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Case Report: Dual-Energy Computed Tomography of Cardiac Changes in IgG4-Related Disease
Ying Wang1,2, Hui Zhou1,2, Ping Hu1,2
1Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.
Insights
Dual-energy CT (DECT) provides novel insights into cardiac involvement in IgG4-related disease (IgG4-RD). This study highlights DECT
Area of Science:
- Cardiovascular Imaging
- Radiology
- Immunology
Background:
- Dual-energy computed tomography (DECT) is established for cardiac imaging but lacks research in IgG4-related disease (IgG4-RD).
- This study pioneers the investigation of DECT in characterizing cardiac manifestations of IgG4-RD.
Observation:
- A 63-year-old male with IgG4-related pancreatitis underwent multimodality cardiovascular imaging.
- DECT analysis, including iodine maps and spectral curves, differentiated coronary artery lesions.
- Noninvasive fractional flow reserve (FFRCT) and extracellular volume fraction (ECV) assessed myocardial ischemia and fibrosis.
Findings:
- DECT successfully identified coronary artery lesions characteristic of IgG4-RD.
- The technique simultaneously evaluated myocardial morphology, function, and histology.
- DECT distinguished IgG4-related coronary lesions from non-calcified plaques.
Implications:
- DECT offers a comprehensive assessment of cardiac IgG4-RD, aiding in diagnosis and treatment planning.
- This approach may guide personalized therapy and prevent severe complications.
- DECT enhances understanding of IgG4-RD's impact on the cardiovascular system.
Background:
Dual-energy computed tomography (DECT) is used in coronary plaque characterization, myocardial perfusion imaging, and pulmonary embolism diagnosis; however, there is no relevant research on DECT in IgG4-related diseases (IgG4-RD) involving the coronary artery. We are the first to report DECT findings of cardiac morphology and function in IgG4-RD.
Patient Findings:
Multimodality cardiovascular imaging from a 63-year-old male patient, who presented with IgG4-related pancreatitis, was analyzed. An iodine map and spectral curves were obtained from the DECT, which can help to distinguish between non-calcified plaques and IgG4 lesions of the coronary artery, noninvasive FFRCT (fractional flow reserve derived from coronary computed tomography angiography) and ECV (extracellular volume fraction) demonstrated myocardial ischemia and myocardial fibrosis, respectively.
Conclusion:
The DECT can detect coronary artery tumor-like lesions caused by IgG4-RD and simultaneously assess the morphological, functional, and histological characteristics of the myocardium. This may help to guide individualized and timely treatment and avoid potentially life-threatening complications.
