CT findings of upper urinary tract lesions in IgG4-related disease: Comparison with urothelial carcinoma

Minobu Kamo, Taiki Nozaki, Natsuka Muraishi, Kazunori Hattori, Koyu Suzuki, Masato Okada, Jin Yamamura

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objective: IgG4-related disease is characterized by extensive infiltration of IgG4-positive plasma cells and fibrosis in various organs. The objective of this study is to investigate CT findings of IgG4-related lesions involving the upper urinary tract and compare them with those of urothelial carcinomas. Materials And Methods: This study reviewed pretreatment CT images of 13 consecutive patients with IgG4-related disease with upper urinary tract lesions and 80 consecutive patients with urothelial carcinomas. The findings assessed were laterality, location, growth pattern, margins, internal structure, presence of calcification and lipid component, enhancement pattern, and extraurinary findings. Results: Bilaterality (p < 0.0001), an extramural growth pattern (p < 0.0001), a greater number of affected segments (p = 0.04), and a gradual dynamic enhancement pattern (p < 0.001) were significantly more frequent in patients with IgG4-related disease. With regard to extraurinary findings, paraaortic fat stranding (p = 0.03), presacral fat stranding (p < 0.001), fat stranding of the pelvic walls (p < 0.001), and aortic involvement (p < 0.001) were seen more frequently in patients with IgG4-related disease; on the other hand, there was no statistically significant difference in terms of frequency of pancreatic involvement. Hydronephrosis and renal involvement were seen more frequently in patients with urothelial carcinoma, although the difference was not statistically significant. Conclusion: CT findings suggestive of IgG4-related upper urinary tract lesions in comparison with urothelial carcinoma are bilateral and have a longer urinary tract involvement and exhibit an extramural growth pattern, ill-defined margins, a gradual enhancement pattern, aortic involvement, and fat stranding in the paraaortic, presacral, or pelvic wall areas.

Original languageEnglish
Pages (from-to)406-412
Number of pages7
JournalAmerican Journal of Roentgenology
Issue number2
Publication statusPublished - 2020 Aug
Externally publishedYes


  • IgG4-related disease
  • Pancreatitis
  • Spiral CT
  • Ureteral neoplasms
  • Urinary tract

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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