Utility of FDG PET/CT in IgG4-related systemic disease

Published on Apr 1, 2012in Clinical Radiology2.118
· DOI :10.1016/J.CRAD.2011.10.011
Koya Nakatani9
Estimated H-index: 9
(Kyoto University),
Yuji Nakamoto47
Estimated H-index: 47
(Kyoto University),
Kaori Togashi66
Estimated H-index: 66
(Kyoto University)
IgG4-related systemic disease (IgG4-RSD) is an emerging clinical entity about which much remains to be elucidated, in terms of its aetiology, pathogenesis, diagnosis, treatment and outcome. Autoimmune pancreatitis (AIP) and Mikulicz disease (MD) are the two major, well-studied constituents of IgG4-RSD. AIP and MD have common characteristics of forming tumour-mimicking lesions that consist of lymphoplasmacytic infiltrates and fibrosclerosis with numerous immunoglobulin G4 (IgG4)-positive plasma cells, as well as various multi-organ manifestations of IgG4-RSD. 2-[18F]-fluoro-2-deoxy- d- glucose positron-emission tomography/ computed tomography (FDG PET/CT) enables the acquisition of whole-body images and provides functional information about disease activity; as such it has a valuable role in staging extent of disease, guiding biopsy, and monitoring response to treatment. However, FDG PET/CT is likely to be only one component of the management strategy, and clinical, laboratory, imaging and histological findings are crucial in the overall diagnosis of the condition. At present FDG PET/CT does not have a well-established role in the assessment of patients with IgG4-RSD and future prospective studies are required to define the cost-effectiveness and clinical impact in this patient group more accurately.
📖 Papers frequently viewed together
1,049 Citations
60 Citations
110 Citations
#1Martin Gotthardt (Radboud University Nijmegen Medical Centre)H-Index: 14
#2Chantal P. Bleeker-Rovers (Radboud University Nijmegen Medical Centre)H-Index: 36
Last. Wim J.G. Oyen (Radboud University Nijmegen Medical Centre)H-Index: 84
view all 4 authors...
Nuclear medicine imaging procedures play an important role in the assessment of inflammatory diseases. With the advent of 3-dimensional anatomic imaging, there has been a tendency to replace traditional planar scintigraphy by CT or MRI. Furthermore, scintigraphic techniques may have to be combined with other imaging modalities to achieve high sensitivity and specificity, and some may require time-consuming labeling procedures. On the other hand, new developments such as combined SPECT/CT increas...
186 CitationsSource
#1Aravind Sugumar (Mayo Clinic)H-Index: 17
#1Shounak Majumder (Mayo Clinic)H-Index: 13
Last. Suresh T. Chari (Mayo Clinic)H-Index: 83
view all 3 authors...
Autoimmune pancreatitis (AIP) is a chronic fibroinflammatory disease of the pancreas that belongs to the spectrum of immunoglobulin G-subclass4-related diseases (IgG4-RD) and typically presents with obstructive jaundice. Idiopathic duct-centric pancreatitis (IDCP) is a closely related but distinct disease that mimics AIP radiologically but manifests clinically most commonly as recurrent acute pancreatitis in young individuals with concurrent inflammatory bowel disease. IgG4 levels are often elev...
49 CitationsSource
Purpose of reviewAn enlarged salivary gland or lacrimal gland raises a wide differential diagnosis that includes both benign inflammatory conditions and malignant disorders. This review aims to address the numerous controversies that have arisen regarding inflammatory diseases of the salivary gland
68 CitationsSource
Purpose of reviewTo summarize the existing knowledge of various clinical presentations of IgG4-related systemic disease (IgG4-RSD) and to review the evolving list of organs affected by IgG4-RSD.Recent findingsThe term IgG4-RSD encompasses a variety of clinical entities once regarded as being entirel
223 CitationsSource
#1Mitsuhiro Momose (Shinshu University)H-Index: 11
#2Masumi Kadoya (Shinshu University)H-Index: 38
Last. Shigeyuki Kawa (Shinshu University)H-Index: 55
view all 9 authors...
Purpose We ascertained the difference in the level of pulmonary hilar (PH) gallium-67 (Ga-67) uptake in autoimmune pancreatitis (AIP) patients between the active (before corticosteroid therapy) and remittent (after 4 weeks of corticosteroid therapy) phases using a semiquantitative measurement method based on single photon emission computed tomography (SPECT) with integrated low-dose computed tomography (CT).
2 CitationsSource
#1Takako SaekiH-Index: 29
#2Shinichi Nishi (Niigata University)H-Index: 38
Last. Ichiei Narita (Niigata University)H-Index: 39
view all 24 authors...
IgG4-related disease is a recently recognized multi-organ disorder characterized by high levels of serum IgG4 and dense infiltration of IgG4-positive cells into several organs. Although the pancreas was the first organ recognized to be affected by IgG4-related disorder in the syndrome of autoimmune pancreatitis, we present here clinico-pathological features of 23 patients diagnosed as having renal parenchymal lesions. These injuries were associated with a high level of serum IgG4 and abundant Ig...
394 CitationsSource
#1Kenichi Takano (Sapporo Medical University)H-Index: 23
#2Motohisa Yamamoto (Sapporo Medical University)H-Index: 35
Last. Tetsuo Himi (Sapporo Medical University)H-Index: 35
view all 6 authors...
Abstract Purpose Recent studies have revealed that Mikulicz disease (MD) differs from Sjogren syndrome and is an immunoglobulin G 4 (IgG 4 )–related systemic disease. Kuttner tumor (KT) is also reported to be an IgG 4 -related disease. In this study, we examined the clinicopathologic and serologic findings in MD (39 patients) and KT (6 patients) and attempted to discern the similarities between MD and KT. Materials and methods We diagnosed 39 patients with MD and 6 patients with KT. We analyzed ...
54 CitationsSource
#1Hiroki Takahashi (Sapporo Medical University)H-Index: 51
#2Motohisa Yamamoto (Sapporo Medical University)H-Index: 35
Last. Kohzoh Imai (Sapporo Medical University)H-Index: 87
view all 6 authors...
Abstract IgG4-related disease is a distinct clinical entity, whose characteristic features are the following; Serum IgG4 is prominently elevated, IgG4-positive plasma cells infiltrate in involved tissues, various mass-forming lesions with fibrosis develop in a timely and spatial manner and the response to corticosteroids is prompt and good. IgG4-related diseases mainly target two organs. One is the pancreas (autoimmune pancreatitis; AIP), and the other comprises the lacrimal and salivary glands,...
149 CitationsSource
#1Chirag Patel (Churchill Hospital)H-Index: 11
#1C.N. Patel (Churchill Hospital)H-Index: 1
Last. Andrew Scarsbrook (Leeds Teaching Hospitals NHS Trust)H-Index: 26
view all 4 authors...
Integrated positron-emission tomography/computed tomography (PET/CT) with 2-[ 18 F]-fluoro-2-deoxy- d- glucose (FDG) has revolutionized oncological imaging in recent years and now has a firmly established role in a variety of tumour types. There have been simultaneous step-wise advances in scanner technology, which are yet to be exploited to their full potential in clinical practice. This article will review these technological developments and explore how refinements in imaging protocols can fu...
29 CitationsSource
#1Suresh T. Chari (Mayo Clinic)H-Index: 83
#2Guenter Kloeppel (Mayo Clinic)H-Index: 2
Last. Tooru Shimosegawa (Mayo Clinic)H-Index: 69
view all 6 authors...
Abstract Autoimmune pancreatitis (AIP) has been extensively reported from Japan, Europe, and the United States. Whereas the descriptions of AIP from Japan have predominantly been based on the presence of a distinct clinical phenotype, reports from Europe and the United States describe at least 2 histopathologic patterns in patients' condition currently diagnosed as AIP, viz, lymphoplasmacytic sclerosing pancreatitis (LPSP) and idiopathic duct centric pancreatitis (IDCP) or granulocyte epithelial...
241 CitationsSource
Cited By82
#1Fardad Behzadi (Brigham and Women's Hospital)
#2Chong Hyun Suh (UOU: University of Ulsan)H-Index: 30
Last. Jeffrey P. Guenette (Brigham and Women's Hospital)H-Index: 9
view all 6 authors...
Abstract This systematic review aims to clarify and comprehensively detail the sometimes variable published imaging features as well as the pathogenesis, clinical diagnostic criteria, and treatment options of IgG4-Related Diseases (IgG4-RD) in the head and neck to aid the radiologist in diagnosing relapse and new sites of disease. A literature search in PubMed and EMBASE for reported cases of IgG4-RD was performed in December 2019. Case reports or series of IgG4-RD in the head and neck in adults...
#1Thomas Thompson (University of Manchester)H-Index: 2
#2Thomas Brophy (University of Manchester)
Last. Richard Napier-Hemy (University of Manchester)
view all 5 authors...
#1Katsuya Mitamura (Kagawa University)H-Index: 3
#2Hanae Arai-Okuda (Kagawa University)H-Index: 1
Last. Yoshihiro Nishiyama (Kagawa University)H-Index: 34
view all 10 authors...
#1Kou Hasegawa (Okayama University)H-Index: 4
#2Yoshihisa Hanayama (Okayama University)H-Index: 6
Last. Fumio Otsuka (Okayama University)H-Index: 35
view all 9 authors...
AbstractObjective: To differentiate patients with IgG4-related diseases (RD) from patients with other hyper IgG4 conditions who visit general medicine department.Methods: Fifty-six patients with hi...
#1J-Matthias Löhr (Karolinska University Hospital)H-Index: 10
#2Ulrich Beuers (UvA: University of Amsterdam)H-Index: 66
Last. Heiko Witt (TUM: Technische Universität München)H-Index: 40
view all 35 authors...
The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, ...
12 CitationsSource
#1Akira OshitaH-Index: 9
#2Yusuke KonoH-Index: 1
Last. Hideo KawakamiH-Index: 15
view all 7 authors...
A 77-year-old man with symptoms of chest pain was diagnosed with immunoglobulin G4 (IgG4)-related disease. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed an intense uptake in the submandibular gland, lymph nodes and abdominal aortic wall. Diffusion-weighted imaging with background body signal suppression (DWIBS) revealed signal enhancements at the same location as those of the FDG-PET/CT findings. The DWIBS signal intensity decreased after steroid treat...
1 CitationsSource
#1Marta Casal Moura (Mayo Clinic)H-Index: 3
#2Ria Gripaldo (Emory University)
Last. Jay H. Ryu (Mayo Clinic)H-Index: 80
view all 4 authors...
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder that has been recognized to involve virtually any organ in the body and typically manifests mass-like lesions (tumefactive). Although initial reports of this disease (autoimmune pancreatitis [AIP]) were described in the Japanese population, it has since been reported worldwide. It is most commonly seen in adults of middle age or older, more often men than women. The pathogenesis of IgG4-RD is largely unknown, bu...
#1Toshiaki Tanaka (Sapporo Medical University)H-Index: 16
#2Naoya Masumori (Sapporo Medical University)H-Index: 37
Retroperitoneal fibrosis is characterized by fibrotic lesions around the abdominal aorta and common ileac artery causing ureteral obstruction. Secondary retroperitoneal fibrosis is associated with malignant disease, drugs, exposure to radiation and surgery. In contrast, the majority of retroperitoneal fibrosis is classified into idiopathic retroperitoneal fibrosis, for which immunological etiology has been suggested. Recently, idiopathic retroperitoneal fibrosis has been considered to be a spect...
2 CitationsSource
#1Hiroyuki YamashitaH-Index: 16
Last. Noriko Oyama-Manabe (Hokkaido University)H-Index: 20
view all 8 authors...
Advanced imaging techniques may enable early diagnosis and monitoring of therapy in various rheumatic diseases. To prevent irreversible tissue damage, inflammatory rheumatic disease must be diagnosed and treated in preclinical stages, requiring highly sensitive detection techniques. PET provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation. This section provides an overview of the current utility of FDG-...
#1Kentaro Tamura (Jikei University School of Medicine)H-Index: 1
#2Manabu SuzukiH-Index: 4
Last. Haruhito SugiyamaH-Index: 19
view all 10 authors...
In general, we have to assume tuberculous pleurisy when a patient presents with pleural effusion and elevated adenosine deaminase (ADA). However, other diseases need to be considered, including immunoglobulin (Ig)G4-related disease (IgG4-RD). This case involved a 65-year-old asymptomatic man with right pleural effusion showing elevated ADA. He had no articular findings or rashes. Results were negative for all autoantibodies. Pleura, mediastinal lymph nodes, and areas around the aorta and vertebr...