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  • RCCSE中国核心学术期刊(A+)
  • 中国百强报刊
  • 百种中国杰出学术期刊
  • 中国精品科技期刊
  • 中国高校百佳科技期刊
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Yong Huifang1, Dong Xue2, Wang Wensen3, et al. Computed tomography and magnetic resonance imaging features of IgG4-related pancreatitis[J]. Chinese Journal of Digestive Surgery, 2019, 18(7): 689-697. DOI: 10.3760/cma.j.issn.1673-9752.2019.07.014
Citation: Yong Huifang1, Dong Xue2, Wang Wensen3, et al. Computed tomography and magnetic resonance imaging features of IgG4-related pancreatitis[J]. Chinese Journal of Digestive Surgery, 2019, 18(7): 689-697. DOI: 10.3760/cma.j.issn.1673-9752.2019.07.014

Computed tomography and magnetic resonance imaging features of IgG4-related pancreatitis

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  • Objective:To summarize the computed tomography (CT) and magnetic resonance imaging (MRI) features of IgG4related pancreatitis.
    Methods:The retrospective and descriptive study was conducted. The clinical data of 23 patients with IgG4associated pancreatitis who were admitted to Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from November 2012 to May 2018 were collected. There were 21 males and 2 females, aged from 45 to 83 years, with an average age of 63 years. Patients underwent upper abdominal enhanced CT and enhanced MRI examinations. Observation indicators: (1) imaging examination of the patients; (2) imaging characteristics on CT and MRI examinations; (3) followup. Followup using outpatient examination including laboratory and imaging examination was performed to detect clinical symptoms and signs once a month within 3 months postoperatively, once every 3 months within 3 months to 1 year postoperatively, once every 6 months with 1-2 years postoperatively, and once a year after 2 years postoperatively up to August 2018. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers.
    Results:(1) Imaging examination of the patients: 19 of 23 patients underwent upper abdominal enhanced CT combined with upper abdominal enhanced MRI scanning, 3 underwent upper abdominal enhanced CT combined with upper abdominal MRI plain scanning, and 1 underwent only upper abdominal enhanced MRI scanning. (2) Imaging characteristics on CT and MRI examinations: pancreatic manifestations included 7 aspects. ① Location of lesion and morphological classification: of 23 patients, 17 were diffuse type, showing sausagelike appearance; 4 were focal type, including 2 with mass in the pancreatic head and 2 with mass in the pancreatic body and tail; 2 were multiple type, including 1 with mass in the pancreatic head, body and tail, and 1 with mass in the pancreatic body and tail. ② Density of lesions on CT examination: of 23 patients, 22 received CT plain scanning, including 10 with equal density and 12 with slightly low density; 1 didn′t receive CT plain scanning. ③ Signal of lesions on MRI examination: on T1 weighted imaging, 16 of 23 patients showed homogeneous slightly low signal, 4 showed isointensity signal, 2 showed mixed slightly low signal, and 1 showed slightly high signal. On T2 weighted imaging, 21 of 23 patients showed homogeneous slightly high signal, 1 showed isointensity signal, and 1 showed mixed slightly high signal. Of 23 patients, 19 underwent diffuse weighted imaging (DWI) and 4 didn′t undergo DWI. There were 17 patients with slightly high signal and 2 with high signal on DWI. On apparent diffusion coefficient imaging, 10 patients showed slightly low signal, and 9 showed low signal intensity. ④ Calcification: of 23 patients, 2 had multiple calcifications including 1 of diffuse type with calcification located at pancreatic head, and 1 of focal type with calcification located at pancreatic body and tail; 20 had no calcification;1 without CT plain scanning cannot be judged calcification. ⑤ Enhancement pattern: 23 patients showed progressive delayed enhancement of pancreatic lesions on enhancement scanning, homogeneous or heterogeneous enhancement in the arterial phase, and further enhancement in the portal venous phase and delayed phase (enhancement degree of focal type and multiple type was basically consistent with that of normal pancreas). ⑥ Halo sign surrounding lesions: of 23 patients, 7 had no halo sign, including 2 of diffuse type, 3 of focal type, and 2 of multiple type; 16 had halo sign (15 of diffuse type and 1 of focal type), including 11 with halo sign surrounding pancreatic body and tail, 3 with halo sign surrounding whole pancreas, and 1 with halo sign posterior pancreatic body and tail, and 1 with halo sign anterior pancreatic head. ⑦ The main pancreatic duct: 14 of 23 patients had irregular stenosis of the main pancreatic duct, 7 had mild dilatation of the main pancreatic duct, and 2 had no dilatation of the main pancreatic duct. Extrapancreatic manifestations included 3 aspects. ① Bile duct dilatation: 10 of 23 patients had simple intrahepatic and extrahepatic bile duct dilatation, 8 had no intrahepatic or extrahepatic bile duct dilatation, and 5 had intrapancreatic common duct stenosis with upstream bile duct dilatation. ② Extrapancreatic organ involvement: 18 of 23 patients had extrapancreatic organ involvement (5 with gall bladder involvement, 4 with intrahepatic and extrahepatic bile duct and gall bladder involvement, 3 with intrahepatic and extrahepatic bile duct involvement, 1 with lung involvement, 1 with spleen involvement, 1 with common duct involvement, 1 with kidney involvement, 1 with lung and intrahepatic and extrahepatic bile duct involvement, 1 with fibrosis of mesenteric root), and 5 had no extrapancreatic organ involvement. ③ Retroperitoneal lymph nodes: 2 of 23 patients had enlarged retroperitoneal lymph nodes, 21 had no enlarged retroperitoneal lymph nodes. (3) Followup: of 23 patients, 19 were followed up for 3-74 months, with a median time of 22 months. Sixteen of 19 patients had various degrees of improvement in clinical symptoms, laboratory and imaging manifestations after standardized hormonotherapy, and 3 had no response to hormonotherapy.
    Conclusions: CT and MRI examinations have important diagnostic value for IgG4related pancreatitis. The pancreas mainly show diffuse swelling and halo sign surrounding lesions is a typical imaging characteristic.

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