalmometer and CT. The proptosis values measured by 3D reconstruction software, CT, and Hertel exophthalmometer were closely related to each other, but showed significant differences (p < 0.001). In contrast, the amount of change in proptosis after orbital decompression were not different among the three measurements (p = 0.153). The intra-observer correlation coefficients of the 3D reconstruction software, CT, and Hertel exophthalmometer measurements were 0.997, 0.942, and 0.953, respectively. In patients with strabismus, the intra-observer correlation coefficient of CT and Hertel exophthalmometer decreased to 0.895 and 0.920, respectively, but the intra-observer correlation coefficient of the 3D reconstruction software did not change to 0.996. The inter-observer correlation coefficients of CT and 3D reconstruction software for three different ophthalmologists were 0.742 and 0.846, respectively. In conclusion, the measurement of proptosis by 3D reconstruction software seems to be a reliable method, especially in the presence of eyeball deviation.