Nerve Lesions
It is now widely recognized that type 1 autoimmune pancreatitis (AIP), which pathologically corresponds to lymphoplasmacytic sclerosing pancreatitis (LPSP), is part of the IgG4-related disease (IgG4-RD) spectrum and is associated with a wide range of extr
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Nerve Lesions Yasunari Fujinaga, Tomoharu Watanabe, Satoshi Kawakami, Masumi Kadoya, Hideaki Hamano, and Shigeyuki Kawa
18.1
Introductory Remarks
Type 1 autoimmune pancreatitis (AIP), which pathologically corresponds to lymphoplasmacytic sclerosing pancreatitis (LPSP), is a distinctive disorder of the pancreas characterized pathologically by a lymphoplasmacytic infiltrate, fibrosis, and obliterative phlebitis. Its cause has not been fully elucidated, but since the report of Hamano et al. [1], serum IgG4 has been believed to play an important role in the pathophysiology of this condition. By accumulating larger numbers of cases, it has become evident that AIP is associated with lesions in multiple organs, some of the most frequently affected being the lacrimal gland, salivary gland, pulmonary hilar lymph nodes, lung, bile duct, kidney, retroperitoneum, and prostate. These lesions have previously been referred to collectively by a variety of names: IgG4-related sclerosing disease [2], systemic IgG4-related plasmatic disease (SIPS) [3], and IgG4-positive multiorgan lymphoproliferative syndrome (IgG4 + MOLPS) [4]. However, in recent years, the name has been unified as IgG4-related disease (IgG4-RD).
Y. Fujinaga (*) • T. Watanabe • S. Kawakami • M. Kadoya Department of Radiology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto City 390-8621, Japan e-mail: [email protected] H. Hamano Division of Medical Informatics, Department of Internal medicine, Gastroenterology, Shinshu University Hospital, Matsumoto City, Japan S. Kawa Center for Health, Safety, and Environmental Management, Shinshu University, 3-1-1, Asahi, Matsumoto City 390-8621, Japan
18.2
Experience at Our Institution
We encountered lesions of the infraorbital nerve (first branch of the maxillary nerve, which is the second branch [V2] of the trigeminal nerve) associated with AIP and investigated whether these lesions are increased in frequency in this condition. Of 71 AIP cases, MRI of the head and neck was performed in 11 patients. Twenty patients undergoing head and neck MRI during the same period served as the control group [5]. The control group did not include any patients with a history of head and neck malignant tumors, lymph node swelling, pain, hoarseness, radiotherapy, or osteomyelitis, nor did it include patients with maxillary sinus hypoplasia or maxillary sinus tumors. All images were obtained on a 1.5 T MR unit, and the infraorbital nerves were observed on an image viewer on T1-weighted images, T2-weighted images, or short T1 inversion recovery (STIR) coronal sections. The nerve diameter was measured in a total of 62 right and left eyes in the AIP and control groups combined, and the mean widths of the nerve diameters were compared between the two groups. In the glucocorticoid-treated patients, changes in the nerve diameter before and after therapy were investigated. The MRI studies were also examined for other nerve lesions in the head and neck region. In AIP group, serum IgG4 values were determined, and the presence/
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