Therapeutic Response to Rituximab in IgG4-Related Hypophysitis Evidenced on 18F-FDG PET and MRI

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Abstract
Baseline 18F-FDG PET and MRI were performed in a patient with IgG4-related hypophysitis, showing a 15-mm hypervascular hypermetabolic lesion with sellar and suprasellar extension. Lack of response after 10 months of first-line corticosteroid therapy was demonstrated on both 18F-FDG PET and MRI. Three months later, after 2 injections of 1 g of rituximab associated with continued corticosteroid therapy, MRI showed substantial shrinkage of the pituitary lesion with minimal residual Gd enhancement, whereas 18F-FDG PET evidenced complete metabolic response. As such, joint 18F-FDG PET and MRI assessment during therapy may have a potential interest for treatment response evaluation in pituitary IgG4-related disease.

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