IgG4相关眼眶疾病的MRI特征分析  

The value of MRI in the diagnosis of ocular adnexal IgG4-related disease

作　　者：申钿 冯莉莉 申艳光 SHEN Tian;FENG Lili;SHEN Yanguang(Department of Radiology,The Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学第三附属医院放射科,北京100029

出　　处：《医学影像学杂志》2022年第4期562-566,共5页Journal of Medical Imaging

摘　　要：目的分析IgG4相关眼眶疾病的MRI表现,探讨MRI对该病的诊断价值。方法选取经临床综合诊断证实的IgG4相关眼眶疾病22例患者MRI资料,均行MR平扫及增强扫描,分析其MRI影像特点。结果22例患者中,Mikulicz病13例,MRI表现为泪腺弥漫性肿大,T_(1)WI呈等信号,T_(2)WI呈略低信号,增强后明显强化。炎性假瘤9例;泪腺型2例,表现为泪腺弥漫性肿大,边缘模糊;弥漫型3例,病变可同时累及眶隔前组织、眼肌、视神经、眼环、泪腺、眶内脂肪或眶周组织;混合型3例,3例均可见泪腺增大、眶隔前组织受累,2例同时累及眼外肌,1例额神经增粗;肿块型1例,表现为边界清楚的肿块;受累组织MRI T_(1)WI呈等信号,T_(2)WI呈等-略低信号,增强呈中度-明显强化。22例患者的时间-信号强度曲线(TIC)中13例为Ⅰ型或Ⅱ型,7例为Ⅲ型,2例为IV型。增强前信号强度(SIpre)为596.8±146.5、最大信号强度(SImax)为1326.3±276.8、最后一个时相信号强度(SIlast)为1245.8±272.0,达峰时间(Tpeak):SIpeak所对应时间为(81.1±41.5)s,峰值强化指数(CIpeak)为1.16±0.39、最大强化率(ERmax)为1.29±0.44、流出率(WR)为(11.2±8.5)%。DWI呈高信号,ADC值为(0.88±0.24)×10^(-3)mm^(2)·s^(-1)。结论IgG4相关眼眶疾病MRI表现复杂,眶内多种组织受累,其中泪腺受累最常见,MRI能准确显示IgG4相关眼眶炎性疾病累及范围、与邻近结构的关系,对该病的诊断及随访具有重要的意义,动态增强扫描及DWI能为该病诊断及鉴别诊断提供重要依据。Objective To investigate the value of MRI in the diagnosis of ocular adnexal IgG4-related disease by analyzing the MR findings in 22 patients with ocular adnexal IgG4-related disease.Methods MRI findings of 22 cases with ocular adnexal IgG4-related disease by pathology and laboratory examination were retrospectively reviewed.All patients underwent MRI examination and were perfomed with contrast scanning.Results 13 of 22 patients were Mikulicz disease.The image demonstrated the diffuse enlargement of the lacrimal gland,isointense signal on T_(1)WI,less hypointense signal on T_(2)WI,and marked contrast enhancement.9 of the 22 patients were idiopathic orbital inflammatory pseudotumor(IOIP).2 of 9 were Lacrimal type,bilateral lacrimal gland were involved,which showed diffuse enlargement with poorly defined margins.3 of 9 were Mixed type.The imaging findings depended on which orbital structures were affected.All of the 3 patients involved the eyelids and lacrimal glands,2 of the 3 patients involved extra orbital muscles at the same time,the other one patient involved frontal neural simultaneously.The lesion was hypointense on T_(1)WI and less hypointense or isointense signal on T_(2)WI,moderate and marked contrast enhancement.The SIpre,SImax,SIlast,Tpeak,CIpeak,ERmax and WR of the tumor were 596.8±146.5,1326.3±276.8,1245.8±272.0,(81.1±41.5)s,1.16±0.39,1.29±0.44,(11.2±8.5)%respectively.The patterns of time-contrast index curves were type I or type II in 15 cases,type III in 6 cases and type IV in 1 case.The mean ADC value for inflammatory pseudotumor of the lacrimal gland was(0.88±0.24)×10^(-3)mm^(2)·s^(-1).Conclusion The imaging features of ocular adnexal IgG4-related disease are complex and various.It is common many kinds of orbital tissues are affectes,which most commonly affects lacrimal glands.MR images can show clearly the extention of the lesion and the relationship of the lesion and the surrounding constructions,which is helpful to the diagnosis of ocular adnexal IgG4-related disease.

关 键 词：IgG4相关眼眶疾病 MIKULICZ病 炎性假瘤 磁共振成像 

分 类 号：R816.97[医药卫生—放射医学] R445.2[医药卫生—临床医学]