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Imaging findings of primary immunoglobulin G4-related cervical lymphadenopathy
Masaya Kawaguchi1, Hiroki Kato2, Yusuke Kito3
1Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
Insights
Imaging findings in immunoglobulin G4 (IgG4)-related cervical lymphadenopathy were assessed. Most enlarged nodes were unilateral, located in the submandibular region, and lacked central necrosis or significant perinodal infiltration.
Area of Science:
- Radiology
- Oncology
- Immunology
Background:
- Immunoglobulin G4 (IgG4)-related disease is a systemic fibroinflammatory condition.
- Cervical lymphadenopathy can be a manifestation of IgG4-related disease.
- Accurate imaging assessment is crucial for diagnosis and management.
Purpose of the Study:
- To evaluate the imaging characteristics of primary immunoglobulin G4 (IgG4)-related cervical lymphadenopathy.
- To identify key imaging features that aid in the diagnosis of this condition.
Main Methods:
- Retrospective review of imaging data from five patients with confirmed IgG4-related cervical lymphadenopathy.
- Analysis included contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT scans.
- Assessment of lymph node characteristics such as size, location, necrosis, infiltration, and metabolic activity (SUVmax).
Main Results:
- Thirteen enlarged cervical lymph nodes were identified, predominantly unilateral.
- The majority of enlarged nodes (62%) were located in the submandibular region (level IB).
- Central necrosis and significant perinodal infiltration were uncommon; penetrating vessels were observed in 54% of nodes.
Conclusions:
- Primary IgG4-related cervical lymphadenopathy typically presents as unilateral, submandibular lymphadenopathy.
- Absence of central necrosis and minimal perinodal infiltration are characteristic imaging findings.
- Imaging features, including SUVmax, can help differentiate IgG4-related lymphadenopathy from other causes.
Purpose:
The purpose of the present study was to assess imaging findings of primary immunoglobulin G4 (IgG4)-related cervical lymphadenopathy.
Methods:
Five consecutive patients with clinically, serologically, and histopathologically confirmed primary IgG4-related cervical lymphadenopathy without any other organ involvement were included. All patients underwent contrast-enhanced computed tomography (CT), and four underwent 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. We retrospectively reviewed the images and assessed the number, size, location, central necrosis, perinodal infiltration, penetrating vessels, and maximum standardized uptake values (SUVmax) of the enlarged cervical nodes.
Results:
Thirteen enlarged cervical nodes measuring larger than 10 mm in minimum diameter were identified. The maximum and minimum diameter of enlarged nodes ranged from 1.2 to 3.2 cm (median, 1.8 cm) and from 1.0 to 1.9 cm (median, 1.2 cm), respectively. Lymphadenopathy was unilateral in all patients, and eight enlarged nodes were located at level IB (62%), one at level II (8%), three at level IV (23%), and one at level V (8%). Central necrosis was not seen in any nodes. Perinodal infiltration was seen in only one node (8%), and penetrating vessels were seen in seven nodes (54%). The median SUVmax of nine nodes was 4.45 (range, 2.08-12.44).
Conclusion:
Eight enlarged nodes (62%) were located in the submandibular region. Central necrosis was not observed in any nodes and perinodal infiltration was observed in one node (8%).
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