A Study of the Correlations between CT and MRI Findings and Elevated Serum IgG4 Levels in Newly-diagnosed Patients with IgG4-related Sclerosing Cholangitis

Abstract

Objective: To observe the CT and MRI findings in newly diagnosed patients with IgG4-related sclerosing cholangitis (IgG4-SC) and explore their correlations with serum IgG4 and IgG levels. Methods: The clinical, laboratory, and imaging data of 50 newly diagnosed IgG4-SC patients were retrospectively summarized. The type of lesions, shape of lumen stenosis, degree of dilatation of the diseased bile ducts on MRCP, characteristics and enhancement patterns of the thickened bile duct walls, and the number of other coexisting IgG4-RDs on enhanced MRI and CT were observed. Subsequently, the correlations of the patients' baseline serum IgG4 and IgG levels with the severity of bile duct lesions and the number of other coexisting IgG4-RDs were analyzed. Results: Forty-one patients underwent MRCP examinations, and the following types of IgG4-SC were identified: type Ⅰ in 28 cases, type Ⅱa in 11, type Ⅲ in 1, and type Ⅳ in 1. Extrahepatic bile duct stenosis was funnel-shaped in 37 cases and truncated in 4 cases. Moreover, all the stenotic segments were long (≥1.0 cm) and one diverticulum-like outpouching was seen in the pancreatic segment stenosis. Upstream bile ducts of the stenosis showed dilatation in 37 cases, while the other 4 cases did not show this. Contrast-enhanced MRI and CT examinations showed continuous thickening of the extrahepatic bile duct walls in 42 cases, and diffuse thickening of the intrahepatic bile duct walls was simultaneously observed in 15 cases among them. The thickness of the bile duct walls was uniformly concentric. Meanwhile, other accompanying IgG4-RDs included AIP in 50 cases, kidney involvement in 19, salivary gland involvement in 7, retroperitoneal fibrosis in 5, liver involvement in 4, lung involvement in 4, prostate involvement in 2, sclerosing mediastinitis in 2, thickened gallbladder wall (without stones) in 20, and enlarged upper abdominal lymph nodes in 15 cases. Moreover, higher baseline serum IgG4 and IgG levels were positively correlated with the number of other coexisting IgG4-RDs, but not with the bile duct wall thickness and stenotic segment length. Conclusions: Localized stenosis of the bile ducts with dilatation or non-dilation of the upstream bile ducts, as well as diffuse thickening of the bile duct walls, are the MRI and CT features of newly diagnosed patients with IgG4-SC. Furthermore, higher baseline serum IgG4 and IgG levels are not related to the severity of the diseased bile ducts but are related to the number of other coexisting IgG4-RDs.

Keywords

• x-ray computed tomography
• magnetic resonance imaging
• igg4-related sclerosing cholangitis
• diagnosis