CAJ | 학술논문

目的探讨IgG4相关性疾病(IgG4-RD)眼眶受累的MR表现.方法回顾性分析27例以眼部症状首诊并经实验室和(或)活组织检查证实的IgG4-RD患者的影像资料.患者均行MR平扫,26例同时行增强扫描,其中13例行MR动态增强.结果 27例患者均显示泪腺增大,其中20例两侧对称性受累,5例不对称受累,2例单侧发病.与脑灰质比较,MR T1WI呈略低信号20例(39侧),等信号7例(13侧)；T2 WI呈略低信号14例(27侧),等信号13例(25侧)；增强后明显不均匀强化22例(41侧),明显均匀强化3例(5侧),中度均匀强化3例(4侧).11例(22侧)病变信号强度-时间曲线(TIC)呈速升缓慢流出型,2例(4侧)呈速升速降型.眼外肌受累增粗14例(24侧).额神经增粗强化12例(23侧),上颌神经及其分支受累6例(12侧),下颌神经受累2例(3侧).眶脂体炎性浸润10例(20侧).结论泪腺弥漫性增大是IgG4-RD眼眶受累的最常见表现,三叉神经分支广泛受累是该病另一个特征性表现,多伴眼外肌炎和眶脂体炎.
목적 탐토IgG4상관성질병(IgG4-RD)안광수루적MR표현.방법 회고성분석27례이안부증상수진병경실험실화(혹)활조직검사증실적IgG4-RD환자적영상자료.환자균행MR평소,26례동시행증강소묘,기중13례행MR동태증강.결과 27례환자균현시루선증대,기중20례량측대칭성수루,5례불대칭수루,2례단측발병.여뇌회질비교,MR T1WI정략저신호20례(39측),등신호7례(13측)；T2 WI정략저신호14례(27측),등신호13례(25측)；증강후명현불균균강화22례(41측),명현균균강화3례(5측),중도균균강화3례(4측).11례(22측)병변신호강도-시간곡선(TIC)정속승완만류출형,2례(4측)정속승속강형.안외기수루증조14례(24측).액신경증조강화12례(23측),상합신경급기분지수루6례(12측),하합신경수루2례(3측).광지체염성침윤10례(20측).결론 루선미만성증대시IgG4-RD안광수루적최상견표현,삼차신경분지엄범수루시해병령일개특정성표현,다반안외기염화광지체염.
Objective To study the MR findings of IgG4-related disease (RD) involving the orbit.Methods The orbital MR findings were retrospectively reviewed in 27 IgG4-RD patients confirmed by pathology and/or laboratory examination.All patients underwent MR examination,26 of which had contrast enhancement.Additionally,13 patients also underwent dynamic contrast-enhanced (DCE) MR and their time-signal intensity curves(TIC) were analyzed.Results Twenty-seven patients showed enlargement of the lacrimal gland,including 20 bilateral and diffuse,5 asymmetric and 2 unilateral enlargement.On MR T1 WI,the enlarged lacrimal gland appeared slightly hypointense in 20 patients (38 sides) and isointense in 7 (13 sides) compared with gray matter.On T2WI,the lesions revealed slightly hypointense in 14 patients (27 sides) and isointense in 13 (25 sides).The lesions displayed marked heterogeneous contrast enhancement in 22 patients (41 sides),marked homogeneous contrast enhancement in 3 (5 sides) and moderate enhancement in 3 (4 sides).The TICs exhibited a rapidly enhancing and slow washout pattern in 11 patients (22 sides) and a rapidly enhancing and rapid washout pattern in 2 (4 sides).The thickening of the extraocular muscles was found in 14 patients (24 sides).The trigeminal nerve and its branches were involved in 12 patients (23 sides),which were most seen with the frontal nerve thickening (12 cases,23 sides),followed by maxillary nerve and its branches (6 cases,12 sides).The intraorbital fat with inflammatory infiltration was found in 10 patients (20 sides).Conclusions The diffuse enlargement of bilateral lacrimal glands was the most common imaging finding of the IgG4-RD involving the orbit,other findings included orbital myositis,involvement of the branches of trigeminal nerve and the intraorbital fat.The patten of neurotropism may be a typical imaging feature of this entity.