Anatomic and Functional Imaging of Immunoglobulin G4–related                     Disease and Its Mimics

Kong, Min J; Nguyen, Bao D.

doi:10.1148/rg.220097

Cited by 5 publications

(6 citation statements)

References 73 publications

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“…At the onset, the lesions might mimic a malignancy (or a paraneoplastic syndrome) or an infectious disease or they may be mistaken as another autoimmune condition, while severe cardiac and vessel involvement should be differentiated from an acute myocardial infarction or rupture of an aortic aneurysm [ 25 , 29 , 35 ]. Functional imaging with 18-Fluoro-deoxyglucose positronic emission tomography/computed tomography, despite not being specific, represents a useful tool to indicate the sites of IgG4-mediated increased activity in addition to traditional ultrasound, computed tomography, and magnetic resonance imaging-based findings [ 36 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

Cârșote

Nistor

2023

Biomedicines

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Recently, Riedel’s thyroiditis (RT) was assimilated into the larger spectrum of immunoglobulin IgG4-related disease (IgG4-RD) in addition to a particular frame of IgG4-related thyroid disease (IgG4-RTD), underlying IgG4-RT, IgG4-associated Hashimoto’s thyroiditis (and its fibrotic variant), and IgG4-related Graves’s disease. Our objective was to overview recent data on RT, particularly IgG4-RD and IgG4-RTD. The case and study– sample analysis (2019–2023) included 293 articles and selected 18 original studies: nine single case reports (N = 9, female/male = 2/1, aged: 34–79 years, 5/9 patients with serum IgG4 available data, 2/5 with high serum IgG4) and four case series (N = 21; 4/5 series provided data on IgG4 profile, 3/21 had serum IgG4 assays, and 2/3 had abnormally high values). IgG4-RD and thyroid findings were analyzed in three cohorts (N = 25). Another two studies (N = 11) specifically addressed IgG4-RTD components. On presentation, the patients may have hypothyroidism, transitory thyrotoxicosis, goiter, long-term history of positive anti-thyroid antibodies, and hypoechoic ultrasound thyroid pattern. The 5-year analysis (N = 66) showed the rate of serum IgG4 evaluation remained low; normal values do not exclude RT. Mandatory histological and immunohistochemistry reports point out a high content of IgG4-carrying plasma cells and IgG4/IgG ratio. Unless clinically evident, histological confirmation provides a prompt indication of starting corticoid therapy since this is the first-line option. Surgery, if feasible, is selective (non-responders to medical therapy, emergency tracheal intervention, and open/core needle biopsy). Current open issues are identifying the role of serum IgG4 assays in patients with IgG4-RD, finding out if all cases of RT are IgG4-mediated, applying IgG4-RTD criteria of differentiation among four entities, and providing an RT/IgG4-RTD guideline from diagnosis to therapy. It remains that the central aim of approaching RT in daily practice is the early index of suspicion in order to select patients referred for further procedures that provide enough histological/immunohistochemistry material to confirm RT and its high IgG4 burden.

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Section: Introductionmentioning

confidence: 99%

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

Cârșote

Nistor

2023

Biomedicines

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“…As formas mais comuns de apresentação incluem pancreatite autoimune tipo 1, colangite esclerosante, sialadenite esclerosante, doenças da órbita e fibrose retroperitoneal (FRP) (3). A manifestação do paciente do presente estudo foi a fibrose retroperitoneal, que é caracterizada por reação inflamatória crônica no retroperitônio com consequente formação de tecido fibrótico periaórtico ou periilíaco (14).…”

Section: Discussionunclassified

“…Na RM, dependendo do grau de inflamação ativa, uma lesão de sinal baixo ou intermediário é vista nas imagens ponderadas em T1, e uma lesão de intensidade de sinal variável é vista nas imagens ponderadas em T2 (6). O padrão de realce também varia, dependendo do estado inflamatório subjacente: o realce precoce é observado na sua fase inflamatória ativa, enquanto a fase não ativa crônica mostra realce tardio, o que é típico da maioria dos processos fibróticos crônicos (14).…”

Section: Discussionunclassified

Fibrose Retroperitoneal Imunomediada por doença relacionada ao IgG4: um relato de caso

Sarmento,

Pimentel,

Tavares

et al. 2023

Braz. J. Hea. Rev.

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A doença relacionada à imunoglobulina IgG4 (IgG4-RD) é uma condição com reconhecimento crescente (3), que passou a ser melhor descrita apenas na última década (7). Esta doença é uma condição fibroinflamatória imunomediada, multissistêmica, mais prevalente em homens de meia-idade e com diversas formas de apresentação. A fibrose retroperitoneal (FRP) é uma delas, esta caracterizada por reação inflamatória crônica no retroperitônio com consequente formação de tecido fibrótico, forma evidenciada no paciente do presente estudo. Nós apresentamos o caso de um paciente de 75 anos, com passado de câncer de próstata operado com cura, com queixa de dor lombar com irradiação para membros inferiores, sem melhora ao tratamento sintomático e evolução com disfunção renal. Na investigação adicional com exames de imagem, estudo patológico e imuno-histoquímica, foi diagnosticado IgG4-RD. Sendo assim, a combinação de achados clínicos, sorológicos, radiológicos e histopatológicos deve ser a base do diagnóstico desta afecção e o início precoce do tratamento com corticóides são fatores essenciais para evitar progressão da doença.

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“…Rituximab's mechanism of action, targeting CD20-positive B cells and modulating the immune response, aligns with the underlying immunopathology of IgG4-RD [ 21 , 24 ]. It has also shown potential as a steroid-sparing agent and a treatment option for corticosteroid-resistant cases [ 4 , 25 ]. Several immunosuppressive agents, such as azathioprine, mycophenolate mofetil, methotrexate, and rituximab, have been used as steroid-sparing agents to achieve and maintain remission in IgG4-RD.…”

Section: Reviewmentioning

confidence: 99%

“…Blood IgG4 levels that are above average are suggestive but not definitive. Tissue involvement and fibrosis may be shown in CT and MRI studies [ 4 ]. These findings do not provide sufficient diagnostic specificity for IgG4-RD.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Uses of Rituximab and Clinical Features in Immunoglobulin G4-Related Disease: A Systematic Review

Patel,

Saxena,

Patel

et al. 2023

Cureus

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This research presents a systematic review focusing on rituximab's therapeutic applications in immunoglobulin G4 (IgG4)-related disease (IgG4-RD), a rare condition characterized by immune-mediated systemic inflammation and tissue fibrosis, as well as the clinical features of IgG4-RD. While the disease commonly affects organs such as the bile ducts, lymph nodes, retroperitoneum, pancreas, and salivary glands, it can potentially involve other organs. This intricacy often leads to diagnostic challenges due to clinical overlaps with cancer, infections, and other autoimmune disorders. The diagnosis of IgG4-RD necessitates a comprehensive approach involving laboratory tests, imaging studies, and clinical assessments. Symptoms can vary, ranging from lymphadenopathy to jaundice, affecting multiple organs. Although elevated blood IgG4 levels and findings of tissue involvement and fibrosis on imaging can be suggestive, they lack the specificity for a definitive diagnosis. Early diagnosis is crucial for initiating corticosteroids and immunosuppressive to prevent further damage from IgG4-RD. This study highlights the therapeutic role of rituximab in managing this condition. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, the research identifies and evaluates relevant literature across various electronic databases, including PubMed, ScienceDirect, and Google Scholar. This review includes 14 selected publications, comprising three systematic reviews, three observational studies, four narrative reviews, and four case reports. The study design ensures a comprehensive evaluation of rituximab's potential efficacy in treating IgG4-RD and its associated clinical characteristics. Based on this study, it can be concluded that IgG4-RD can potentially be treated with rituximab, particularly in cases of relapse and maintaining remission.

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Anatomic and Functional Imaging of Immunoglobulin G4–related Disease and Its Mimics

Cited by 5 publications

References 73 publications

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

Fibrose Retroperitoneal Imunomediada por doença relacionada ao IgG4: um relato de caso

Therapeutic Uses of Rituximab and Clinical Features in Immunoglobulin G4-Related Disease: A Systematic Review

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