肝脏炎性肌纤维母细胞瘤影像学表现与病理学对比研究

Hepatic Inflammatory Myofibroblastic Tumor:Comparative Study of Imaging Findings with Pathology

目的探讨肝脏炎性肌纤维母细胞瘤(hepatic inflammatory myofibroblastic tumor,HIMT)的CT、MRI表现,并与术后病理学改变进行对比,以加强对本病的认识,提高诊断准确率。方法回顾性分析9例经手术或穿刺活检病理证实的肝脏HIMT影像学表现与病理特点,9例均行CT平扫和增强多期扫描,其中4例同时行CT、MRI平扫和增强多期扫描。结果9例中8例为单发病灶,1例多发,共10个病灶,位于肝左叶2个,肝右叶8个。CT平扫:全部病例显示为低密度影;MRI平扫:T1WI为稍低信号(3例)、等或略低信号(1例),T2WI为高信号(2例)、等或稍高信号(2例);动态增强扫描表现:边缘强化5例,分隔强化2例,全瘤强化1例,无强化1例;除1例动脉期明显不均匀边缘强化,门静脉期和延迟期仍见强化,以及1例无强化外,其余7例动态增强均表现为动脉期未见明显强化,门静脉期轻度强化,延迟期强化较前明显。病理主要表现为不同程度的凝固性坏死、周边纤维组织包绕和炎症细胞浸润。结论肝脏HIMT影像表现具有一定的特征性,CT、MRI平扫及动态增强扫描能够反映HIMT血供特点和病理特征,结合临床可与肝内其它疾病鉴别。

Objective To investigate the CT and MRI findings of hepatic inflammatory myofibroblastic tumor （HIMT） and to improve the diagnostic accuracy.Methods The imaging findings and pathological features of 9 patients with HIMT confirmed by operation and biopsy pathological examination were reviewed retrospectively. All patients underwent both the plain and contrast enhanced CT scans; 2 patients underwent both CT and MRI examination.Results Eight patients had a single lesion, 1 patient had multiple lesions and a total of 10 lesions were found. Among them, one lesion was in the left lobe, 9 lesions were in the right lobe. On plain CT scan the lesion appeared as a hypo-dense mass. 2 of the lesions on MRI T1WI had a hypo-intense appearance, on T2WI it had a hyper-intense appearance and was iso-intense in appearance in 7 lesions. Upon contrast enhanced T1WI, 5 lesions demonstrated enhancement of the borders, intra-lesional septal enhancement was seen in 2 lesions and one of lesion had uniform enhancement. One of the lesions demonstrated complete lack of enhancement. One of the lesions had heterogeneous enhancement of the margins in the arterial phase while it demonstrated uniform enhancement in delayed and portal phase. One of the lesions had no enhancement in any phase. The remaining 7 lesions demonstrated no enhancement in arterial phase, minimal enhancement during the portal phase and had intense enhancement in delayed phase. On pathological examination the lesions demonstrated coagulative necrosis, the borders had plenty of fibrosis and plenty of inflammatory infiltrate.Conclusion HIMT has a characteristic appearance on imaging. CT and MRI appearance correlates with the lesions vascularity and pathological appearance. Clinical correlation can be helpful in differentiating it from other liver lesions.