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IgG4-related kidney disease: MRI findings with emphasis on the usefulness of diffusion-weighted imaging

Bohyun Kim1, Jin Hee Kim1, Jae Ho Byun1

  • 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-Gu, Seoul 138-736, Republic of Korea.

European Journal of Radiology
|April 29, 2014
PubMed
Abstract

Insights

Diffusion-weighted imaging (DWI) significantly improves the detection of immunoglobulin G4 (IgG4)-related kidney disease (IgG4-KD) lesions. Adding DWI to MRI enhances diagnostic accuracy for suspected IgG4-KD.

Area of Science:

  • Nephrology
  • Radiology
  • Immunology

Background:

  • Immunoglobulin G4 (IgG4)-related kidney disease (IgG4-KD) is a manifestation of IgG4-related disease, characterized by specific kidney lesions.
  • Accurate imaging is crucial for diagnosing IgG4-KD, but conventional MRI sequences may have limitations in lesion detection.

Purpose of the Study:

  • To investigate the magnetic resonance imaging (MRI) findings of IgG4-related kidney disease (IgG4-KD).
  • To evaluate the utility of diffusion-weighted imaging (DWI) in detecting renal lesions associated with IgG4-KD.

Main Methods:

  • Retrospective analysis of MRI scans from 31 patients diagnosed with IgG4-KD.
  • Consensus review by two radiologists to assess lesion characteristics (distribution, signal intensity) on T1-weighted, T2-weighted, DWI, and dynamic contrast-enhanced MRI sequences.
  • Comparison of per-patient sensitivity and lesion detection rates across different MRI sequences.

Main Results:

  • IgG4-KD lesions typically presented as bilateral, multiple, renal parenchymal nodules.
  • Lesions showed T1 isointensity, T2 hypointensity, and hyperintensity on DWI (b=1000), with progressive enhancement on dynamic contrast-enhanced images.
  • DWI demonstrated significantly higher sensitivity (100%) and detected more lesions (median 9) compared to T2-weighted (77.4% sensitivity, median 2 lesions) and dynamic contrast-enhanced images (median 5 lesions).

Conclusions:

  • Characteristic MRI findings for IgG4-KD include bilateral, multiple, parenchymal nodules with T2 hypointensity and diffusion restriction.
  • Diffusion-weighted imaging (DWI) is highly effective for detecting IgG4-KD lesions.
  • Incorporating DWI into conventional MRI protocols can significantly enhance the diagnosis of suspected IgG4-KD.
Keywords:
Diffusion weighted imagingIgG4-related kidney diseaseIgG4-related systemic diseaseMRI

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