Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Radiol. 2022 Oct;23(10):976-985. doi: 10.3348/kjr.2022.0233. Epub 2022 Aug 31.
To compare the clinical and radiological features of various etiologies of chronic diffuse lacrimal gland enlargement.
We retrospectively reviewed 91 consecutive patients who underwent surgical biopsy for chronic diffuse lacrimal gland enlargement and were diagnosed with non-specific dacryoadenitis (DA) (n = 42), immunoglobulin G4-related dacryoadenitis (IgG4-RD) (n = 33), and lymphoma (n = 16). Data on patient demographics, clinical presentation, and CT imaging findings (n = 73) and MRI (n = 43) were collected. The following radiologic features of lacrimal gland enlargement were evaluated: size, unilaterality, wedge sign, angle with the orbital wall, heterogeneity, signal intensity, degree of enhancement, patterns of dynamic contrast-enhanced, and apparent diffusion coefficient value. Radiological features outside the lacrimal glands, such as extra-lacrimal orbital involvement and extra-orbital head and neck involvement, were also evaluated. The clinical and radiological findings were compared among the three diseases.
Compared to the DA and IgG4-RD groups, the lymphoma group was significantly older (mean 59.9 vs. 46.0 and 49.4 years, respectively; = 0.001) and had a higher frequency of unilateral involvement (62.5% vs. 31.0% and 15.2%, respectively; = 0.004). Compared to the IgG4-RD and lymphoma groups, the DA group had significantly smaller lacrimal glands (2.3 vs. 2.8 and 3.3 cm, respectively; < 0.001) and a lower proportion of cases with a wedge sign (54.8% vs. 84.8% and 87.5%, respectively; = 0.005). The IgG4-RD group showed more frequent involvement of the extra-orbital head and neck structures, including the infraorbital nerve (36.4%), paranasal sinus (72.7%), and salivary gland (58.6%) compared to the DA and lymphoma groups (4.8%-28.6%) (all < 0.005).
Patient age, unilaterality, lacrimal gland size, wedge sign, and extra-orbital head and neck involvement differed significantly different between lymphoma, DA, and IgG4-RD. Our results will be useful for the differential diagnosis and proper management of chronic lacrimal gland enlargement.
比较各种病因慢性弥漫性泪腺增大的临床和影像学特征。
我们回顾性分析了 91 例因慢性弥漫性泪腺增大而行手术活检的患者，这些患者被诊断为非特异性泪腺炎（DA）（n=42）、免疫球蛋白 G4 相关泪腺炎（IgG4-RD）（n=33）和淋巴瘤（n=16）。收集了患者人口统计学、临床表现和 CT 成像（n=73）和 MRI（n=43）的资料。评估了泪腺增大的以下影像学特征：大小、单侧性、楔形征、与眶壁的角度、异质性、信号强度、增强程度、动态对比增强模式和表观扩散系数值。还评估了泪腺外的眼眶外眶内和头颈部外眶内的其他放射学特征。比较了三种疾病的临床和放射学表现。
与 DA 和 IgG4-RD 组相比，淋巴瘤组的年龄明显更大（平均 59.9 岁、46.0 岁和 49.4 岁，分别； = 0.001），单侧受累的频率更高（62.5%、31.0%和 15.2%，分别； = 0.004）。与 IgG4-RD 和淋巴瘤组相比，DA 组的泪腺明显更小（2.3cm、2.8cm 和 3.3cm，分别； < 0.001），楔形征的比例也更低（54.8%、84.8%和 87.5%，分别； = 0.005）。与 DA 和淋巴瘤组相比，IgG4-RD 组眼眶外头颈部结构的受累更为频繁，包括眶下神经（36.4%）、副鼻窦（72.7%）和唾液腺（58.6%）（分别为 4.8%-28.6%）（均 < 0.005）。
在淋巴瘤、DA 和 IgG4-RD 之间，患者年龄、单侧性、泪腺大小、楔形征和眼眶外头颈部受累存在显著差异。我们的研究结果将有助于慢性泪腺增大的鉴别诊断和适当治疗。
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