American College of Rheumatology and the European League Against Rheumatism classification criteria for IgG4-related disease: an update for radiologists

Ren, Hainan; Mori, Nobuhiro; Sato, Satoko; Mugikura, Shunji; Masamune, Atsushi; Takase, Kei

doi:10.1007/s11604-022-01282-1

Cited by 6 publications

(2 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pituitary involvement is found in 1.7–8% of patients with IgG4-related disease, although plasmacytic/IgG4-related hypophysitis can occur without the involvement of other sites [ 14 ]. When the pituitary gland is the only involved site, the diagnosis of IgG4-related disease cannot be made, according to the 2019 American College of Rheumatology/European League Against Rheumatism classification criteria [ 15 , 16 ]. Frequently encountered symptoms include anterior hypopituitarism (86/102, 84%), diabetes insipidus/arginine vasopressin deficiency (71/89, 80%), and bitemporal hemianopia (19/31, 61%) [ 14 ].…”

Section: Etiology and Imaging Features Of Hypophysitismentioning

confidence: 99%

Neuroimaging of hypophysitis: etiologies and imaging mimics

Kurokawa

Baba

et al. 2023

Jpn J Radiol

View full text Add to dashboard Cite

Hypophysitis is an inflammatory disease affecting the pituitary gland. Hypophysitis can be classified into multiple types depending on the mechanisms (primary or secondary), histology (lymphocytic, granulomatous, xanthomatous, plasmacytic/IgG4 related, necrotizing, or mixed), and anatomy (adenohypophysitis, infundibulo-neurohypophysitis, or panhypophysitis). An appropriate diagnosis is vital for managing these potentially life-threatening conditions. However, physiological morphological alterations, remnants, and neoplastic and non-neoplastic lesions may masquerade as hypophysitis, both clinically and radiologically. Neuroimaging, as well as imaging findings of other sites of the body, plays a pivotal role in diagnosis. In this article, we will review the types of hypophysitis and summarize clinical and imaging features of both hypophysitis and its mimickers.

show abstract

Section: Etiology and Imaging Features Of Hypophysitismentioning

confidence: 99%

Neuroimaging of hypophysitis: etiologies and imaging mimics

Kurokawa

Baba

et al. 2023

Jpn J Radiol

View full text Add to dashboard Cite

show abstract

“…Of note, radiology findings account for 5 out of 8 scoring domains in the 2019 ACR-EULAR classification criteria. Ren et al have provided a review on imaging interpretation per classification criteria in clinical practice [ 16 ] but, to our knowledge, there has yet to be published studies evaluating the diagnostic performance of the radiology domain.…”

Section: Introductionmentioning

confidence: 99%

Radiology domain in the diagnosis of IgG4-RD according to the 2019 American College of Rheumatology and European League Against Rheumatism classification

Elbanna,

Kowa,

Mirajkar

et al. 2024

Insights Imaging

View full text Add to dashboard Cite

Objectives To evaluate the performance of radiology-related inclusion criteria of the 2019 ACR-EULAR classification system in the diagnosis of IgG4-related disease (IgG4-RD). Methods This retrospective single-institution study included patients who received a diagnosis of IgG4-RD between January 2010 and December 2020. Two abdominal radiologists independently reviewed baseline imaging studies and scored radiology findings according to the 2019 ACR-EULAR classification criteria. Additional scores were assigned based on serological, histopathological, and immunostaining features. Results Seventy-four patients (58 males and 16 females) with a mean age of 59.3 ± 13.9 years diagnosed with IgG4-RD were included. 51/74 (68.9%) were classified as having IgG4-RD according to the 2019 ACR-EULAR classification criteria. To reach a score ≥ 20 in these 51 patients, the radiology domain was sufficient in 20/51 (39.2%) and adding the serology domain was required for another 20/51 (39.2%). The remaining 11/51 patients (21.6%) required the histopathology and immunostaining domains. Radiological involvement of two or more organs at presentation was significantly associated with a score of ≥ 20 and seen in 43/51 (84.3%) compared to 5/23 (21.7%) of the non-classified group (p < 0.001). The group classified as having IgG4-RD showed a significantly higher proportion of elevated IgG4 levels (39/51, 76.5%) than the non-classified group (8/23, 34.8%) (< 0.001). Conclusion The study findings support the effectiveness of the radiology-related inclusion criteria of the 2019 ACR-EULAR classification system in diagnosing IgG4-RD. Combining radiology and serology domains achieved the cut-off in 80% of IgG-RD patients, enabling non-invasive diagnosis. The classification of IgG4-RD was significantly associated with multi-organ involvement, particularly affecting the pancreas and biliary system. Critical relevance statement This study is the first to evaluate the diagnostic performance of the radiology domain in the 2019 ACR-EULAR classification criteria. The study results confirm its utility and potential to enable non-invasive diagnosis when combined with serological testing in a significant proportion of patients. Key points • A significant proportion of patients can be diagnosed with IgG4-RD using the radiology and serology domains exclusively. • Multi-organ involvement is significantly associated with classifying patients as IgG4-RD, with the pancreas and biliary system most frequently affected. • A high level of inter-reader agreement in the scoring of the radiology domain supports its reliability. Graphical Abstract

show abstract