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. 2019 May;14(1):110-115.
doi: 10.2185/jrm.2974. Epub 2019 May 30.

Autoimmune pancreatitis with spontaneous remission on 18F-fluorodeoxyglucose positron emission tomography/computed tomography

Yoshiro Kusano  1
Affiliations

Autoimmune pancreatitis with spontaneous remission on 18F-fluorodeoxyglucose positron emission tomography/computed tomography

Yoshiro Kusano. J Rural Med. 2019 May.

Abstract

A 79-year-old man with elevated blood glucose was started on insulin therapy. IgG4 was as high as 1,830 mg/dL, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) confirmed diffuse pancreatic enlargement and accumulation of FDG. Based on the above, autoimmune pancreatitis (AIP) was diagnosed, but steroid treatment was not performed. IgG4 later declined, and FDG accumulation in the pancreas disappeared on FDG-PET/CT at the age of 83 years. AIP was thought to have gradually remitted spontaneously over time. FDG-PET/CT is useful for evaluating AIP activity.

Keywords: FDG-PET/CT; IgG4; autoimmune pancreatitis; diabetes.

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Conflict of interest statement

The author reports no conflict of interest.

Figures

Figure 1
Figure 1
Changes in abdominal CT and MRCP findings. a. At the age of 73 (traffic accident): There is no pancreas swelling (arrow). b. At the age of 79 (at the time of admission): Diffuse pancreatic swelling (arrow). c. At the age of 79 (when admitted) MRCP: The main pancreatic duct is unclear at the head of the pancreas, but is normal at the tail (arrow). The bile duct system is of normal thickness, but narrows at the area penetrating the pancreatic head (arrow). d. At the age of 83: Pancreatic swelling had reduced and improved (arrow).
Figure 2
Figure 2
Changes on FDG-PET and FDG-PET/CT. a, b. At the age of 79: Diffuse pancreatic enlargement is observed, and FDG accumulation with an SUV max of 5.4 to 7.2 is observed. Right subclavian, abdominal periaortic, subdiaphragmatic, iliac, and inguinal lymph nodes are also enlarged, and show FDG accumulation. c, d. At the age of 83: Cervical, subclavian, mediastinal, abdominal aortic, pelvic, and inguinal lymph node enlargement and accumulation of FDG were also observed, but accumulation of FDG in the pancreas disappeared.
Figure 3
Figure 3
Total insulin dose and changes in blood CPR, IgG4, and HbA1c. olid line: IgG4, broken line: HbA1c.
See this image and copyright information in PMC

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