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MRI and ultrasonography are useful tools for a non-invasive diagnosis of IgG4-related disease
  1. Augustin Lecler1,
  2. Thomas Sené2
  1. 1Neuroradiology, The Fondation Adolphe de Rothschild Hospital, Paris, France
  2. 2Internal Medicine, The Fondation Adolphe de Rothschild Hospital, Paris, France
  1. Correspondence to Dr Augustin Lecler, Neuroradiology, The Fondation Adolphe de Rothschild Hospital, Paris, France; alecler{at}for.paris

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We read with much interest the 2019 classification criteria for IgG4-related disease by the American College of Rheumatology and the European League Against Rheumatism.1

This new classification driven by scientific evidence and research provides a substantial amount of new information, which will considerably improve the identification and management of patients with IgG4-related disease.

Despite the fact that radiology is integrated into the diagnostic criteria, only CT and/or positron emission tomography-CT are mentioned. We humbly suggest that the use of ultrasonography and/or MRI is missing. MRI is considered to be a relevant tool for diagnosing IgG4-related disease in the majority of organs included in the entry criteria such as the pancreas, bile ducts, orbits, lacrimal glands, major salivary glands, pachymeninges or thyroid gland.2 3 Its diagnostic accuracy is superior to that of CT and/or PET-CT for almost all organs, especially when imaging head and neck, orbital or brain IgG4-related disease. For example, detecting pachymeningitis with CT is challenging, whereas MRI is very sensitive.4 Moreover, MRI has proved to have high specificity to diagnose IgG4-related ophthalmic disease, in front of an enlargement of the infraorbital nerve.5 6 Advanced MRI techniques such as diffusion-weighted imaging, have excellent accuracy in distinguishing IgG4-ROD from lymphoma.7 Similarly, ultrasonography has been reported to easily detect changes in major salivary glands affected by IgG4-related diseases, even for inexperienced observers.8

One of the major points of the 2019 classification criteria for IgG4-related disease is that a positive diagnostic of IgG4-related disease can be achieved without invasive, tissue-based pathological confirmation. The update implies that non-invasive techniques such as imaging should have the best accuracy possible. CT and PET-CT have excellent sensitivity to detect lesions compatible with IgG4-related disease. However, MRI and ultrasonography have an even higher specificity in most organs. Moreover, MRI and ultrasonography are non-radiating techniques as opposed to CT and PET-CT.

Therefore, we believe that MRI and ultrasonography should be mentioned as first-line radiological examination choices in patients with a suspected diagnosis of IgG4-RD, especially for the head and neck and brain.

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Footnotes

  • Twitter @ThSene

  • Contributors AL and TS have written the Correspondence together.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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