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IgG4相关硬化性胆管炎初诊患者CT和MRI表现与血清IgG4水平升高相关性研究

董力宁 闫威 张洁 杨大为 刘朋 徐辉 杨正汉 王振常 靳二虎

董力宁, 闫威, 张洁, 等. IgG4相关硬化性胆管炎初诊患者CT和MRI表现与血清IgG4水平升高相关性研究[J]. CT理论与应用研究, 2022, 32(0): 1-9. DOI: 10.15953/j.ctta.2022.158
引用本文: 董力宁, 闫威, 张洁, 等. IgG4相关硬化性胆管炎初诊患者CT和MRI表现与血清IgG4水平升高相关性研究[J]. CT理论与应用研究, 2022, 32(0): 1-9. DOI: 10.15953/j.ctta.2022.158
DONG L, YAN W, ZHANG J, et al. Study of correlations between CT and MRI findings and elevated serum IgG4 levels in newly-diagnosed patients with IgG4-related sclerosing cholangitis[J]. CT Theory and Applications, 2022, 32(0): 1-9. DOI: 10.15953/j.ctta.2022.158. (in Chinese)
Citation: DONG L, YAN W, ZHANG J, et al. Study of correlations between CT and MRI findings and elevated serum IgG4 levels in newly-diagnosed patients with IgG4-related sclerosing cholangitis[J]. CT Theory and Applications, 2022, 32(0): 1-9. DOI: 10.15953/j.ctta.2022.158. (in Chinese)

IgG4相关硬化性胆管炎初诊患者CT和MRI表现与血清IgG4水平升高相关性研究

doi: 10.15953/j.ctta.2022.158
基金项目: 北京市医院管理中心临床医学发展专项(定量影像研究(ZYLX202101))。
详细信息
    作者简介:

    董力宁:女,首都医科大学附属北京友谊医院放射科住院医师,主要从事腹部疾病影像诊断,E-mail:liningdln@126.com

    靳二虎:男,医学博士,首都医科大学附属北京友谊医院放射科主任医师、教授、博士研究生导师,主要从事医学影像诊断相关的临床、教学和科研工作,专业特长是腹盆部疾病影像诊断,E-mail:erhujin@263.net

    通讯作者:

    靳二虎*,

Study of Correlations between CT and MRI Findings and Elevated Serum IgG4 Levels in Newly-diagnosed Patients with IgG4-related Sclerosing Cholangitis

  • 摘要: 目的:观察IgG4相关硬化性胆管炎(IgG4-SC)的CT和MRI表现,探究初诊患者影像特征与血清IgG4、IgG水平的关系。方法:总结50例IgG4-SC初诊患者的临床、实验室及影像资料,通过MRCP观察病变分型、管腔狭窄形态与扩张程度;增强MRI和CT观察管壁增厚、强化模式及合并其他IgG4-RD的数量,分析基线血清IgG4及IgG水平与胆管病变和合并其他IgG4-RD数量的相关性。结果:初诊41例MRCP见Ⅰ型IgG4-SC 28例,Ⅱa型11例,Ⅲ型、Ⅳ型各1例;肝外胆管狭窄端呈漏斗状37例、截断状4例,狭窄段均为长狭窄(≥1.0 cm),其中1例胰腺段狭窄伴憩室样外凸;狭窄上游胆管扩张37例,不扩张4例。初诊42例增强MRI/CT均显示肝外胆管壁连续性增厚,15例见肝内胆管壁弥漫性增厚,管壁增厚呈向心性。50例IgG4-SC均合并AIP,其他受累器官还包括肾19例、涎腺7例、腹膜后纤维化5例、肝4例、肺4例、前列腺2例、硬化性纵隔炎2例、胆囊壁增厚20例及上腹部淋巴结肿大15例。基线血清IgG4、IgG水平升高与合并其他IgG4-RD的数量呈正相关,而与胆管壁厚度、狭窄段长度不相关。结论:胆管局限性狭窄伴上游胆管扩张或不扩张以及管壁弥漫性增厚是IgG4-SC初诊患者的特征性MRI和CT表现。基线血清IgG4及IgG水平升高与胆管病变的严重程度无关,而与合并其他IgG4-RD的数量有关。

     

  • 图  1  初诊IgG4-SC患者MRCP分型表现

    (a)~(d)分别显示1~4型IgG4-SC。(a)图为1型,胆总管下段狭窄(箭),其上游肝内外胆管扩张。(b)图为2a型,胆总管下段及肝内胆管多发狭窄(箭),狭窄上游肝内外胆管扩张。(c)图为3型,胆总管下段和肝门部胆管狭窄(箭),其上游胆管扩张。(d)图为4型,肝门部胆管狭窄(箭),肝内胆管梗阻性扩张。

    Figure  1.  MRCP classifications of IgG4-SC in newly diagnosed patients

    图  2  初诊IgG4-SC患者MRCP狭窄端及狭窄段形态

    (a)图显示肝外胆管狭窄端呈漏斗状(箭),狭窄段较长且管腔断续可见。(b)图显示狭窄端呈截断状,狭窄段管腔不可见(箭)。(c)图显示肝外胆管胰上段狭窄,管腔粗细不均(箭)。(d)图显示肝外胆管胰腺段狭窄伴邻近十二指肠侧憩室样外凸(箭)。

    Figure  2.  Morphologic patterns of the stenotic end and segment of IgG4-SC in newly diagnosed patients on MRCP

    图  3  51岁,男性,初诊IgG4-SC患者增强MRI表现

    (a)~(a)分别为轴面T1WI的蒙片、动脉期、门静脉期、延迟期图像,可见肝外胆管壁均匀向心性增厚及渐进性强化(箭),同时见胆囊壁增厚及异常强化。(e)为肝内胆管层面的轴面T1WI延迟期,(f)为冠状面T1WI延迟期,可见肝内、外胆管壁弥漫性增厚及明显强化(箭),肝内胆管扩张。

    Figure  3.  Contrast-enhanced MRI findings of IgG4-SC in a 51-year-old male newly-diagnosed patient

    表  1  IgG4-SC患者血清IgG4、IgG升高与影像表现的相关性分析

    Table  1.   Correlation analysis between elevated serum IgG4 and IgG levels and imaging findings in patients with IgG4-SC

    影像表现血清IgG4升高血清IgG升高
    rPrP
    肝外胆管狭窄段长度  -0.3480.070-0.0860.717
    管壁厚度MRI测量   0.2080.2710.2090.363
    管壁厚度CT测量    0.2470.4160.6550.078
    合并其他IgG4-RD的数量0.613*0.0000.524*0.003
     注:*为P<0.01,相关性显著。
    下载: 导出CSV
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  • 收稿日期:  2022-08-05
  • 修回日期:  2022-09-12
  • 录用日期:  2022-09-13
  • 网络出版日期:  2022-09-28

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