成人IgG4相关性颌下腺疾病的超声表现

Sonographic appearance immunoglobulin G4-related submandibular gland disease in adult patients

目的分析及归纳IgG4 相关性颌下腺疾病的超声影像特征。方法回顾性分析19 例22 灶IgG4 相关性颌下腺疾病的超声表现，包括颌下腺尺寸、形态、病变范围、内部回声、血流、周围淋巴结。结果19 例22 灶IgG4 相关性颌下腺疾病的超声表现可分为局限性结节样改变、弥漫性结节样改变、类肿瘤样改变3 种类型。局限性结节样改变（2 例2 灶），病侧腺体的浅侧、被膜下显示不均匀增粗的低回声区，内见条状强回声，血流偏多。弥漫性结节样改变（11 例12 灶），病侧腺体呈网格状或蜂窝状，具体表现为腺体回声增强、增粗、不均匀、血流丰富，内见弥漫、散在、大小不一的结节样低回声，其周围显示条状强回声。类肿瘤样改变（7 例8 灶），病侧腺体表现为回声不均匀减低、增粗，内夹杂多发条状强回声，并显示放射状丰富血流。结论超声检查可作为IgG4 相关性颌下腺疾病首选的影像学检查方法。该病超声影像呈局限性结节样改变、弥漫性结节样改变、类肿瘤样改变3 种类型。当怀疑患IgG4 相关性颌下腺疾病时，应进一步检查IgG4 相关性疾病常累及的组织和器官，同时进行超声引导下穿刺活检明确诊断。

Objective To analyze and summarize the sonographic features of immunoglobulin G4 （IgG4）-related submandibular gland disease. Methods The retrospective analysis on the sonographic results of 22 lesions in 19 patients with IgG4-related submandibular gland disease were conducted, including submandibular gland size,shape, lesion range, internal echo, blood flow, and peripheral lymph nodes. Results The sonographic features of 22 lesions of IgG4-related submandibular gland disease were classified into localized nodule changes, diffuse nodule changes, and tumor-forming changes. The localized nodule appearance, includes 2 lesions in 2 patients, shows a hypo-echoic area with a coarse echotexture in the superficial site of the gland and rich blood flow. In the diffuse nodule appearance, includes 12 lesions in 11 patients, the gland shows an irregular net or honeycomb structure.Further, the gland shows echo enhancement, thickening, uneven, and rich blood flow with the features of multiple,variously sized hypoechoic foci and surrounding parallel echogenic foci. The tumor-forming appearance, includes 8 lesions in 7 patients, shows the decrease of echogenic heterogeneity, coarse gland texture, multiple parallel echogenicity, and rich blood flow. Conclusions Ultrasonography can be used as the preferred diagnostic method for IgG4-related submandibular gland disease. When a patient is suspected of having IgG4-related submandibular gland disease, the tissues and organs often involved in IgG4 related diseases should be further examined, meanwhile conducting ultrasound-guided biopsy.