Utility of FDG PET/CT for differential diagnosis of patients clinically suspected of IgG4-related disease

Purpose: We investigated the capacity of ¹⁸F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) to differentially diagnose immunoglobulin G4-related disease (IgG4-RD) in clinically suspected patients. Materials and Methods: Subjects were 94 clinically suspected patients who had tissue IgG4 staining (n = 85) or serum IgG4 greater than 135mg/dL (n = 9) and underwent FDG PET/CT within 40 days. Clinical, serologic, pathological, and PET/CT findings were analyzed. Binary logistic regression analysis was performed to assess the diagnostic performance of PET/CT. Results: Final diagnosiswas IgG4-RDin 28,malignancy in 29, IgG4-unrelated inflammation in 35, and undetermined cause in 2 subjects. Patients with IgG4-RD had lower maximum standardized uptake value (SUVmax) of FDG uptake in lesions (4.6 ± 1.7 vs 7.1 ± 5.0) and higher submandibular gland SUVmax (2.8 ± 1.0 vs 2.3 ± 0.6) and were more likely to have diffuse/heterogeneous uptake pattern (78.6% vs 54.8%). The relation between SUVmax of lesions and histopathological findings was weak. On binary logistic regression analysis, lesion SUVmax, submandibular gland SUVmax, and multiorgan involvement were significant predictors of IgG4-RD and provided an area under the receiver operating characteristics curve of 0.824. With optimum criteria, FDG PET/CT had a sensitivity of 85.7% and specificity of 66.1% for diagnosing IgG4-RD. Conclusions: FDG PET/CT findings may have the capacity to potentially differentiate IgG4 RD from other diseases in clinically suspected patients.