Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor
Ruo-Fan Sheng, Chang-Wen Zhai, Yuan Ji, Cai-Zhong Chen, Li Yang and Meng-Su Zeng
Shanghai, China
Author Affiliations: Department of Radiology (Sheng RF, Chen CZ, Yang L and Zeng MS) and Department of Pathology (Zhai CW and Ji Y), Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
Corresponding Author: Meng-Su Zeng, MD, PhD, Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China (Tel: +86-21-64041990ext2130; Fax: +86-21-64439906; Email: zeng.mengsu@zs-hospital.sh.cn)
Abstract：BACKGROUND: Hepatic inflammatory pseudotumor (IPT) is classified into 2 types based on IgG4 stain: IgG4-related and non-IgG4-related; the two types differ not only in their pathological characteristics, but also in the clinical features. This study aimed to investigate the MR character of hepatic IPT, and differentiate the IgG4-related IPT from the non-IgG4-related IPT.
METHODS: Twenty-five patients with 27 histologically proven hepatic IPTs were retrospectively analyzed. Ten lesions were diagnosed as IgG4-related IPT, and the other 17 as non-IgG4-related IPT. The MR signal features on T1, T2-weighted, dynamic-enhanced, and diffusion-weighted imaging were evaluated and compared.
RESULTS: The dominant lesions were subcapsularly distributed (n=17, 63.0%) with clear boundary (n=20, 74.1%), and showed progressive enhancement pattern (n=21, 77.8%) with diffuse homogeneous (n=12, 44.4%) or heterogeneous (n=8, 29.6%) hyperintensity, accompanied by delayed capsule-like enhancement (n=17, 63.0%) and central nonenhanced areas (n=18, 66.7%). Morphological features (P>0.05) were not sufficient to differentiate IgG4-related IPT from non-IgG4-related IPT; the wash-out pattern was only found in 2 IgG4-related IPT, while the progressive enhancement pattern was more common in the non-IgG4-related lesions (n=16) (P=0.022). During portal and delayed phases, iso-/hypoenhanced lesions were only seen in 3 IgG4-related IPT, and circular-enhanced lesions (n=5) existed exceptionally in the non-IgG4-related group with significant differences (P=0.029 and 0.027). Most IgG4-related IPTs had lower apparent diffusion coefficient compared with the liver parenchyma (n=6), while most non-IgG4-related IPTs had higher apparent diffusion coefficient value (n=13) (P=0.046).
CONCLUSIONS: Although MR images of hepatic IPT have certain characteristics, they are not enough to differentiate IgG4-related IPT from non-IgG4-related IPT. The enhancement pattern, signal features on portal and delayed phases, and the apparent diffusion coefficient value of the lesion may be helpful for the diagnosis.
. [J]. Hepatobiliary Pancreat Dis Int, 2017, 16(6): 631-637.
Sheng RF, Zhai CW, Ji Y, Chen CZ, Yang L, Zeng MS. Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor. Hepatobiliary Pancreat Dis Int, 2017, 16(6): 631-637.
2017, Vol. 16 
