症例2の回答 55歳男性 体重減少、心窩部痛、１ヶ月前頃より上腹部のつかえ感あり腹部膨満感自覚。５日で５キロの体重減少あり
Key words: AIP, autoimmune pancreatitis, 自己免疫性膵炎、IgG4関連疾患、IgG4-related sclerosing disease, IgG4-related sclerosing cholangitis, IgG4関連硬化性胆管炎、IgG4-related sclerosing sialadenitis, IgG4関連唾液腺炎、Mikulicz diasese, ミクリッツ病, IgG4, steroid, ステロイド
参考文献
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・Sahani DV, et al. Autoimmune pancreatitis: Imaging features. Radiology 2004; 233:345-352
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・Manfredi R, et al. Autoimmune pancreatitis: CT patterns and their changes after steroid treatment. Radiology 247; 435-443
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・Irie H, et al. Autoimmune pancreatitis: CT and MR characteristics. AJR 1998; 170:1323-1327
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・Park SJ, et al. Clinical characteristics, recurrence features, and treatment outcomes 55 patients with autoimmune pancreatitis. Korean J Gastroenterl. 2008;52:230-246
・Suga K, et al. F-18 FDG PET-CT findings in Mikulicz diseaase and systemic involvement of IgG4-related lesions. Clin Nucl Med. 2009; 34:164-167
・Kim KP, et al. Autoimmune chronic pancreatitis. Am J Gastroenterol 2004;99:1605-1616
・Park SJ, et al. Clinical characteristics, recurrence features, and treatment outcomes 55 patients with autoimmune pancreatitis. Korean J Gastroenterl. 2008;52:230-246
・Suga K, et al. F-18 FDG PET-CT findings in Mikulicz diseaase and systemic involvement of IgG4-related lesions. Clin Nucl Med. 2009; 34:164-167
・Taniguchi T, et al. Diffusion-weighted magnetic resonance imaging in autoimmune pancreatitis. Jpn J Radiol. 2009;27:138-42. Epub 2009 May 3.
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この文献より限局型PKとAIP鑑別のためのダイナミック造影パターンのFig1の図を以下に引用。
上記左図Ａは、正常膵とＡＩＰのダイナミックパターンの比較
四角が正常、丸がＡＩＰです。
四角の正常に比較してＡＩＰは膵実質相の濃染が悪く
肝実質相（門脈相）では両者に濃染の差はありません。
上記右図Ｂは、ＰＫとＡＩＰのダイナミックパターンの比較
丸がＡＩＰ、四角がＰＫです。
ＡＩＰは肝実質相にかけて濃染が高まりますが、
ＰＫは肝実質相でも濃染不良となっています。
つまり、一言でいえば、ＡＩＰは、
「膵実質相では濃染が遅延するが肝実質相では正常と変わらない」
となります。
by イチロウ の補足解説でした。