Klingenstein Annemarie, Garip-Kuebler Aylin, Priglinger Siegfried, Hintschich Christoph, Mueller-Lisse Ullrich G
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Department of Radiology, Ludwig-Maximilians-University, Munich, Germany.
Clin Ophthalmol. 2021 Mar 12;15:1119-1127. doi: 10.2147/OPTH.S299655. eCollection 2021.
To detect radiological features that, in addition to clinical findings, may aid in correct differentiation between IgG4-related ophthalmic disease (IgG4-ROD) and ocular adnexal lymphoma (OAL).
In this retrospective, single-center, comparative analysis, we compared cross-sectional imaging findings of 13 consecutive patients with histologically proven IgG4-ROD and a control group of 29 consecutive OAL-patients diagnosed between 10/2014 and 09/2019. Statistical significance was accepted at a <0.05 significance level.
IgG4-ROD-patients had longer time-to-diagnosis, higher orbital recurrence rates, but smaller lesions compared to OAL-patients (=0.002; =0.006 and =0.006; Mann-Whitney -test). Frequent cross-sectional imaging findings in both IgG4-ROD-patients and OAL-patients included extraocular muscle enlargement (92% and 93%, respectively; most often in the lateral rectus muscles and the levator-complex), and lacrimal-gland enlargement (85% and 83%, respectively). Other imaging findings comprised infraorbital nerve-involvement (IgG4-ROD, 23%, OAL, 17%) and orbital fat inflammation (IgG4-ROD, 23%, OAL, 28%). Bony infiltration and remodeling, heterogenous contrast-media distribution, and infiltration of the lacrimal system were seen slightly more often in IgG4-ROD (23%, 38%, 15% and 15% versus 17%, 14%, 3% and 7%). However, cross-sectional imaging features did not differ significantly between patient subgroups. Clinical symptoms predominantly occurred unilaterally (IgG4-ROD, 9/13, 69%, OAL, 24/29, 83%), while imaging findings were most often bilateral (IgG4-ROD, 11/13, 85%, OAL, 23/29, 79%, <0.001, McNemar test).
No morphological cross-sectional imaging sign could reliably distinguish between IgG4-ROD and OAL, leaving histopathology indispensable for definite diagnosis. Yet, importantly, for both IgG4-ROD and OAL, cross-sectional imaging frequently detected bilateral orbital disease when only one eye was clinically affected.
除临床症状外，探寻有助于正确鉴别IgG4相关性眼病（IgG4-ROD）和眼眶附属器淋巴瘤（OAL）的影像学特征。
在这项回顾性、单中心比较分析中，我们比较了13例经组织学证实的IgG4-ROD患者的横断面影像学检查结果，以及2014年10月至2019年9月期间连续诊断的29例OAL患者组成的对照组。显著性水平设定为<0.05，具有统计学意义。
与OAL患者相比，IgG4-ROD患者的诊断时间更长，眼眶复发率更高，但病变较小（P=0.002；P=0.006和P=0.006；Mann-Whitney U检验）。IgG4-ROD患者和OAL患者常见的横断面影像学表现包括眼外肌增粗（分别为92%和93%；最常见于外直肌和提上睑肌复合体）以及泪腺增大（分别为85%和83%）。其他影像学表现包括眶下神经受累（IgG4-ROD为23%，OAL为s17%）和眶脂肪炎症（IgG4-ROD为23%，OAL为28%）。IgG4-ROD患者出现骨浸润和重塑、不均匀造影剂分布以及泪腺系统浸润的情况略多于OAL患者（分别为23%、38%、15%和15%，而OAL患者分别为17%、14% %、3%和7%）。然而，患者亚组之间的横断面影像学特征差异无统计学意义。临床症状主要为单侧出现（IgG4-ROD为9/13，69%；OAL为24/29，83%），而影像学表现最常见为双侧（IgG4-ROD为11/13，85%；OAL为23/29，79%，P<0.001，McNemar检验）。
没有形态学横断面影像学征象能够可靠地区分IgG4-ROD和OAL，组织病理学检查对于明确诊断不可或缺。然而，重要的是，对于IgG4-ROD和OAL，当仅一只眼出现临床症状时，横断面影像学检查经常能发现双侧眼眶病变。
