IgG4相关性疾病的影像改变.ppt

IgG4相关性疾病的影像改变;IgG4相关性疾病的历史及概念;IgG4相关性疾病;IgG4相关性疾病;IgG4相关性疾病;自身免疫性胰腺炎（autoimmune pancreatitis，AIP);国外报道AIP病例数约占同期CP的2%-10%，我国报道比例3.6%-9.7%。男女比例约2:1，多见于老年人，大部分患者初次发病年龄超过50岁，但也可于青少年期发病。 易被误诊为胰腺癌，因疑诊胰腺癌而行手术切除最常见的良性病变，约占所有胰十二指肠切除术的2.5％左右。;自身免疫性胰腺炎（autoimmune pancreatitis，AIP);影像学表现;Different patterns of autoimmune pancreatitis;Vlachou et al， RadioGraphics 2011; 31:1379–1402 ;F-43，间断上腹部疼痛，肝酶升高，胰管扩张；实验室检查：IG4/IG2升高，脂肪酶升高；CEA,CA199正常;M-75，上腹部疼痛.;focal autoimmune pancreatitis ;;诊断标准;2010年 AlP诊断标准国际共识; 患者有典型影像学征象，且有实验室检查或胰腺外受累证据，即可诊断AIP，可行激素治疗。 如影像学不典型，需除外胰腺癌，再结合实验室检查、组织病理学证据做出诊断。 如行诊断性激素治疗，必须除外胰腺癌，疗程不长于2周；复查影像学提示胰腺或胰腺外病变明显好转者支持AIP诊断。;IgG4相关性硬化性胆管炎;IgG4相关性硬化性胆管炎;;Follow-up MRCP image obtained 2 years later, after steroid therapy。;A 61-year-old man with biopsy proven IgG4-related sclerosing cholangitis mimicking cholangiocarcinoma.;diagnosis of IgG4-related disease following cholecystectomy;IgG4相关性肾病;IgG4相关性肾病的影像学表现;IgG4相关性肾病的影像学表现;Takahashi et al Radiology: Volume 242: Number 3—March 2007;Takahashi et al Radiology: Volume 242: Number 3—March 2007;M. Kawano Clin Exp Nephrol (2011) 15:615–626;Sunchan Kim, Korean J Urol 2013;54:209-211;M. Kawano Clin Exp Nephrol (2011) 15:615–626;男，58岁,外院检查发现右肾占位。 2013年1月CT ;2013年7月CT;;女 43岁；纳差、恶心、皮肤巩膜黄染2个月。;;;IgG4相关间质性肺疾病;IgG4相关间质性肺疾病;Schematic of four types of IgG4-related lung disease: (a) solid nodular, (b) round-shaped GGO,(c) alveolar interstitial, and (d) bronchovascular;(a, b) Thin-section CT scans of left lung in a 76-year-old woman (case 3) with IgG4-related lung disease demonstrate a solid nodule in the left upper lobe (black arrow). This nodule is accompanied by perinodular spiculation. DiffuseGGOis also shown in the left upper lobe separated by a solid nodule (white arrows).;(a– d) Thin-section CT scans in a 43-year-old man (case 6) with IgG4-related lung disease. Multiple GGOs are shown in both lungs. Each lesion is well defined and round shaped (arrow).;(a, b) Thin-section CT scans in a 59-year-old man (case 7) wit