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Wang Y, Guan Z, Gao D, Luo G, Li K, Zhao Y, Wang X, Zhang J, Jin J, Zhao Z, Yang C, Zhang J, Zhu J, Huang F. The value of 18F-FDG PET/CT in the distinction between retroperitoneal fibrosis and its malignant mimics. Semin Arthritis Rheum 2017; 47:593-600. [PMID: 28958769 DOI: 10.1016/j.semarthrit.2017.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/11/2017] [Accepted: 07/28/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To discuss the utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) in the diagnosis of idiopathic retroperitoneal fibrosis (iRPF). METHODS IRPF patients diagnosed between September 2011 and June 2016 were included. Retroperitoneal malignancy patients were included as control. The morphological features and FDG uptake of retroperitoneal lesions were measured along with lymph node (LN) mapping. RESULTS Seventy-one iRPF patients were included. Fifteen lymphoma patients and 6 retroperitoneal metastatic malignancy patients were included as control. Significant differences in morphological features were observed between iRPF and lymphoma but not retroperitoneal metastatic carcinoma. Compared with malignancy, iRPF displayed a lower frequency of high-FDG-uptake retroperitoneal lesions (P = 0.017) and a lower mean maximum standardized uptake value (SUVmax) (P < 0.001). LNs located at axillary, retroperitoneal, supraclavicular, inguinal or peritoneal sites were more frequently observed in retroperitoneal malignancy, therefore, were defined as specific LNs. The area under the curve (AUC) for SUVmax was 0.893 with a sensitivity of 85.7% and a specificity of 80.3%, when the cut-off value of the SUVmax was 6.23. The AUC for the logistic regression model combining the lesions above renal arteries, the SUVmax and the number of specific LNs was 0.987 with a sensitivity of 90.5% and a specificity of 98.6%. The risk stratification model analysis indicated that most of the retroperitoneal malignancy patients were at moderate or high level, while most of the iRPF patients were at low risk. CONCLUSIONS Retroperitoneal malignancy can mimic iRPF morphologically. 18F-FDG PET/CT can help to distinguish iRPF from retroperitoneal lymphoma and metastatic malignancy.
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Affiliation(s)
- Yiwen Wang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Zhiwei Guan
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China
| | - Dai Gao
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Gui Luo
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Kunpeng Li
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Yurong Zhao
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Xiuru Wang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jie Zhang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jingyu Jin
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Zheng Zhao
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Chunhua Yang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jianglin Zhang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jian Zhu
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China.
| | - Feng Huang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China.
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Yalcin MU, Gurses KM, Kocyigit D, Yorgun H, Aytemir K. Wrapped coronary arteries: a rare manifestation of retroperitoneal fibrosis. Int J Rheum Dis 2015; 18:913-6. [PMID: 26176789 DOI: 10.1111/1756-185x.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Muhammed Ulvi Yalcin
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Kadri Murat Gurses
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Duygu Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
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Sakamoto A, Nagai R, Saito K, Imai Y, Takahashi M, Hosoya Y, Takeda N, Hirano K, Koike K, Enomoto Y, Kume H, Homma Y, Maeda D, Yamada H, Fukayama M, Hirata Y, Ishizaka N. Idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, and inflammatory pericarditis--retrospective analysis of 11 case histories. J Cardiol 2011; 59:139-46. [PMID: 22154614 DOI: 10.1016/j.jjcc.2011.07.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/25/2011] [Accepted: 07/30/2011] [Indexed: 01/08/2023]
Abstract
Retroperitoneal fibrosis, inflammatory aortic aneurysm, and pericardial and mediastinal fibrosis are characterized by infiltration of immuno-inflammatory cells and deposition of thickened fibrous tissues. Several recent studies suggested that an immunoglobulin-G4 (IgG4)-related immunological mechanism may play a role in these diseases. By searching the clinical database of patients admitted to our department between 2000 and 2010, we summarized the clinical data of 11 patients who were diagnosed to have these disorders. The diagnoses were idiopathic retroperitoneal fibrosis (8 cases), mediastinal and/or pericardial fibrosis (4 cases), inflammatory abdominal aneurysm (2 cases), and inflammatory coronary periarteritis (1 case). Hypertension, diabetes, and dyslipidemia were found in 45%, 36%, and 55%, respectively, in these patients, and they were all either current or former smokers. Two patients with pericardial involvement showed a rushed clinical course, resulting in in-hospital death. Serum levels of IgG were elevated in 67%, and soluble interleukin-2 receptor was elevated in 75%, when measured. Immunohistochemical analysis showed marked infiltration of IgG4-positive plasma cells in the pericardium in patients who died of constrictive pericarditis. Our data support the notion that immune-inflammatory mechanism, which might be IgG4-related sometimes, may play a role in idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, and mediastinal/pericardial fibrosis, although clinical course may differ substantially.
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Affiliation(s)
- Aiko Sakamoto
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Ishizaka N, Sakamoto A, Imai Y, Terasaki F, Nagai R. Multifocal fibrosclerosis and IgG4-related disease involving the cardiovascular system. J Cardiol 2011; 59:132-8. [PMID: 22137380 DOI: 10.1016/j.jjcc.2011.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 10/12/2011] [Accepted: 10/18/2011] [Indexed: 01/09/2023]
Abstract
The cardiovascular system may be involved as a target organ of multifocal fibrosclerosis, which may manifest as idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, inflammatory periarteritis, and inflammatory pericarditis. These pathological conditions can sometimes occur concomitantly. Idiopathic retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm are both characterized by the presence of fibro-inflammatory tissue around the abdominal aorta expanding into the surrounding retroperitoneal structures, and together they may be termed 'chronic periaortitis'. Cardiovascular fibrosclerosis has become non-uncommonly encountered condition since imaging modalities have made its diagnosis more feasible. In addition, recent studies have demonstrated that a certain fraction, but not all, of cardiovascular fibrosclerosis may have a link with immunoglobulin-G4 (IgG4)-related sclerosing disease (IgG4-SD). IgG4-SD is histologically characterized by dense fibrosclerosis and infiltration of lymphocytes and IgG4-positive plasma cells, and these histopathologic findings seem to be essentially similar regardless of the organs involved. In this mini review, we summarize what is known so far about multifocal fibrosclerosis of the cardiovascular system and its association with IgG4-SD, and what remains to be clarified in future investigations.
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Affiliation(s)
- Nobukazu Ishizaka
- Department of Cardiology, Osaka Medical College, Takatsuki-shi, Daigaku-machi 2-7, Osaka 569-8686, Japan.
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Swartz RD. Idiopathic Retroperitoneal Fibrosis: A Review of the Pathogenesis and Approaches to Treatment. Am J Kidney Dis 2009; 54:546-53. [DOI: 10.1053/j.ajkd.2009.04.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 04/03/2009] [Indexed: 12/24/2022]
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Lee YK, Seo JB, Kim SS, Lim TH. Thoracic Periaortic Fibrosis Mimicking Malignant Tumor: CT and18F-FDG PET Findings. AJR Am J Roentgenol 2007; 188:345-7. [PMID: 17242240 DOI: 10.2214/ajr.05.1389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Young Kyung Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Research Institute of Radiology, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea
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Sakamoto A, Okamoto K, Ishizaka N, Tejima K, Hirata Y, Nagai R. 18F-Fluorodeoxyglucose Positron Emission Tomography in a Case of Retroperitoneal Fibrosis. Int Heart J 2006; 47:645-50. [PMID: 16960419 DOI: 10.1536/ihj.47.645] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A patient with recurrent abdominal pain was admitted to our hospital. Computed tomography showed a soft dense mass surrounding the abdominal aorta at the infrarenal level, which was compatible with retroperitoneal fibrosis. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography showed abnormal uptake of (18)F-FDG into these lesions. Two months after the initiation of corticosteroid therapy, the abnormal uptake of (18)F-FDG had ceased along with a reduction in the fibrous mass surrounding the abdominal aorta.
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Affiliation(s)
- Aiko Sakamoto
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Omura Y, Yoshioka K, Tsukamoto Y, Maeda I, Morikawa T, Konishi Y, Inoue T, Sato T. Multifocal fibrosclerosis combined with idiopathic retro-peritoneal and pericardial fibrosis. Intern Med 2006; 45:461-4. [PMID: 16679702 DOI: 10.2169/internalmedicine.45.1601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old man who had been diagnosed with retroperitoneal fibrosis (RPF) was admitted to our hospital complaining of dyspnea. Imaging studies showed massive pericardial effusion. His condition deteriorated and pericardiostomy was performed. A biopsy of the pericardium revealed marked fibrosis with infiltration of lymphocytes, which was identical to RPF findings. A diagnosis of multifocal fibrosclerosis was made. Despite aggressive treatment, he died with clinical signs of cardiovascular failure. The autopsy specimen revealed proliferation of fibrosis with infiltration of lymphocytes in multiple organs. Even after successful decompression of urinary obstruction for RPF, long-term follow-up is necessary in these patients because of the possibility of other fatal complications such as pericardial fibrosis.
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Affiliation(s)
- Yoko Omura
- Department of Internal Medicine, Osaka City General Hospital, Osaka
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