Imaging features of the lacrimal and salivary glands of patients with IgG4-related Mikulicz's disease: a report of three cases

We present ultrasonographic (US) and magnetic resonance (MR) imaging features of the lacrimal and salivary glands of three patients with IgG4-related Mikulicz's disease (IgG4-MD). US revealed punched-out, soap-bubble, or reticular patterns of parenchymal hypoechogenicity of the involved lacrimal, parotid, and submandibular glands. Conventional MR imaging features were less specific. However, apparent diffusion coefficients of many of the involved glands were reduced compared with healthy glands. We discuss possible histological changes in the affected glands that were attributable to the observed imaging features. We also discuss the differences in imaging features between IgG4-MD and Sjogren's syndrome (SS). We conclude that US may be a useful adjunct for diagnosing IgG4-MD and that MR sialography could effectively distinguish IgG4-MD from SS.