Sonographic evaluation of the treatment response in patients with immunoglobulin G4-related disease of the submandibular glands.
OBJECTIVE
To evaluate the usefulness of sonography for monitoring the response to glucocorticoid treatment in patients with immunoglobulin G4 (IgG4)-related disease.


METHODS
We conducted a retrospective study using sonography in 12 patients with bilateral swollen submandibular glands who had a diagnosis of IgG4-related disease based on an elevated serum IgG4 level (>135 mg/dL) and histopathologic findings between January 2010 and December 2012. Among these patients, 6 were treated with prednisolone, and the other 6 were placed under observation. B-mode sonographic examinations of the submandibular glands were performed with or without color Doppler imaging at the initial examination and 6 months later. Findings were compared between the groups (treated and untreated), and their relationship with the treatment response of the primarily involved organs was investigated.


RESULTS
In the treated group, the submandibular glands of all 6 patients decreased in both size and volume after treatment (average volume ± SD, 27,449.7 ± 24,227.6 to 4609.7 ± 1911.4 mm(3); P = .004). The internal echo texture, characterized by multiple hypoechoic foci scattered against a heterogeneous hyperechoic background of submandibular tissue with demarcated hyperechoic lines, with or without hypoechoic tumor formation, disappeared or was obscured in all cases. In addition, the blood flow signals were reduced in all 3 patients who underwent color Doppler sonography, and the response observed on sonography was found to correlate with the IgG4 level and recovery of specific organ involvement. In contrast, in the untreated group, the submandibular glands showed a tendency to increase in both size and volume (average volume, 9326.3 ± 3054.8 to 12,217.4 ± 4605.5 mm(3); P= .2) without a decrease in the blood flow signals.


CONCLUSIONS
Sonography is considered useful for evaluating the response to glucocorticoid therapy in patients with IgG4-related disease of the submandibular glands.
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.) sa@is.icc.u-tokai.ac.jp.
Satomi
S
Asai
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Shinji
S
Sato
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Kenji
K
Okami
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Noboru
N
Takanashi
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Kazuo
K
Umezawa
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Anar
A
Damdinsuren
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Hiromichi
H
Matsushita
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Naoya
N
Nakamura
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Yasuo
Y
Suzuki
Departments of Laboratory Medicine (S.A., A.D., H.Ma., H.Mi.), Rheumatology (S.S., Y.S.), Otolaryngology (K.O.), Critical Care and Emergency Medicine (K.U.), and Pathology (N.N.), Tokai University School of Medicine, Isehara, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Japan (N.T.).
Hayato
H
Miyachi
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013364:Submandibular Gland Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
D000893:Anti-Inflammatory Agents; D007074:Immunoglobulin G; D011239:Prednisolone
glucocorticoid; head and neck ultrasound; immunoglobulin G4–related disease; sonography; treatment response