目的：探讨18F-FDG PET/CT在IgG4相关性疾病（IgG4-RD）中的应用。方法：本研究回顾性分析47例依据IgG4-RD综合诊断标准诊断为IgG4-RD病例的临床相关信息和18F-FDG PET/CT表现。结果：47例IgG4-RD中，以男性为主（35/47，74.47%），年龄23~79岁，平均47.5岁。43例出现多器官受累，以淋巴结（29/47）、胰腺（27/47）及唾液腺（16/47）多见。所有受累病灶均表现为代谢增高，以唾液腺摄取最高（SUVmax为6.44±4.98），其次为淋巴结及胰腺。81.58%的外分泌腺受累患者（31/38）表现为腺体对称性或弥漫性肿胀伴代谢均匀或不均匀性增高。根据血清IgG4是否升高进行分组分析，发现IgG4升高组更容易出现嗜酸性粒细胞升高、前列腺受累，同时受累的泪腺及胰腺摄取程度更高，对激素治疗更敏感（P均<0.05）。41例IgG4-RD有效随访中，65.85%的患者对激素治疗敏感，治疗后血清IgG4下降不明显，但其受累病灶的18F-FDG摄取程度明显降低。结论：PET/CT在IgG4-RD的诊断及鉴别诊断、活检部位的选择、全身脏器受累情况、疗效监测等方面具有重要价值。
Abstract
Objective: To investigate the application of 18F-FDG PET/CT in IgG4-related diseases(IgG4-RD). Methods: This study retrospectively analyzed 47 cases of IgG4-RD diagnosed according to the comprehensive diagnostic criteria of IgG4-RD. The data of clinical information and 18F-FDG PET/CT presentation were collected and analyzed. Results: Of the 47 IgG4-RD patients, male was predominant(35/47, 74.47%) and the average age was 47.51 years(range 23~79 years). Forty-three cases displayed multiple organs involvement, and lymph nodes(29/47), pancreas(27/47) and salivary glands(16/47) were more common. All the involved lesions displayed high FDG uptake, and in which the salivary gland was the highest uptake(SUVmax 6.44±4.98), followed by lymph nodes and pancreas. 81.58% of the patients(31/38) involved the exocrine glands exhibiting symmetrical or diffuse gland swelling with increased homogeneous or heterogeneous metabolism. According to the grouping analysis of serum IgG4 elevation, the elevated IgG4 group was more prone to eosinophil elevation, prostate involvement, higher uptake of involved lacrimal gland and pancreas, and more sensitive to hormone therapy(All P<0.05). In the effective follow-up of 41 cases, 65.85% of patients were sensitive to hormone therapy. Although the serum IgG4 level was not significantly decreased after treatment, the 18F-FDG uptake of the involved lesions was significantly reduced. Conclusion: PET/CT is of great value in the diagnosis and differential diagnosis of IgG4-RD, the choice of biopsy site, the assessment of systemic organ involvement, and the monitoring of therapeutic effect.
关键词
免疫球蛋白G /
氟脱氧葡萄糖F18 /
正电子发射断层显像术
Key words
Immunoglobulin G /
Fluorodeoxyglucose F18 /
Positron-emission tomography
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基金
广东省科技计划项目（2017B020247016；2018YT024）。
