Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma

Annemarie Klingenstein,1 Aylin Garip-Kuebler,1 Siegfried Priglinger,1 Christoph Hintschich,1 Ullrich G Mueller-Lisse2 1Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany; 2Department of Radiology, Ludwig-Maximilians-University, Munich, GermanyCorrespondence: Annemarie Klinge...

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Autores principales:	Klingenstein A, Garip-Kuebler A, Priglinger S, Hintschich C, Mueller-Lisse UG
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	igg4 idiopathic orbital inflammation ct ocular adnexal lymphoma Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/0a75fab23272447c9ee277e7beebe27d
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spelling	oai:doaj.org-article:0a75fab23272447c9ee277e7beebe27d2021-12-02T15:52:24ZMorphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma1177-5483https://doaj.org/article/0a75fab23272447c9ee277e7beebe27d2021-03-01T00:00:00Zhttps://www.dovepress.com/morphologic-cross-sectional-imaging-features-of-igg4-related-orbitopat-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Annemarie Klingenstein,1 Aylin Garip-Kuebler,1 Siegfried Priglinger,1 Christoph Hintschich,1 Ullrich G Mueller-Lisse2 1Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany; 2Department of Radiology, Ludwig-Maximilians-University, Munich, GermanyCorrespondence: Annemarie KlingensteinLudwig-Maximilians-University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstraße 8, Munich, D-80336, GermanyTel +49 89 44005 3811Fax +49 89 44005 5160Email Annemarie.Klingenstein@med.uni-muenchen.deAim: 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).Methods: 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 p< 0.05 significance level.Results: IgG4-ROD-patients had longer time-to-diagnosis, higher orbital recurrence rates, but smaller lesions compared to OAL-patients (p=0.002; p=0.006 and p=0.006; Mann–Whitney U-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%, p< 0.001, McNemar test).Conclusion: 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.Keywords: IgG4, idiopathic orbital inflammation, CT, ocular adnexal lymphomaKlingenstein AGarip-Kuebler APriglinger SHintschich CMueller-Lisse UGDove Medical Pressarticleigg4idiopathic orbital inflammationctocular adnexal lymphomaOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 1119-1127 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	igg4 idiopathic orbital inflammation ct ocular adnexal lymphoma Ophthalmology RE1-994
spellingShingle	igg4 idiopathic orbital inflammation ct ocular adnexal lymphoma Ophthalmology RE1-994 Klingenstein A Garip-Kuebler A Priglinger S Hintschich C Mueller-Lisse UG Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma
description	Annemarie Klingenstein,1 Aylin Garip-Kuebler,1 Siegfried Priglinger,1 Christoph Hintschich,1 Ullrich G Mueller-Lisse2 1Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany; 2Department of Radiology, Ludwig-Maximilians-University, Munich, GermanyCorrespondence: Annemarie KlingensteinLudwig-Maximilians-University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstraße 8, Munich, D-80336, GermanyTel +49 89 44005 3811Fax +49 89 44005 5160Email Annemarie.Klingenstein@med.uni-muenchen.deAim: 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).Methods: 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 p< 0.05 significance level.Results: IgG4-ROD-patients had longer time-to-diagnosis, higher orbital recurrence rates, but smaller lesions compared to OAL-patients (p=0.002; p=0.006 and p=0.006; Mann–Whitney U-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%, p< 0.001, McNemar test).Conclusion: 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.Keywords: IgG4, idiopathic orbital inflammation, CT, ocular adnexal lymphoma
format	article
author	Klingenstein A Garip-Kuebler A Priglinger S Hintschich C Mueller-Lisse UG
author_facet	Klingenstein A Garip-Kuebler A Priglinger S Hintschich C Mueller-Lisse UG
author_sort	Klingenstein A
title	Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma
title_short	Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma
title_full	Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma
title_fullStr	Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma
title_full_unstemmed	Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma
title_sort	morphologic cross-sectional imaging features of igg4-related orbitopathy in comparison to ocular adnexal lymphoma
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/0a75fab23272447c9ee277e7beebe27d
work_keys_str_mv	AT klingensteina morphologiccrosssectionalimagingfeaturesofigg4relatedorbitopathyincomparisontoocularadnexallymphoma AT garipkueblera morphologiccrosssectionalimagingfeaturesofigg4relatedorbitopathyincomparisontoocularadnexallymphoma AT priglingers morphologiccrosssectionalimagingfeaturesofigg4relatedorbitopathyincomparisontoocularadnexallymphoma AT hintschichc morphologiccrosssectionalimagingfeaturesofigg4relatedorbitopathyincomparisontoocularadnexallymphoma AT muellerlisseug morphologiccrosssectionalimagingfeaturesofigg4relatedorbitopathyincomparisontoocularadnexallymphoma
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Morphologic Cross-Sectional Imaging Features of IgG4-Related Orbitopathy in Comparison to Ocular Adnexal Lymphoma

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