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Effectiveness of imaging modalities for screening IgG4-related dacryoadenitis and sialadenitis (Mikulicz's disease) and for differentiating it from Sjögren's syndrome (SS), with an emphasis on sonography.

Shimizu M, Okamura K, Kise Y, Takeshita Y, Furuhashi H, Weerawanich W, Moriyama M, Ohyama Y, Furukawa S, Nakamura S, Yoshiura K - Arthritis Res. Ther. (2015)

Bottom Line: The aim of this study was to clarify the effectiveness of various imaging modalities and characteristic imaging features in the screening of IgG4-related dacryoadenitis and sialadenitis (IgG4-DS), and to show the differences in the imaging features between IgG4-DS and Sjögren's syndrome (SS).There were significant differences between sonography and CT (p = 0.0001) and between sonography and FDG-PET/CT (p = 0.0058) concerning accuracy.Consequently, we recommend sonography as a modality for the screening of IgG4-DS, because it is easy to use, involves no radiation exposure and is an effective imaging modality.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Radiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. shimizu@rad.dent.kyushu-u.ac.jp.

ABSTRACT

Introduction: The aim of this study was to clarify the effectiveness of various imaging modalities and characteristic imaging features in the screening of IgG4-related dacryoadenitis and sialadenitis (IgG4-DS), and to show the differences in the imaging features between IgG4-DS and Sjögren's syndrome (SS).

Methods: Thirty-nine patients with IgG4-DS, 51 with SS and 36 with normal salivary glands were enrolled. Images of the parotid and submandibular glands obtained using sonography, 2-[(18)F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT), computed tomography (CT) and magnetic resonance imaging (MRI) were retrospectively analyzed. Six oral and maxillofacial radiologists randomly reviewed the arranged image sets under blinded conditions. Each observer scored the confidence rating regarding the presence of the characteristic imaging findings using a 5-grade rating system. After scoring various findings, diagnosis was made as normal, IgG4-DS or SS, considering all findings for each case.

Results: On sonography, multiple hypoechoic areas and hyperechoic lines and/or spots in the parotid glands and obscuration of submandibular gland configuration were detected mainly in patients with SS (median scores 4, 4 and 3, respectively). Reticular and nodal patterns were observed primarily in patients with IgG4-DS (median score 5). FDG-PET/CT revealed a tendency for abnormal (18)F-FDG accumulation and swelling of both the parotid and submandibular glands in patients with IgG4-DS, particularly in the submandibular glands. On MRI, SS had a high score regarding the findings of a salt-and-pepper appearance and/or multiple cystic areas in the parotid glands (median score 4.5). Sonography showed the highest values among the four imaging modalities for sensitivity, specificity and accuracy. There were significant differences between sonography and CT (p = 0.0001) and between sonography and FDG-PET/CT (p = 0.0058) concerning accuracy.

Conclusions: Changes in the submandibular glands affected by IgG4-DS could be easily detected using sonography (characteristic bilateral nodal/reticular change) and FDG-PET/CT (abnormal (18)F-FDG accumulation). Even inexperienced observers could detect these findings. In addition, sonography could also differentiate SS. Consequently, we recommend sonography as a modality for the screening of IgG4-DS, because it is easy to use, involves no radiation exposure and is an effective imaging modality.

No MeSH data available.


Related in: MedlinePlus

Results of FDG-PET/CT. Values are shown with median and quartile points for a, b the parotid glands and c, d the submandibular glands. a Abnormal accumulation of 18F-FDG in the parotid glands, b size of the parotid glands, c abnormal accumulation of 18F-FDG in the submandibular glands and d size of the submandibular glands. Abnormal accumulation of 18F-FDG and swelling of the glands in both the parotid and submandibular glands of a patient with IgG4-DS (a-d). Separation of IgG4-DS from the other conditions is especially good regarding the abnormal accumulation of 18F-FDG in the submandibular glands (c), and significant differences can be observed between IgG4-DS and SS (p <0.0001), and between IgG4-DS and normal glands (p <0.0001). FDG-PET/CT 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography, IgG4-DS IgG4-related dacryoadenitis and sialadenitis, SS Sjögren’s syndrome
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Fig4: Results of FDG-PET/CT. Values are shown with median and quartile points for a, b the parotid glands and c, d the submandibular glands. a Abnormal accumulation of 18F-FDG in the parotid glands, b size of the parotid glands, c abnormal accumulation of 18F-FDG in the submandibular glands and d size of the submandibular glands. Abnormal accumulation of 18F-FDG and swelling of the glands in both the parotid and submandibular glands of a patient with IgG4-DS (a-d). Separation of IgG4-DS from the other conditions is especially good regarding the abnormal accumulation of 18F-FDG in the submandibular glands (c), and significant differences can be observed between IgG4-DS and SS (p <0.0001), and between IgG4-DS and normal glands (p <0.0001). FDG-PET/CT 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography, IgG4-DS IgG4-related dacryoadenitis and sialadenitis, SS Sjögren’s syndrome

Mentions: FDG-PET/CT involving patients with IgG4-DS showed a tendency for abnormal accumulation of 18F-FDG and swelling of both the parotid (median scores 2 and 4, respectively) and submandibular glands (median scores 5 and 4, respectively) (Fig. 4a–d). Separation between IgG4-DS and the other conditions was particularly good regarding the abnormal accumulation of 18F-FDG in the submandibular glands (median score 2 for normal glands and 1 for SS) (Fig. 4c). In relation to this finding, significant differences were observed between IgG4-DS and SS (p <0.0001), and between patients with IgG4-DS and those with normal glands (p <0.0001); however, this was not seen between patients with normal glands and SS (p = 0.1180). Intra-observer agreement rates between the repeat diagnoses were high (kappa values, 0.51–0.89). Regarding all other findings, significant differences (p ≤0.0049) were observed between any two of three diagnoses.Fig. 4


Effectiveness of imaging modalities for screening IgG4-related dacryoadenitis and sialadenitis (Mikulicz's disease) and for differentiating it from Sjögren's syndrome (SS), with an emphasis on sonography.

Shimizu M, Okamura K, Kise Y, Takeshita Y, Furuhashi H, Weerawanich W, Moriyama M, Ohyama Y, Furukawa S, Nakamura S, Yoshiura K - Arthritis Res. Ther. (2015)

Results of FDG-PET/CT. Values are shown with median and quartile points for a, b the parotid glands and c, d the submandibular glands. a Abnormal accumulation of 18F-FDG in the parotid glands, b size of the parotid glands, c abnormal accumulation of 18F-FDG in the submandibular glands and d size of the submandibular glands. Abnormal accumulation of 18F-FDG and swelling of the glands in both the parotid and submandibular glands of a patient with IgG4-DS (a-d). Separation of IgG4-DS from the other conditions is especially good regarding the abnormal accumulation of 18F-FDG in the submandibular glands (c), and significant differences can be observed between IgG4-DS and SS (p <0.0001), and between IgG4-DS and normal glands (p <0.0001). FDG-PET/CT 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography, IgG4-DS IgG4-related dacryoadenitis and sialadenitis, SS Sjögren’s syndrome
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4546818&req=5

Fig4: Results of FDG-PET/CT. Values are shown with median and quartile points for a, b the parotid glands and c, d the submandibular glands. a Abnormal accumulation of 18F-FDG in the parotid glands, b size of the parotid glands, c abnormal accumulation of 18F-FDG in the submandibular glands and d size of the submandibular glands. Abnormal accumulation of 18F-FDG and swelling of the glands in both the parotid and submandibular glands of a patient with IgG4-DS (a-d). Separation of IgG4-DS from the other conditions is especially good regarding the abnormal accumulation of 18F-FDG in the submandibular glands (c), and significant differences can be observed between IgG4-DS and SS (p <0.0001), and between IgG4-DS and normal glands (p <0.0001). FDG-PET/CT 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography, IgG4-DS IgG4-related dacryoadenitis and sialadenitis, SS Sjögren’s syndrome
Mentions: FDG-PET/CT involving patients with IgG4-DS showed a tendency for abnormal accumulation of 18F-FDG and swelling of both the parotid (median scores 2 and 4, respectively) and submandibular glands (median scores 5 and 4, respectively) (Fig. 4a–d). Separation between IgG4-DS and the other conditions was particularly good regarding the abnormal accumulation of 18F-FDG in the submandibular glands (median score 2 for normal glands and 1 for SS) (Fig. 4c). In relation to this finding, significant differences were observed between IgG4-DS and SS (p <0.0001), and between patients with IgG4-DS and those with normal glands (p <0.0001); however, this was not seen between patients with normal glands and SS (p = 0.1180). Intra-observer agreement rates between the repeat diagnoses were high (kappa values, 0.51–0.89). Regarding all other findings, significant differences (p ≤0.0049) were observed between any two of three diagnoses.Fig. 4

Bottom Line: The aim of this study was to clarify the effectiveness of various imaging modalities and characteristic imaging features in the screening of IgG4-related dacryoadenitis and sialadenitis (IgG4-DS), and to show the differences in the imaging features between IgG4-DS and Sjögren's syndrome (SS).There were significant differences between sonography and CT (p = 0.0001) and between sonography and FDG-PET/CT (p = 0.0058) concerning accuracy.Consequently, we recommend sonography as a modality for the screening of IgG4-DS, because it is easy to use, involves no radiation exposure and is an effective imaging modality.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Radiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. shimizu@rad.dent.kyushu-u.ac.jp.

ABSTRACT

Introduction: The aim of this study was to clarify the effectiveness of various imaging modalities and characteristic imaging features in the screening of IgG4-related dacryoadenitis and sialadenitis (IgG4-DS), and to show the differences in the imaging features between IgG4-DS and Sjögren's syndrome (SS).

Methods: Thirty-nine patients with IgG4-DS, 51 with SS and 36 with normal salivary glands were enrolled. Images of the parotid and submandibular glands obtained using sonography, 2-[(18)F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT), computed tomography (CT) and magnetic resonance imaging (MRI) were retrospectively analyzed. Six oral and maxillofacial radiologists randomly reviewed the arranged image sets under blinded conditions. Each observer scored the confidence rating regarding the presence of the characteristic imaging findings using a 5-grade rating system. After scoring various findings, diagnosis was made as normal, IgG4-DS or SS, considering all findings for each case.

Results: On sonography, multiple hypoechoic areas and hyperechoic lines and/or spots in the parotid glands and obscuration of submandibular gland configuration were detected mainly in patients with SS (median scores 4, 4 and 3, respectively). Reticular and nodal patterns were observed primarily in patients with IgG4-DS (median score 5). FDG-PET/CT revealed a tendency for abnormal (18)F-FDG accumulation and swelling of both the parotid and submandibular glands in patients with IgG4-DS, particularly in the submandibular glands. On MRI, SS had a high score regarding the findings of a salt-and-pepper appearance and/or multiple cystic areas in the parotid glands (median score 4.5). Sonography showed the highest values among the four imaging modalities for sensitivity, specificity and accuracy. There were significant differences between sonography and CT (p = 0.0001) and between sonography and FDG-PET/CT (p = 0.0058) concerning accuracy.

Conclusions: Changes in the submandibular glands affected by IgG4-DS could be easily detected using sonography (characteristic bilateral nodal/reticular change) and FDG-PET/CT (abnormal (18)F-FDG accumulation). Even inexperienced observers could detect these findings. In addition, sonography could also differentiate SS. Consequently, we recommend sonography as a modality for the screening of IgG4-DS, because it is easy to use, involves no radiation exposure and is an effective imaging modality.

No MeSH data available.


Related in: MedlinePlus