Analysis of clinical and imaging predictors of response to corticosteroid therapy in inflammatory dacryoadenitis

Purpose To identify clinical and Magnetic Resonance Imaging (MRI) features predictive of response to corticosteroid therapy in patients with inflammatory dacryoadenitis.Methods This retrospective clinical comparative study included patients diagnosed with inflammatory dacryoadenitis who received corticosteroid therapy and underwent baseline MRI prior to treatment. Patients were classified as good responders (complete or partial response) or poor responders (no response or refractory disease) according to their clinical outcomes. The primary outcome was response to corticosteroid therapy.Results Fifty-six patients were included, of whom 44 (79%) were women with a mean age of 42 years (±16). In multivariate analysis, good responders were older than poor responders (aOR = 1.07 [1.01, 1.15]; p = 0.037) and had a shorter duration of symptoms (aOR = 0.97 [0.94, 0.99]; p < 0.001). After adjusting for age and symptom duration, hyperintensity of the lacrimal gland on Diffusion-Weighted Imaging (DWI) was associated with a poorer response to corticosteroids (aOR = 0.19 [0.03, 0.93]; p = 0.040). No differences were observed in diffusion restriction on apparent diffusion coefficient (ADC) maps or in ADC values. A clinico-radiological score incorporating age, symptom duration and lacrimal gland width on baseline MRI showed good predictive performance for treatment response (AUC = 0.84, 95% CI 0.73–0.94).Conclusion Younger age and a longer symptom duration are associated with poorer corticosteroid response in inflammatory dacryoadenitis. Although DWI hyperintensity was linked to treatment failure, the absence of corresponding ADC abnormalities limits its reliability as a predictive marker. Overall, conventional MRI appears to have limited value in predicting therapeutic response.