Division of Endoscopy, Shizuoka Cancer Center, Suntogun, Japan.
Pancreatology. 2009;9(5):694-9. doi: 10.1159/000199439. Epub 2009 Aug 14.
BACKGROUND/AIMS: Autoimmune pancreatitis (AIP) is an IgG4-related systemic disease often accompanied with a variety of lesions outside of the pancreas and is treated with steroid therapy. The aim of this study is to analyze the usefulness of positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) in the evaluation of distribution and activity of systemic lesions of AIP during steroid therapy.
Eleven cases of AIP had their FDG-PET images evaluated before and 3 months after steroid therapy and another 2 cases only before therapy. AIP activity was determined by the level of serum markers, IgG and IgG4, and compared with findings of PET.
In all 13 cases of AIP, a moderate to intense level of FDG accumulation was recognized in the pancreatic lesion before steroid therapy. Of 13 patients, 11 (84.6%) showed FDG accumulation in the multiple organs, such as mediastinal and other lymph nodes, salivary gland, biliary tract, prostate, and aortic wall. In 11 patients who underwent PET before and after steroid therapy, FDG accumulation was diminished in almost all systemic lesions, with a mean of maximum standardized uptake value (SUV(max)) in the pancreatic lesion from 5.12 to 2.69. Similar to the SUV level, serum IgG and IgG4 were decreased in most of the cases after steroid therapy.
FDG-PET is an effective modality to evaluate the response of steroid therapy and the distribution and activity of various systemic lesions of AIP.
背景/目的：自身免疫性胰腺炎（AIP）是一种 IgG4 相关的系统性疾病，常伴有胰腺外多种病变，采用类固醇治疗。本研究旨在分析 18F-氟脱氧葡萄糖（FDG-PET）在评估类固醇治疗期间 AIP 系统性病变分布和活性中的作用。
11 例 AIP 患者在类固醇治疗前和治疗后 3 个月进行 FDG-PET 图像评估，另有 2 例仅在治疗前进行评估。通过血清标志物、IgG 和 IgG4 的水平来确定 AIP 的活性，并与 PET 结果进行比较。
在所有 13 例 AIP 患者中，在类固醇治疗前的胰腺病变中观察到中等到强烈的 FDG 积聚。在 13 例患者中，11 例（84.6%）在纵隔和其他淋巴结、唾液腺、胆道、前列腺和主动脉壁等多个器官中显示 FDG 积聚。在 11 例接受类固醇治疗前后 PET 的患者中，几乎所有系统性病变的 FDG 积聚均减少，胰腺病变的最大标准化摄取值（SUV(max)）从 5.12 降至 2.69。与 SUV 水平相似，大多数病例在类固醇治疗后 IgG 和 IgG4 降低。
FDG-PET 是评估类固醇治疗反应和 AIP 各种系统性病变分布和活性的有效方法。
