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Abstract：
OBJECTIVE: The objective of this study was to examine the imaging features of hepatic inflammatory pseudotumors (IPTs) associated with IgG4-related and IgG4-unrelated conditions and to enhance the approach toward distinguishing between these two types of IPTs.
METHODS: A retrospective study was conducted, involving 20 patients diagnosed with hepatic IPTs. Imaging procedures were conducted within a timeframe of 4 weeks prior to hepatectomy or biopsy. The imaging features were then analyzed and compared using chi-squared analysis.
RESULTS: Seventeen (81.0%) IPTs were located in the hepatic subcapsular area; six (66.7%) IgG4-related IPTs were distributed around the hepatic hilum; and eleven (91.7%) IgG4-unrelated and three (33.3%) IgG4-related IPTs had unclear boundaries. All lesions exhibited similar characteristics in CT scans, T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI), with the apparent diffusion coefficient (ADC) values slightly higher than the surrounding liver tissue. Delayed hypoenhancement, observed in five cases (55.6%), was exclusively present in IgG4-related IPTs. The remaining IPT lesions displayed progressive enhancement, septal and marginal enhancement, and persistent enhancement. Central enhancement was absent in three IgG4-related IPTs (33.3%) and ten IgG4-unrelated IPTs (83.3%). The duct-penetrating sign was identified in two IgG4-unrelated IPTs (16.7%) and seven IgG4-related IPTs (77.8%). Furthermore, seven patients with IgG4-related IPTs had additional lesions outside the liver.
CONCLUSIONS: IgG4-related lesions are frequently found in the vicinity of the hepatic hilum; they display the duct-penetrating sign and affect other organs as well. Both groups exhibited progressive or persistent contrast enhancement in typical IPT lesions, but delayed hypoenhancement was only observed in the IgG4-related IPT group. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement.
UNASSIGNED: Differences in imaging features differentiate IgG4-related and -unrelated inflammatory pseudotumors (IPT). IgG4-related lesions are frequently near the hepatic hilum, display duct-penetrating sign, and affect other organs. Only the IgG4-related group demonstrated delayed hypoenhancement. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement.
CONCLUSIONS: Compared with IgG 4-unrelated IPTs, IgG4-related IPTs show delayed hypoenhancement and affect other organs. IgG4-unrelated IPTs have unclear boundaries and lack central enhancement. Improved IPT diagnostic capabilities can help minimize additional, potentially unnecessary, interventions.
METHODS: A retrospective study was conducted, involving 20 patients diagnosed with hepatic IPTs. Imaging procedures were conducted within a timeframe of 4 weeks prior to hepatectomy or biopsy. The imaging features were then analyzed and compared using chi-squared analysis.
RESULTS: Seventeen (81.0%) IPTs were located in the hepatic subcapsular area; six (66.7%) IgG4-related IPTs were distributed around the hepatic hilum; and eleven (91.7%) IgG4-unrelated and three (33.3%) IgG4-related IPTs had unclear boundaries. All lesions exhibited similar characteristics in CT scans, T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI), with the apparent diffusion coefficient (ADC) values slightly higher than the surrounding liver tissue. Delayed hypoenhancement, observed in five cases (55.6%), was exclusively present in IgG4-related IPTs. The remaining IPT lesions displayed progressive enhancement, septal and marginal enhancement, and persistent enhancement. Central enhancement was absent in three IgG4-related IPTs (33.3%) and ten IgG4-unrelated IPTs (83.3%). The duct-penetrating sign was identified in two IgG4-unrelated IPTs (16.7%) and seven IgG4-related IPTs (77.8%). Furthermore, seven patients with IgG4-related IPTs had additional lesions outside the liver.
CONCLUSIONS: IgG4-related lesions are frequently found in the vicinity of the hepatic hilum; they display the duct-penetrating sign and affect other organs as well. Both groups exhibited progressive or persistent contrast enhancement in typical IPT lesions, but delayed hypoenhancement was only observed in the IgG4-related IPT group. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement.
UNASSIGNED: Differences in imaging features differentiate IgG4-related and -unrelated inflammatory pseudotumors (IPT). IgG4-related lesions are frequently near the hepatic hilum, display duct-penetrating sign, and affect other organs. Only the IgG4-related group demonstrated delayed hypoenhancement. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement.
CONCLUSIONS: Compared with IgG 4-unrelated IPTs, IgG4-related IPTs show delayed hypoenhancement and affect other organs. IgG4-unrelated IPTs have unclear boundaries and lack central enhancement. Improved IPT diagnostic capabilities can help minimize additional, potentially unnecessary, interventions.
摘要：
目的：本研究的目的是检查与IgG4相关和IgG4无关的肝脏炎性假瘤（IPT）的影像学特征，并加强区分这两种类型IPT的方法。
方法：进行了回顾性研究，涉及20例诊断为肝脏IPT的患者。在肝切除术或活检之前的4周内进行成像程序。然后使用卡方分析对成像特征进行分析和比较。
结果：17例（81.0%）IPT位于肝囊下区域；6例（66.7%）与IgG4相关的IPT分布在肝门周围；11例（91.7%）与IgG4无关的IPT和3例（33.3%）与IgG4相关的IPT的边界不清楚。所有病变在CT扫描中表现出相似的特征，T1加权成像(T1WI),T2加权成像(T2WI),和弥散加权成像（DWI），表观扩散系数(ADC)值略高于周围肝脏组织。延迟增强不足，在5例(55.6%)中观察到，仅存在于IgG4相关的IPT中。其余IPT病灶显示渐进性增强,间隔和边缘增强，和持续增强。在三个IgG4相关的IPT（33.3％）和十个IgG4无关的IPT（83.3％）中没有中央增强。在两个IgG4无关的IPT（16.7％）和七个IgG4相关的IPT（77.8％）中发现了导管穿透征象。此外，7例IgG4相关IPT患者在肝外有额外病变.
结论：与IgG4相关的病变常见于肝门附近；它们显示导管穿透征，并影响其他器官。两组在典型的IPT病变中均表现出渐进性或持续性的对比增强，但是仅在IgG4相关的IPT组中观察到延迟的低增强。IgG4无关的IPT病变通常表现出模糊的边界，缺乏中心增强。
■影像学特征的差异可区分IgG4相关和无关的炎性假瘤（IPT）。IgG4相关病变常在肝门附近，显示管道穿透标志，影响其他器官。只有IgG4相关组表现出延迟的低增强。IgG4无关的IPT病变通常表现出模糊的边界，缺乏中心增强。
结论：与IgG4无关的IPT相比，IgG4相关的IPT显示延迟的低增强并影响其他器官。IgG4无关的IPT具有不清楚的边界并且缺乏中枢增强。改进的IPT诊断功能可以帮助最大限度地减少额外的,可能是不必要的，干预措施。
方法：进行了回顾性研究，涉及20例诊断为肝脏IPT的患者。在肝切除术或活检之前的4周内进行成像程序。然后使用卡方分析对成像特征进行分析和比较。
结果：17例（81.0%）IPT位于肝囊下区域；6例（66.7%）与IgG4相关的IPT分布在肝门周围；11例（91.7%）与IgG4无关的IPT和3例（33.3%）与IgG4相关的IPT的边界不清楚。所有病变在CT扫描中表现出相似的特征，T1加权成像(T1WI),T2加权成像(T2WI),和弥散加权成像（DWI），表观扩散系数(ADC)值略高于周围肝脏组织。延迟增强不足，在5例(55.6%)中观察到，仅存在于IgG4相关的IPT中。其余IPT病灶显示渐进性增强,间隔和边缘增强，和持续增强。在三个IgG4相关的IPT（33.3％）和十个IgG4无关的IPT（83.3％）中没有中央增强。在两个IgG4无关的IPT（16.7％）和七个IgG4相关的IPT（77.8％）中发现了导管穿透征象。此外，7例IgG4相关IPT患者在肝外有额外病变.
结论：与IgG4相关的病变常见于肝门附近；它们显示导管穿透征，并影响其他器官。两组在典型的IPT病变中均表现出渐进性或持续性的对比增强，但是仅在IgG4相关的IPT组中观察到延迟的低增强。IgG4无关的IPT病变通常表现出模糊的边界，缺乏中心增强。
■影像学特征的差异可区分IgG4相关和无关的炎性假瘤（IPT）。IgG4相关病变常在肝门附近，显示管道穿透标志，影响其他器官。只有IgG4相关组表现出延迟的低增强。IgG4无关的IPT病变通常表现出模糊的边界，缺乏中心增强。
结论：与IgG4无关的IPT相比，IgG4相关的IPT显示延迟的低增强并影响其他器官。IgG4无关的IPT具有不清楚的边界并且缺乏中枢增强。改进的IPT诊断功能可以帮助最大限度地减少额外的,可能是不必要的，干预措施。
