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“Stripe sign”- MRI characteristic of extraocular muscles in tendon sparing thyroid eye disease

The classic radiographic finding in thyroid eye disease (TED), fusiform enlargement of the extraocular muscles (EOMs), spares the segment closest to the eye, so-called “tendon sparing”. The etiology of this disparity in muscle expansion has not been fully described. This T 1 weighted fat saturation gadolinium enhanced magnetic resonance image (MRI) demonstrates TED with variable muscle expansion (Figure 1). The inner hypo intense region, the global layer of the muscle, progressively expands anteriorly to posteriorly. The outer hyper intense “stripe”, the orbital layer of the muscle, does not expand to the same extent. The expansion of the central hypo