IgG4相关腹部疾病的临床及影像学表现  

Clinical and imaging features of IgG4 related abdominal diseases

作　　者：李瑞利[1] 王燕[1] 王晓月 宋文艳[1] 李宏军[1] LI Ruili;WANG Yan;WANG Xiaoyue;SONG Wenyan;LI Hongjun(Department of Radiology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院放射科,北京100069

出　　处：《肝胆胰外科杂志》2022年第3期164-169,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨IgG4相关腹部疾病的临床及影像学表现,提高对该病的认识及诊断水平。方法回顾性分析2012年10月至2021年1月首都医科大学附属北京佑安医院28例IgG4相关腹部疾病的临床及影像学资料。结果腹部多个器官(2~5个)受累多见,胆管(100.0%)和胰腺(85.7%)最常受累。胆管受累复杂多样,胆总管下段受累最多见,常合并胰腺炎;肝门区及肝内胆管受累少见,肝门部胆管受累多伴肝内炎性假瘤;胆管受累表现为管壁增厚伴延迟强化,管腔细线样狭窄。胰腺弥漫性肿大常见,周围见“胶囊样”假包壳,形似腊肠,T1WI压脂序列胰腺信号弥漫减低,DWI呈高信号,ADC呈低信号,具有特征性,增强后呈渐进性延迟强化。局灶型肿大多以胰头和胰尾肿大为主,体部胰管轻度扩张。胆囊受累表现为囊壁均匀、非水肿性增厚及延迟强化。腹膜后及受累脏器周围的淋巴结多轻度增大,孤立、未融合,均匀强化。泌尿系统受累少见,多同时累及双侧,表现为肾实质内单发或多发肿块样强化减低灶,软组织密度影包绕肾盂,输尿管壁增厚伴上段积水扩张。结论IgG4相关腹部疾病的影像学表现具有一定的特征性,熟悉这些影像学特征、并结合临床表现、实验室检查和组织病理综合分析,有助于作出准确诊断。Objective To investigate the clinical and imaging manifestations of IgG4 related abdominal diseases in order to improve the understanding and diagnostic level of the disease.Methods The clinical and imaging data of 28 patients with IgG4 related abdominal diseases were retrospectively analyzed.Results Multiple(two to five)abdominal organs were frequently involved,and the most commonly involved organs were biliary tract(100.0%)and pancreas(85.7%).The involvement of biliary tract was complex and varied.The involvement of the lower bile duct was the most common,which was often associated with pancreatitis.Hilar and intrahepatic bile duct involvement was rare,hilar bile duct involvement was often complicated with intrahepatic inflammatory pseudotumor.Bile duct involvement showed wall thickening with delayed enhancement and the lumen was thread-line narrow.Diffuse enlargement of the pancreas was common,surrounded by“capsule like”pseudocapsule,shaped like sausage.The signal intensity of pancreas was diffusely decreased on T1WI fat pressure sequence,and high signal intensity on DWI,low signal intensity on ADC and gradually delayed enhancement.The focal type of enlargement was mainly the enlargement of the head and tail of the pancreas,with mild dilatation of the pancreatic duct in the body.Gallbladder involvement manifested uniform wall,non-edematous thickening and delayed enhancement.The lymph nodes in retroperitoneum and around the involved organs were mostly slightly enlarged,isolated,not fused,and uniformly enhanced.Urinary system involvement is rare,mostly involving both sides,showing single or multiple mass like and enhancement decline in renal parenchyma,soft tissue density shadow surrounding the renal pelvis,ureteral wall thickening with upper hydronephrosis and dilatation.Conclusion The imaging features of IgG4 related abdominal diseases have certain characteristics.The imaging characteristics,combined with clinical manifestations,laboratory examination and histopathological analysis,are helpful to make an a

关 键 词：IGG4相关性疾病 腹部疾病 体层摄影术 X线计算机 磁共振成像 

分 类 号：R593[医药卫生—内科学] R572[医药卫生—临床医学]