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Abstract Number: 1286

Inflammatory Activity of IgG4-Related Disease Lesions Assessed By Quantitative Positron Emission Tomography Correlates with Circulating Plasmablasts Levels

Alvise Berti1, Carla Canevari2, Francesca Gallivanone3, Marco Lanzillotta4, Emanuele Bozzalla Cassione4, Corrado Campochiaro5, Giuseppe Alvise Ramirez4, Maria Grazia Sabbadini4 and Emanuel Della Torre4, 1Internal Medicine and Clinical Immunology, Vita-Salute San Raffaele University, Milan, Italy, 2Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy, 3Consiglio Nazionale delle Ricerche, IBFM, Milan, Italy, 4Unit of Medicine and Clinical Immunology, San Raffaele Scientific Institute, Milan, Italy, 5San Raffaele Scientific Institute, Milan, Italy

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Diagnostic imaging, IgG4 Related Disease, inflammation and positron emission tomography (PET), Plasmablasts

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Session Information

Date: Monday, November 14, 2016

Title: Imaging of Rheumatic Diseases - Poster II: XR/CT/PET/MRI

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:  IgG4-Related Disease (IgG4-RD) is a multisystemic inflammatory disease characterized by fibrous swelling and IgG4+ plasma cells infiltration of affected organs.18-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan is emerging as a promising imaging technique for diagnosis and staging of IgG4-RD. We aim to correlate the intensity and distribution of FDG-PET uptake with clinical and immunological parameters in patients with active untreated IgG4-RD.

Methods:  Patients with active, untreated, biopsy proven IgG4-RD were included in the study. Disease activity was assessed through clinical (IgG4-RD Responder Index (RI)) and immunological (erythrocyte sedimentation rate (ESR), C reactive protein (CRP), serum IgG4, and circulating plasmablasts) parameters. Plasmablasts, a recently characterized disease biomarker, were identified as CD19+CD20-CD27+CD38bright cells on flow cytometry. FDG-PET/CT was performed in all patients at diagnosis. Quantitative assessment of FDG uptake was measured using the mean Standardized Uptake Value corrected for the Partial Volume Effect (PVC-SUV) and with total lesion glycolysis (TLG). Lymph nodes < 1 cm of diameter were excluded from the analysis because of the risk of PVC-SUV over/under-estimation. In patients with multiorgan involvement, the IgG4-RD lesion with the highest PVC-SUV was selected to correlate FGD uptake with clinical and serological parameters.

Results:  We studied 19 patients (12 males, 7 females) with a mean age of 61 years (range, 30-78 years). Eleven (58%) patients had multiorgan IgG4-RD, with a average number of organ affected of 2.2 (range, 1-6). Involved organs were: lymphnodes (8 patients), aorta (6 patients), pancreas (4 patients); lung, parotids and submandibolar glands (3 cases each), paranasal sinuses, palate, orbits, bones and lachrymal glands (2 cases each); meninges, thyroid, subcutaneous nodule and spleen (one case each). The median IgG4-RD RI was 6 (range 6-15; normal < 3). The median levels of ESR, CRP, serum IgG4 and plasmablasts at baseline were 30 mm/h (range 4-121 mm/h, normal <20 mm/h), 9,9 mg/L (range 0.0-48.0 mg/L; normal <6mg/L), 455 mg/dL (range 80-2100 mg/dL, normal <135 mg/dL), and 5365 cells/mL (range 130-40840 cells/mL, normal <650 cells/mL), respectively. The mean PCV-SUV was 10.36 (range, 2.78-39.34) and the mean TLG was 429.24 (range, 91.37-3479.65). Significant positive correlation was found between PVC-SUV and circulating plasmablasts levels (r=.46, p=.004). No statistically significant correlation was found between either PVC-SUV or TLG and CRP, ESR, serum IgG4 levels, IgG4-RD RI at baseline (p>.05), and not even between TLG and circulating plasmablasts (p>.05). 

Conclusion:  We first demonstrated a positive correlation between circulating plasmablasts and inflammatory activity of IgG4-RD lesions as assessed by PVC-SUV on FDG-PET. Inflammatory markers, serum IgG4 levels, and IgG4-RD RI do not appear to correlate with metabolic activity in IgG4-RD lesions. Our results further strengthen the utility of circulating plasmablasts as a biomarker of IgG4-RD activity.


Disclosure: A. Berti, None; C. Canevari, None; F. Gallivanone, None; M. Lanzillotta, None; E. Bozzalla Cassione, None; C. Campochiaro, None; G. A. Ramirez, None; M. G. Sabbadini, None; E. Della Torre, None.

To cite this abstract in AMA style:

Berti A, Canevari C, Gallivanone F, Lanzillotta M, Bozzalla Cassione E, Campochiaro C, Ramirez GA, Sabbadini MG, Della Torre E. Inflammatory Activity of IgG4-Related Disease Lesions Assessed By Quantitative Positron Emission Tomography Correlates with Circulating Plasmablasts Levels [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/inflammatory-activity-of-igg4-related-disease-lesions-assessed-by-quantitative-positron-emission-tomography-correlates-with-circulating-plasmablasts-levels/. Accessed .
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