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array:24 [ "pii" => "S2387020616000991" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.02.034" "estado" => "S300" "fechaPublicacion" => "2015-10-05" "aid" => "3191" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;145:321-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 3 "PDF" => 2 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S002577531400880X" "issn" => "00257753" "doi" => "10.1016/j.medcli.2014.11.019" "estado" => "S300" "fechaPublicacion" => "2015-10-05" "aid" => "3191" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;145:321-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 41 "formatos" => array:2 [ "HTML" => 28 "PDF" => 13 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Utilidad de la PET/TC en la enfermedad por IgG4" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "322" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of PET/CT in IgG4-related disease" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1750 "Ancho" => 2333 "Tamanyo" => 337525 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudio PET/TC (<span class="elsevierStyleItalic">maximum intensity projection</span> o MIP) y cortes axiales de la fusión pretratamiento (A) que muestra masa pulmonar derecha con aumento del metabolismo glucídico compatible por PAAF de pseudotumor inflamatorio (flecha) y adenopatías hipermetabólicas hiliomediastínicas, supraclaviculares, axilares e inguinales, así como notable hipermetabolismo difuso en el parénquima renal y salivar bilateral (flechas). Estudio postratamiento a los 5 meses (B), que muestra la práctica desaparición del metabolismo glucídico a nivel pulmonar, ganglionar, renal y salivar.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Montserrat Cortés-Romera, Aida Sabaté-Llobera, Cristina Gámez-Cenzano, Joan Torras-Ambròs" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Cortés-Romera" ] 1 => array:2 [ "nombre" => "Aida" "apellidos" => "Sabaté-Llobera" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Gámez-Cenzano" ] 3 => array:2 [ "nombre" => "Joan" "apellidos" => "Torras-Ambròs" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616000991" "doi" => "10.1016/j.medcle.2016.02.034" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616000991?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531400880X?idApp=UINPBA00004N" "url" => "/00257753/0000014500000007/v1_201509120059/S002577531400880X/v1_201509120059/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020616000966" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.02.031" "estado" => "S300" "fechaPublicacion" => "2015-10-05" "aid" => "3178" "copyright" => "Elsevier España, S.L.U." 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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;145:319-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "HTML" => 5 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Serum tumour markers in asymptomatic patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "319" "paginaFinal" => "320" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Marcadores tumorales séricos en pacientes asintomáticos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joaquim Torné Cachot, José Manuel Baucells Azcona, Jesús Blanch Falp, David Blancas Altabella" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Joaquim" "apellidos" => "Torné Cachot" ] 1 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Baucells Azcona" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Blanch Falp" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Blancas Altabella" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315001876" "doi" => "10.1016/j.medcli.2015.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315001876?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616001054?idApp=UINPBA00004N" "url" => "/23870206/0000014500000007/v2_201604010141/S2387020616001054/v2_201604010141/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Usefulness of PET/CT in IgG4-related disease" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "322" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Montserrat Cortés-Romera, Aida Sabaté-Llobera, Cristina Gámez-Cenzano, Joan Torras-Ambròs" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Montserrat" "apellidos" => "Cortés-Romera" "email" => array:1 [ 0 => "mcortes@bellvitgehospital.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Aida" "apellidos" => "Sabaté-Llobera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "Gámez-Cenzano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Joan" "apellidos" => "Torras-Ambròs" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unitat PET-TC IDI, Hospital Universitari de Bellvitge-Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servei de Nefrologia, Hospital Universitari de Bellvitge-Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la PET/TC en la enfermedad por IgG4" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1750 "Ancho" => 2333 "Tamanyo" => 333154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CT study (maximum intensity projection or MIP) and imaging of pretreatment axial slices (A) showing right lung mass with increased glucose metabolism consistent with inflammatory pseudotumor FNA (arrow) and hypermetabolic, mediastinal hilar, supraclavicular, axillary and inguinal lymphadenopathy and remarkable diffuse hypermetabolism in the bilateral salivary gland and renal parenchyma (arrows). Study after treatment, at 5 months (B), showing the virtual disappearance of glucose metabolism in the lungs, lymph nodes, kidney and salivary glands.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The immunoglobulin G4-related disease (IgG4-RD) is a systemic entity with frequent pseudo masses in various organs, made up of lymphoplasmacytic infiltrates and fibrosclerosis areas with abundant IgG4-positive plasma cells.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a> This disease includes forms of autoimmune pancreatitis (AIP), sclerosing cholangitis, sialadenitis, retroperitoneal fibrosis, tubulointerstitial nephritis, interstitial pneumonia and prostatitis, with frequent occurrence of inflammatory pseudotumor and lymphadenopathy. The treatment of choice is corticosteroids.</p><p id="par0010" class="elsevierStylePara elsevierViewall">PET/CT with <span class="elsevierStyleSup">18</span>F-FDG is an imaging technique widely used in oncology, and increasingly recognized as a valid tool for the diagnosis, characterization and monitoring of therapeutic response in the infectious and inflammatory disease.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report a case of a male patient aged 73 with a history of ischemic heart disease and diffuse large B-cell lymphoma in complete remission after chemotherapy. In a control CT scan of the lymphoma, a pulmonary mass was seen in the right lower lobe with supraclavicular, mediastinal hilar lymphadenopathy. Malignancy was ruled out after fine needle aspiration (FNA) and bronchoscopy, with negative cultures. Given the patient's history, a second FNA confirmed the presence of lymphoplasmacytic infiltrates and fibrosclerosis with abundant IgG4-positive plasma cells. In addition, the patient had anemia, thrombocytopenia, polyclonal hypergammaglobulinemia, renal failure and non-nephrotic range proteinuria. After undergoing a triple bypass due to acute myocardial infarction, our patient experienced progression of renal failure with nephrotic syndrome and occurrence of monoclonal component in plasma. He underwent a kidney biopsy, which showed tubulointerstitial nephritis with IgG4-positive lymphoplasmacytic infiltrates (IgG4/IgG1 ratio<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>10%). Plasma levels of IgG and IgG4 were high: 50,400<span class="elsevierStyleHsp" style=""></span>mg/l (baseline range 6900–14,000) and 20,200<span class="elsevierStyleHsp" style=""></span>mg/l (baseline range 80–1400), respectively. Therefore, he was diagnosed with IgG4-RD. To assess the extent of disease before treatment the patient underwent a PET/CT with <span class="elsevierStyleSup">18</span>F-FDG, which showed multiple lesions with high carbohydrate metabolism: lung mass and multiple supraclavicular, mediastinal hilar, axillary and inguinal lymphadenopathy, salivary gland and renal parenchyma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient started corticosteroid therapy, and after 2 months he showed virtual clinical resolution and decreased levels of IgG and IgG4 (12,800<span class="elsevierStyleHsp" style=""></span>mg/l and 6390<span class="elsevierStyleHsp" style=""></span>mg/l, respectively). After 5 months of therapy he underwent a second PET/CT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), which showed a marked reduction with virtual disappearance of the metabolic activity of the multiple lesions observed before treatment, showing the resolution of the disease, despite the persistence of some residual damage on CT. The patient was asymptomatic and a significant reduction was noted in the levels of IgG (by 8430<span class="elsevierStyleHsp" style=""></span>mg/l) and IgG4 (by 2100<span class="elsevierStyleHsp" style=""></span>mg/l), so the dose of corticosteroids was reduced.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">IgG4-RD is a disease that includes inflammatory and autoimmune processes, AIP and Mikulicz syndrome being its main manifestations. PET/CT assesses the extent of the disease and is often used to distinguish between benign and malignant cases, provided that one of the most important characteristics of IgG4-RD is simulating neoplasm but it responds favorably to the corticosteroids.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5,6</span></a> IgG4-RD usually involves multiple concomitant areas such as pancreas, salivary and lacrimal glands, bile duct, retroperitoneum and prostate, among others, supporting AIP more than pancreatic neoplasm. IgG4 is the best marker to distinguish one process from the other,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> although it is not very specific. Our patient had a suspected malignant lung mass and a second FNA confirmed its inflammatory etiology. However, sometimes it is difficult to find a diagnosis. The intensity of FDG uptake in PET imaging does not differentiate between inflammatory and tumor disease, but its usefulness lies in selecting the most suitable location for the biopsy. PET/CT before treatment showed an increased glucose metabolism in the known and symptomatic lesions as well as in other unknown and asymptomatic lesions, and the involvement of the salivary glands. The sensitivity and specificity of the high plasma levels of IgG4 for diagnosis of AIP are 70 and 90%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a> These are useful to monitor response to treatment only when they are elevated before treatment, and PET-CT can demonstrate the disappearance of inflammatory activity, even though IgG4 levels are still high after treatment, and earlier than the CT morphological changes, as observed in this case. PET/CT scan is a useful tool for therapeutic monitoring and suspected recurrence, although its role in planning the therapeutic strategy and the ideal time of PET/CT completion after treatment is still unknown. This case demonstrates how useful PET-CT imaging is in IgG4-RD.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cortés-Romera M, Sabaté-Llobera A, Gámez-Cenzano C, Torras-Ambròs J. Utilidad de la PET/TC en la enfermedad por IgG4. Med Clin (Barc). 2015;145:321–322.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1750 "Ancho" => 2333 "Tamanyo" => 333154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CT study (maximum intensity projection or MIP) and imaging of pretreatment axial slices (A) showing right lung mass with increased glucose metabolism consistent with inflammatory pseudotumor FNA (arrow) and hypermetabolic, mediastinal hilar, supraclavicular, axillary and inguinal lymphadenopathy and remarkable diffuse hypermetabolism in the bilateral salivary gland and renal parenchyma (arrows). Study after treatment, at 5 months (B), showing the virtual disappearance of glucose metabolism in the lungs, lymph nodes, kidney and salivary glands.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoimmune pancreatitis: proposal of IgG4-related sclerosing disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Kamisawa" 1 => "A. 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