1
|
Abstract
Autoimmune pancreatitis generally results in diffuse increased FDG activity throughout the pancreas on PET/CT images. We present a case of focal autoimmune pancreatitis with abnormal FDG activity involving only the pancreatic tail on PET/CT in a 61-year-old man who was provisionally diagnosed as having pancreatic cancer based on the CT findings. The diagnosis of autoimmune pancreatitis was based on pathological examination and elevated serum immunoglobulin G4 level. Following the steroid therapy, the patient was gradually recovered.
Collapse
|
2
|
Clinical Utility of FDG PET/CT in Patients with Autoimmune Pancreatitis: a Case-Control Study. Sci Rep 2018; 8:3651. [PMID: 29483544 PMCID: PMC5827761 DOI: 10.1038/s41598-018-21996-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/15/2018] [Indexed: 12/24/2022] Open
Abstract
Autoimmune pancreatitis (AIP) shares overlapping clinical features with pancreatic cancer (PC). Importantly, treatment of the two conditions is different. We investigated the clinical usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with suspected AIP before treatment. From September 2008 to July 2016, 53 patients with suspected AIP at National Taiwan University Hospital had PET/CT prior to therapy to exclude malignancy and evaluate the extent of inflammation. Their scans were compared with those from 61 PC patients. PET imaging features were analyzed using logistic regression. Significant differences in pancreatic tumor uptake morphology, maximum standardized uptake value, high-order primary tumor texture feature (i.e. high-gray level zone emphasis value), and numbers and location of extrapancreatic foci were found between AIP and PC. Using the prediction model, the area under curve of receiver-operator curve was 0.95 (P < 0.0001) with sensitivity, specificity, positive predictive, and negative predictive values of 90.6%, 84.0%, 87.9%, and 87.5% respectively, in differentiating AIP from PC. FDG PET/CT offers high sensitivity, albeit slightly lower specificity in differentiating AIP from PC. Nonetheless, additional systemic inflammatory foci detected by the whole body PET/CT help confirm diagnosis of AIP in these patients before initiating steroid therapy, especially when biopsy is inconclusive.
Collapse
|
3
|
Krishnan N, Perazella MA. The Role of PET Scanning in the Evaluation of Patients With Kidney Disease. Adv Chronic Kidney Dis 2017; 24:154-161. [PMID: 28501078 DOI: 10.1053/j.ackd.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Patients with underlying kidney disease are often required to undergo imaging for a variety of purposes including diagnosis and prognosis. A test that is being increasingly used with for this group of patients is the positron emission test (PET) scan. In addition, combining the nuclear medicine technique (PET) with computed tomography scan allows additional imaging advantages over either alone. These imaging modalities are commonly used for a number of extrarenal indications (ie, cancer, coronary artery disease, central nervous system disease, infectious diseases, and others). They have also been used for diagnosis of acute tubulointerstitial nephritis, evaluation and management of retroperitoneal fibrosis, identifying infection within kidney and liver cysts, and distinguishing complex kidney cysts from kidney cancer in patients with underlying CKD. We will review PET scan utility in patients with kidney disease.
Collapse
|
4
|
Abstract
A 62-year-old man presented with pain in the upper abdomen persisting for 2 months. He had the clinical history of diabetes for approximately 10 years. CT and MRI showed a mass located in processus uncinatus of caput pancreatis. The laboratory tests, including pancreas-originated amylase, tumor marker, IgG, IgG4, and so on, were normal. For suspicion of pancreatic cancer, the patient underwent F-FDG PET/CT, which demonstrated focal and high radioactivity accumulation in processus uncinatus of pancreas, without extrapancreatic radioactivity uptake observed. Finally, the surgical pathology confirmed IgG4-related sclerosing pancreatitis.
Collapse
|
5
|
Role of 18F-FDG PET/CT in the management of a case of autoimmune pancreatitis with extrapancreatic manifestations. Clin Nucl Med 2014; 38:e423-5. [PMID: 23510878 DOI: 10.1097/rlu.0b013e31827086b5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autoimmune pancreatitis and pancreatic cancer share many clinical features like advanced age, painless jaundice, weight loss, and elevated serum levels of CA 19-9. The authors report a 58-year-old male patient provisionally diagnosed with periampullary carcinoma on the basis of ultrasonography and serological markers and planned for Whipple resection. (18)F-FDG PET/CT findings were suggestive of autoimmune pancreatitis, subsequently confirmed on cytological diagnosis. The follow-up PET/CT scan after 1 week of steroid therapy showed regression of FDG uptake in most of the lesions with appearance of salivary gland uptake.
Collapse
|
6
|
Ebbo M, Grados A, Guedj E, Gobert D, Colavolpe C, Zaidan M, Masseau A, Bernard F, Berthelot JM, Morel N, Lifermann F, Palat S, Haroche J, Mariette X, Godeau B, Bernit E, Costedoat-Chalumeau N, Papo T, Hamidou M, Harlé JR, Schleinitz N. Usefulness of 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography for staging and evaluation of treatment response in IgG4-related disease: a retrospective multicenter study. Arthritis Care Res (Hoboken) 2014; 66:86-96. [PMID: 23836437 DOI: 10.1002/acr.22058] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/28/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the usefulness of 2-[18F]-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in IgG4-related disease (IgG4-RD) for the staging of the disease and the followup under treatment. METHODS All patients included in the French IgG4-RD registry who underwent ≥1 FDG-PET/CT scan were included in the study. Clinical, biologic, pathologic, radiologic, and FDG-PET/CT qualitative and quantitative findings were retrospectively collected and analyzed. RESULTS Twenty-one patients were included in the study and 46 FDG-PET/CT examinations were evaluated. At either diagnosis or relapse, all evaluated patients presented abnormal 18F-FDG uptake in typical IgG4-RD localizations. In most cases, FDG-PET/CT was more sensitive than conventional imaging to detect organ involvement, especially in arteries, salivary glands, and lymph nodes. In few cases (small-sized lesions and brain or kidney contiguous lesions), false-negative results were noted. Evaluation before and after treatment showed in most cases a good correlation of FDG-PET/CT results with treatment response and disease activity. CONCLUSION This large retrospective study shows that FDG-PET/CT imaging is useful for the staging of IgG4-RD. Moreover, FDG-PET/CT is useful to assess the response to treatment during followup.
Collapse
Affiliation(s)
- Mikael Ebbo
- Centre Hospitalier Universitaire de la Conception, AP-HM, Aix-Marseille Université, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
|
8
|
The use of (18)F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol 2013; 2013:623036. [PMID: 24027590 PMCID: PMC3763592 DOI: 10.1155/2013/623036] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/20/2013] [Indexed: 02/08/2023]
Abstract
FDG-PET, combined with CT, is nowadays getting more and more relevant for the diagnosis of several infectious and inflammatory diseases and particularly for therapy monitoring. Thus, this paper gives special attention to the role of FDG-PET/CT in the diagnosis and therapy monitoring of infectious and inflammatory diseases. Enough evidence in the literature already exists about the usefulness of FDG-PET/CT in the diagnosis, management, and followup of patients with sarcoidosis, spondylodiscitis, and vasculitis. For other diseases, such as inflammatory bowel diseases, rheumatoid arthritis, autoimmune pancreatitis, and fungal infections, hard evidence is lacking, but studies also point out that FDG-PET/CT could be useful. It is of invaluable importance to have large prospective multicenter studies in this field to provide clear answers, not only for the status of nuclear medicine in general but also to reduce high costs of treatment.
Collapse
|
9
|
Abstract
PURPOSE The aim of this study was to compare uptake lesions in sarcoidosis and IgG4-related disease through gallium-67 ((67)Ga) scintigraphy to differentiate between the two diseases. MATERIALS AND METHODS Whole-body (67)Ga scintigraphy findings of 27 patients with sarcoidosis and 16 with IgG4-related disease were reviewed between 2005 and 2011 at our hospital. RESULTS In the case of patients with sarcoidosis, significant accumulation of (67)Ga was observed in the lacrimal gland in the case of 26 patients (96%), in mediastinal lymph nodes (LNs) in 23 (85%), in pulmonary hilar LNs in 21 (78%), in the parotid gland in 10 (38%), in supraclavicular LNs in eight (30%), in muscles in seven (26%), in the lung in five (18%), in inguinal LNs in four (15%), in submandibular LNs in two (7%), and in the heart, spleen, kidney and para-aorta in one patient (4%). In patients with IgG4-related disease, abnormal uptake was detected in the pulmonary hilar LNs in 12 patients (75%), in the lacrimal gland in 10 (62%), in the pancreas in 10 (62%), in the parotid gland in six (37%), in the submandibular gland in six (37%), in the para-aorta in three (19%), in the lung in three (19%), in mediastinal LNs in two (12%), and in the kidney in the case of two patients (12%). Asymmetrical accumulation in the submandibular gland was observed in three of six patients (50%) with IgG4-related disease and in none of the two patients (0%) with sarcoidosis. Significant differences were observed in the uptake ratio of the lacrimal gland, the submandibular gland, supraclavicular LNs, mediastinal LNs, pancreas, and muscle between the two groups (P<0.05). CONCLUSION (67)Ga scintigraphy was useful in differentiating between the two diseases. Uptake in mediastinal LNs, in supraclavicular LNs, and in the muscle was specific to sarcoidosis, whereas uptake in the pancreas and in the submandibular gland indicated IgG4-related disease.
Collapse
|
10
|
George V, Tammisetti VS, Surabhi VR, Shanbhogue AK. Chronic Fibrosing Conditions in Abdominal Imaging. Radiographics 2013; 33:1053-80. [DOI: 10.1148/rg.334125081] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
11
|
Caiafa RO, Vinuesa AS, Izquierdo RS, Brufau BP, Ayuso Colella JR, Molina CN. Retroperitoneal Fibrosis: Role of Imaging in Diagnosis and Follow-up. Radiographics 2013; 33:535-52. [DOI: 10.1148/rg.332125085] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
12
|
Metastatic Embryonal Rhabdomyosarcoma to the Pancreas Presenting as Acute Pancreatitis Detected by FDG PET/CT. Clin Nucl Med 2012; 37:694-6. [DOI: 10.1097/rlu.0b013e31824c6066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Zaidan M, Ebbo M, Brochériou I, Ronco P, Schleinitz N, Boffa JJ. [IgG4-related disease and renal and urological involvement]. Nephrol Ther 2012; 8:499-507. [PMID: 22480723 DOI: 10.1016/j.nephro.2012.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/20/2012] [Accepted: 02/26/2012] [Indexed: 12/24/2022]
Abstract
Hyper-IgG4 syndrome, or IgG4-related disease, is an emerging disorder, involving one or more organ(s), and characterized by "storiform" fibrosis and inflammatory lesions with a predominance of IgG4+ plasma cells and increased IgG4 serum levels. Since the first report of auto-immune pancreatitis, numerous organ lesions have been reported and have been found to occur in a same patient including: sialadenitis, dacryoadenitis, lymphadenopathy, liver and biliary tract involvement, and renal and retroperitoneal lesions. Renal involvement was first described in 2004 and usually presents as functional and/or morphological abnormalities. In most cases, renal pathological analysis reveals tubulointerstitial nephritis that is rarely associated with glomerular lesions. Retroperitoneal fibrosis is also a typical feature that may be associated with periaortitis or inflammatory abdominal aortic aneurysm. First line treatment is based on corticosteroid therapy. Short-term outcome is usually favorable. However, patients should be carefully monitored for relapses and long-term complications. Although the multiple organ lesions share common clinical, biological, radiological and pathological features, no consensus diagnostic criteria have yet been validated for IgG4-related disease. Ruling out differential diagnoses is thus mandatory. Our literature review provides nephrologists, urologists and pathologists with key elements that will help in the early diagnosis and proper management of this new and emerging disorder.
Collapse
Affiliation(s)
- Mohamad Zaidan
- Service de néphrologie et dialyses, hôpital Tenon, Assistance publique des Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
| | | | | | | | | | | |
Collapse
|
14
|
[¹⁸F]FDG-PET/CT in patients affected by retroperitoneal fibrosis: a bicentric experience. Jpn J Radiol 2012; 30:415-21. [PMID: 22421932 DOI: 10.1007/s11604-012-0066-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 02/22/2012] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of our study was to assess the feasibility and usefulness of 2-[(18)F]-fluoro-2-deoxy-D: -glucose positron emission tomography computed tomography ([(18)F]FDG-PET/CT) in patients affected by retroperitoneal fibrosis. MATERIALS AND METHODS We retrospectively evaluated 25 patients studied in two centers: 18 underwent [(18)F]FDG-PET/CT as initial evaluation, three during follow-up, three during steroid therapy, and one to re-evaluate the disease. Among the group who underwent initial evaluation, ten underwent a second [(18)F]FDG-PET/CT after steroid therapy. RESULTS [(18)F]FDG-PET/CT was positive in 18 patients and negative in seven. Among the ten patients who underwent a second study after steroid therapy, six showed complete metabolic response, three partial response, and one no significant maximum standardized uptake value (SUV(max)) reduction. CONCLUSION Our preliminary results show that [(18)F]FDG-PET/CT is feasible and suitable for evaluating retroperitoneal fibrosis and is useful in assessing therapy response. Larger studies are desirable to confirm these findings and to determine the appropriate position of [(18)F]FDG-PET/CT in the diagnostic flow chart for this disease.
Collapse
|
15
|
Ebbo M, Grados A, Daniel L, Vély F, Harlé JR, Pavic M, Schleinitz N. [IgG4-related systemic disease: emergence of a new systemic disease? Literature review]. Rev Med Interne 2011; 33:23-34. [PMID: 21955722 DOI: 10.1016/j.revmed.2011.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 02/08/2023]
Abstract
Hyper-IgG4 syndrome, or IgG4-related systemic disease (IgG4-RSD), has been recently characterized by the association of a focal or diffuse enlargement in one or more organs, elevated levels of serum IgG4 and histopathological findings including "storiform" fibrosis and prominent infiltration of lymphocytes and IgG4-positive plasma cells. Pancreas was the first organ involved with sclerosing pancreatitis (or autoimmune pancreatitis). Since this first description, many extrapancreatic lesions have been described, even in the absence of pancreatitis and include sialadenitis, lacrimal gland inflammation, lymphadenopathy, aortitis, sclerosing cholangitis, tubulointerstitial nephritis, retroperitoneal fibrosis or inflammatory pseudotumors. Multiorgan lesions can occur synchronously or metachronously in a same patient, usually after 50 years of age. They all share common histopathological findings. The disease often responds well to corticosteroid therapy. In this literature review on IgG4-RSD, we present historical, epidemiological and clinical characteristics, and we review the biological and histological diagnostic criteria. To date there is no international validated diagnostic criteria. Pathophysiological hypothesis and therapeutic approaches are also discussed.
Collapse
Affiliation(s)
- M Ebbo
- Service de médecine interne, hôpital de La Conception, Assistance publique-Hôpitaux de Marseille, Marseille cedex 5, France.
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
PURPOSE To clarify the features of gallium-67 (Ga-67) imaging typical of IgG4-related disease. METHODS We retrospectively investigated 14 patients diagnosed with IgG4-related disease who underwent Ga-67 scintigraphy in our hospital between January 2005 and May 2010. Of these, 13 patients who underwent gallium scintigraphy before steroid therapy were enrolled in this study. The patient population comprised 11 men and 2 women with age ranging from 47 to 76 years (mean age, 61.9 years). RESULTS Among the 13 patients, significant accumulation of Ga-67 was detected in the bilateral pulmonary hila in 10 patients (77%), pancreas in 10 (77%), salivary glands in 7 (54%), lacrimal glands in 7 (54%), periaortic lesions in 2 (15%), and lung parenchyma in 1 (8%) patient. High accumulation of Ga-67 in the salivary glands was observed in the parotid glands in 3 cases and in the submandibular glands in 6 cases, with the following pattern: normal parotid gland uptake and symmetrical submandibular gland uptake in 2 cases; symmetrical high accumulation in both parotid and submandibular glands in 1 case; symmetrical high accumulation in parotid glands and normal submandibular gland uptake in 1 case; symmetrical uptake by parotid glands and asymmetric uptake by submandibular glands in 1 case; normal parotid gland uptake and asymmetric submandibular gland uptake in 1 case; and asymmetric parotid gland uptake and symmetrical parotid gland uptake in 1 case. CONCLUSION Characteristic patterns of gallium uptake would be helpful for diagnosis, detection of involved lesions, and differential diagnosis in patients with IgG4-related disease to avoid unnecessary surgery.
Collapse
|
17
|
Abstract
This article educates the reader on idiopathic retroperitoneal fibrosis and emphasizes the importance of considering conditions that mimic this disease on PET/CT through an illustrative case of a 58 year-old man presenting with intermittent abdominal, back, and scrotal pain undergoing successive PET/CT scans, both for diagnosis and following treatment.
Collapse
Affiliation(s)
- Amar Mehta
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
18
|
Murakami K. FDG-PET for hepatobiliary and pancreatic cancer: Advances and current limitations. World J Clin Oncol 2011; 2:229-36. [PMID: 21611100 PMCID: PMC3100499 DOI: 10.5306/wjco.v2.i5.229] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/08/2011] [Accepted: 03/15/2011] [Indexed: 02/06/2023] Open
Abstract
In Japan, the use of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for some malignant tumors came to be covered by the National Health Insurance in 2002. In 2010, the health insurance coverage was expanded to all types of malignant tumors. However, since PET examination requires a large amount of capital investment, facilities at which PET is available are still limited. On the other hand, PET equipment has rapidly been introduced in large hospitals and in the diagnostic imaging centers of major cities during the past few years. Although numerous middle-sized and small hospitals cannot afford to perform PET, physicians can refer their patients to facilities where PET is available. Therefore, it is essential for general physicians to gain accurate knowledge on PET, including the appropriate indications for PET, in order to select patients for referral to PET facilities. PET is not always a useful tool, especially for lesions of the pancreas and hepatobiliary system, which is the main topic of this review. The indications of PET for lesions in these organs vary depending on the purpose of the examination. In this article, we review the indications for PET (or PET/computed tomography [CT]) using FDG of the liver, biliary tract, and pancreas.
Collapse
Affiliation(s)
- Koji Murakami
- Koji Murakami, Division of Nuclear Medicine, Department of Radiology , School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, 160-8582 Tokyo, Japan
| |
Collapse
|
19
|
Jansen I, Hendriksz TR, Han SH, Huiskes AWLC, van Bommel EFH. (18)F-fluorodeoxyglucose position emission tomography (FDG-PET) for monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Eur J Intern Med 2010; 21:216-21. [PMID: 20493425 DOI: 10.1016/j.ejim.2010.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/05/2010] [Accepted: 02/22/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in monitoring disease activity and predicting treatment response in idiopathic retroperitoneal fibrosis (iRPF). PATIENTS AND METHODS This prospective study was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-six patients with iRPF receiving tamoxifen monotherapy underwent repeated FDG-PET (baseline and, if positive, at 3 months) and computed tomographic (CT) scanning (baseline, 4 and 8 months). Maximal RPF mass thickness in 3 different view directions was measured on each CT scan; FDG-uptake was semi-quantified using a visual 4-point scale. Initial and follow-up PET scan results were correlated with clinical, laboratory and CT scan follow-up data. Treatment outcome was the aggregate measure of clinical, laboratory and CT-documented response to tamoxifen. RESULTS FDG-PET was positive in 20 patients. Patients with positive PET scan result had higher C-reactive protein level (P=0.02) and larger mass size (P=0.01) compared with patients with negative PET scan result. Visual PET score correlated with C-reactive protein level (P=0.002) and CT-documented mass thickness (P=0.04). Visual PET score decreased following treatment (P<0.01). This decrease correlated with decrease in ESR (P<0.001) but not with CT-documented mass regression. Positive predicting value (PPV) of initial positive PET scan result was 0.63; PPV of negative follow-up PET scan result in patients with initial positive PET scan result was 0.66. CONCLUSION FDG-PET is valuable in detecting (recurrent) disease activity. Short-term follow-up with FDG-PET cannot be routinely recommended for the therapeutic evaluation of RPF disease in tamoxifen-treated patients.
Collapse
Affiliation(s)
- I Jansen
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | | | | |
Collapse
|
20
|
Buscarini E, Frulloni L, De Lisi S, Falconi M, Testoni PA, Zambelli A. Autoimmune pancreatitis: a challenging diagnostic puzzle for clinicians. Dig Liver Dis 2010; 42:92-8. [PMID: 19805009 DOI: 10.1016/j.dld.2009.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 08/27/2009] [Indexed: 12/11/2022]
Abstract
Autoimmune pancreatitis is a form of pancreatitis with autoimmune stigmata that may present as either focal or diffuse gland involvement. In focal forms, autoimmune pancreatitis shares demographic, clinical, biochemical and imaging features with pancreatic cancer. Since autoimmune pancreatitis is a benign disease and steroid therapy can rapidly resolve symptoms, improve radiological findings and avoid unnecessary surgery, the current clinical challenge is how to differentiate autoimmune pancreatitis from pancreatic neoplasia. Even though definitive diagnosis of the disease is difficult, several diagnostic criteria have been proposed and progress has been made in imaging studies. The management of this unique form of pancreatitis should, therefore, be handled in centres with knowledge of all aspects of the disease. This article briefly reviews clinical aspects of autoimmune pancreatitis with a focus on its diagnostic imaging and management.
Collapse
Affiliation(s)
- E Buscarini
- Gastroenterology Department, Maggiore Hospital, Largo Dossena 2, 26013 Crema, Italy.
| | | | | | | | | | | |
Collapse
|
21
|
Basu S, Zhuang H, Torigian DA, Rosenbaum J, Chen W, Alavi A. Functional imaging of inflammatory diseases using nuclear medicine techniques. Semin Nucl Med 2009; 39:124-45. [PMID: 19187805 DOI: 10.1053/j.semnuclmed.2008.10.006] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Molecular imaging with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) is increasingly used to diagnose, characterize, and monitor disease activity in the setting of inflammatory disorders of known and unknown etiology. These disorders include sarcoidosis, atherosclerosis, vasculitis, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and degenerative joint disease. Gallium-67 ((67)Ga) citrate, labeled leukocytes with technetium-99m ((99m)Tc) or indium-111 ((111)In), and (18)F-fluorodeoxyglucose (FDG) represent the most widely used radiopharmaceutical agents. However, other preparations, such as labeled murine monoclonal antigranulocyte antibodies and labeled human polyclonal nonspecific immunoglobulin G, chemotactic peptides, interleukins, chemokines, and liposomes, have been used to image inflammation. Also, (99m)Tc nanocolloid scintigraphy has been found to be suitable for bone and joint diseases, especially RA. Among the single photon emitting imaging agents, the recommended radiotracer for abdominal inflammation has been (99m)Tc-hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes. During the last several years, FDG-PET imaging has been shown to have great value for the detection of inflammation and has become the centerpiece of such initiatives. This very powerful technique will play an increasingly important role in the management of patients with inflammatory conditions. FDG-PET can provide valuable information in patients with pulmonary and extrapulmonary sarcoidosis, and is a useful tool for testing the efficacy of various treatments. FDG-PET combined with computed tomography holds great promise for assessing atherosclerosis of the large arteries. This modality is very sensitive in detecting large-vessel vasculitis and can be used to monitor the disease course. FDG-PET is also being used to study the inflamed synovial joints both in the experimental and clinical settings, especially for the investigation and management of RA and degenerative joint disease. This technique also has the potential to become the imaging modality of choice in assessing IBD, replacing radiolabeled autologous leukocyte imaging in this setting. Detection of inflammation in the lungs and airways may improve our knowledge about a multitude of disorders that affect these structures. Therefore, functional imaging, led by FDG-PET imaging, is likely to play an increasingly critical role in assessing inflammatory disorders of known and unknown etiologies, and will improve their management immensely in the future.
Collapse
Affiliation(s)
- Sandip Basu
- Radiation Medicine Center (BARC), Tata Memorial Hospital Annex, Mumbai, India
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
Autoimmune pancreatitis is the pancreatic manifestation of a systemic disorder that affects various organs, including the bile duct, retroperitoneum, kidney, and parotid and lacrimal glands. It represents a recently described subset of chronic pancreatitis that is immune mediated and has unique histologic, morphologic, and clinical characteristics. A hallmark of the disease is its rapid response to corticosteroid treatment. Although still a rare disease, autoimmune pancreatitis is increasingly becoming recognized clinically, leading to evolution in the understanding of its prognosis, clinical characteristics, and treatment.
Collapse
Affiliation(s)
- Timothy B Gardner
- Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | | |
Collapse
|
23
|
|
24
|
Young PM, Peterson JJ, Calamia KT. Hypermetabolic activity in patients with active retroperitoneal fibrosis on F-18 FDG PET: report of three cases. Ann Nucl Med 2008; 22:87-92. [DOI: 10.1007/s12149-007-0077-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
|
25
|
Otsuka H, Morita N, Yamashita K, Nishitani H. FDG-PET/CT findings of autoimmune pancreatitis associated with idiopathic retroperitoneal fibrosis. Ann Nucl Med 2007; 21:593-6. [DOI: 10.1007/s12149-007-0069-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 06/13/2007] [Indexed: 01/06/2023]
|
26
|
Nakajo M, Jinnouchi S, Fukukura Y, Tanabe H, Tateno R, Nakajo M. The efficacy of whole-body FDG-PET or PET/CT for autoimmune pancreatitis and associated extrapancreatic autoimmune lesions. Eur J Nucl Med Mol Imaging 2007; 34:2088-95. [PMID: 17713765 DOI: 10.1007/s00259-007-0562-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 07/20/2007] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate retrospectively the efficacy of whole-body (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) for autoimmune pancreatitis (AIP) and associated extrapancreatic autoimmune lesions. METHODS Whole-body FDG-PET or PET/computed tomography (CT) findings were reviewed in six patients with AIP. The initial PET scans were performed 1 h and 2 h after FDG injection in all six patients. Follow-up PET scans were performed during or following steroid therapy in five patients and in one patient who did not have steroid therapy. RESULTS The initial PET scans revealed intense FDG uptake by AIP in all six patients. The maximum standardized uptake value (SUVmax) increased in four patients and was stable in two patients. The intense uptake in the pancreas disappeared during or following steroid therapy in five patients and in one patient who showed spontaneous remission of AIP. Abnormal FDG uptake by extrapancreatic autoimmune diseases was observed in five of the six patients: sclerosing sialadenitis (n = 5), lymphadenopathy (n = 5), retroperitoneal fibrosis (n = 2), interstitial nephritis (n = 2) and sclerosing cholecystitis (n = 1). Abnormal FDG uptake disappeared in the salivary glands (n = 4), lymph nodes (n = 4), retroperitoneum (n = 2), kidneys (n = 1) and gallbladder (n = 1) during or following steroid therapy and remained in the salivary glands and lymph nodes of a spontaneous remission patient. CONCLUSION These results suggest that whole-body FDG-PET may be useful for detecting AIP and associated extrapancreatic autoimmune lesions and for monitoring their disease activity but that dual time point imaging may not be useful for differentiating malignancy from AIP.
Collapse
Affiliation(s)
- Masatoyo Nakajo
- Department of Radiology, Atsuchi Memorial Clinic PET Center, 12-1 Terukuni, Kagoshima City, Japan.
| | | | | | | | | | | |
Collapse
|