磁共振在IgG4相关性眼病中的诊断价值

Diagnostic value of magnetic resonance imaging in patients with IgG4-related ophthalmic disease

目的分析IgG4相关性疾病眼眶受累(IgG4-ROD)的磁共振表现,探讨其诊断价值。方法回顾性分析18例IgG4-ROD患者MR图像,分析MR图像病变部位、双侧还是单侧、形状、边缘、眶内结构、T1WI及T2WI信号特点及强化方式。结果 18例IgG4-ROD病例全部经手术病理检查证实,根据MR表现分为4类:泪腺型、眼外肌型、肿块型、弥漫型。6例(33.3%)表现为泪腺增大,其中4例双侧对称增大,2例单侧增大;7例(38.9%)表现为肌锥内外软组织肿块,其中2单发,5例多发;1例(5.56%)眼外肌增粗;4例(25%)表现为沿邻近颅底孔道、生理腔隙及三叉神经走行区弥漫病变。18例中8例可见看到眶下神经增粗。14例行动态增强检查,时间-信号曲线均表现为快速上升缓慢流出的II型曲线。结论 IgG4-ROD会累及泪腺、眼外肌、内眦、肌锥外间隙等,眶下神经增粗和沿三叉神经分支浸润性生长是该病特征性表现,认识了解IgG4-ROD典型影像学表现,对诊断提高诊断率有帮助。

Objective To evaluate MRI findings of IgG4-related ophthalmic disease. Methods We included 18 patients with histopathologically proven IgG4-ROD. MR images were retrospectively evaluated for location, laterality, shape, margin, T1 and T2 signal intensity on precontrast MRI, internal architecture, ocular adnexal lesion enhancement patterns. Results The lesions involved the lacrimal gland(n=6), focal mass(n=7), extraocular muscles(n=1) and multiple areas(n=4). All lacrimal gland lesions presented as diffuse enlargements. 4 patients had lesions involving multiple areas which extended along the trigeminal nerve, accompanied by expansion of neural foramina along their courses, with no signs of bone destruction.Infraorbital nerve enlargement was present in 8 cases. All ocular adnexal lesions showed isointensity on T1-and hypointensity on T2-weighted images, homogenous enhancement patterns and bone remodelling without destruction. TIC exhibited a rapidly enhancing and slow washout pattern in 14 patients. Conclusion IgG4-ROD can involve the lacrimal gland, extraocular muscles, medial canthus, extraconal space, and infraorbital nerves, and pterygopalatine fossa. Recognition of the typical radiological features of IgG4-ROD may help in the diagnosis of this benign clinical entity.