Objectives

To recognise the multimodality imaging features of IgG4-related disease and gain an understanding of the spectrum of presentations in the hepatobiliary and gastrointestinal systems.

Appreciate the role of imaging in the diagnosis, management and monitoring response to therapy of this condition.

Recognise common mimics and potential pitfalls for the radiologist.

Background

IgG4-related disease is a relatively recently outlined autoimmune/allergic disorder characterised by multisystem fibro-inflammatory lesions rich in IgG4-positive plasma cells, usually associated with raised serum IgG4 levels. It is a multisystem disease with a plethora of imaging findings where it may commonly mimic neoplastic and other inflammatory conditions. In particular, the abdominal manifestations can present a diagnostic conundrum with most organs potentially being involved.

Imaging findings OR Procedure findings

We will discuss the multimodality imaging features of this condition across the spectrum of findings relevant to the gastrointestinal and hepatobiliary systems. These include pancreatitis (and its varying presentations), cholangiopathy, pseudo-tumours, gastric and bowel thickening, and retroperitoneal manifestations.

Cases include the use of ultrasound, CT, MRI, nuclear medicine studies and interventional radiology in the diagnosis and management of patients.

Discussion will include practical tips for diagnosis and management as well as common pitfalls.

Conclusion

IgG4-related disease and its spectrum of clinical and imaging manifestations in the hepatobiliary and gastrointestinal systems is being increasingly recognised. Radiologists should be aware of this systemic condition as it may mimic other, potentially more serious, conditions. It has an excellent response to therapy making a prompt diagnosis important to avoid unnecessary intervention. Imaging plays a pivotal role in the management and follow up.

Objectives

Be able to recognise the normal post-operative anatomical appearances of pancreatic grafts and differentiate this from abnormal appearances.

To be able to recognise post-operative complications, including vascular and parenchymal in both the early and late stages.

Background

Pancreas transplantation is currently the only treatment option available to cure type 1 diabetes mellitus. It is either performed as a stand-alone operation, or in conjunction with a simultaneous pancreas-kidney transplant.

Postoperative complications are common, with rates up to 55% documented in the literature and early detection of the complications by the radiologist is crucial for ensuring graft success.

Imaging findings OR Procedure findings

We present multiple key images from cases from our institution that display normal anatomical appearances of the pancreatic graft, in addition to both common and rare complications.

Conclusion

Many radiologists lack confidence in both the normal anatomical appearances and complications secondary to pancreatic transplantation.

It is important as radiologists to be able to detect early complications to aid the surgeons in ensuring graft success.