肝脏炎性假瘤的影像表现与病理对照分析

Inflammatory pseudotumor of the liver:imaging findings with pathologic correlation

目的探讨肝脏炎性假瘤(IPL)的影像学表现及病理特点,提高对它的认识。方法回顾性分析经病理证实的19例IPL患者的影像学表现与病理特点。14例行CT检查,3例MRI检查,2例同时CT和MRI检查。结果 19例患者中多发病灶5例,收集29个病灶。位于肝右叶15例;CT平扫均为低或等密度;5例MRI检查,T1WI呈低信号,T2WI呈低或稍高信号;动态增强强化方式多样:周边小结节状或厚薄壁环形强化8例;病灶内分隔状或结节状强化3例;全瘤强化8例;16例动态增强表现为动脉期不同程度强化,门脉期及延迟期以延迟强化为主。所有病灶镜下均见纤维组织增生伴不同程度坏死、炎症细胞浸润。结论 CT和MRI可以提供IPL的诊断线索,其影像学表现多样与病灶的病理基础有关。如果临床怀疑,病理诊断是必须的。

Objective To evaluate the imaging findings and pathological basis of inflammatory pseudotumor of the liver （IPL） ,so as to improve understanding of it .Methods Nineteen patients with pathologically proven IPL were reviewed retrospectively .Three patients underwent MRI ,and the remaining 14 underwent CT ,and 2 underwent additional MRI . Results Five patients had multiple lesions and 14 had unique focus （total 29 lesions） .Fifteen patients were in right hepat‐ic lobe .All tumors were isodensity or hypodensity on non contrast CT .On MR imaging ,the lesions manifested hypoin‐tense on T1 WI and hypointensity or mild hyperintensity on T2 WI .The manifestations of enhancement were diverse in dy‐namic contrast scan .There were 8 peripheral enhancements with small nodular shaped or thick ,thin wall shaped ,3 central enhancements with septal or nodular ,8 entire tumor enhancements .The 16 cases were manifested as various degree of en‐hancements in the arterial phase ,and most of them demonstrated delayed enhancement in portal phase and delayed phase . Pathological examination all showed proliferous fibrous tissue with different degrees of organized necrosis and inflammatory cell infiltration .Conclusion CT and MR can provide clues to the diagnosis of IPT in patients with liver masses .The vari‐ous radiological features of IPL are correlated with its pathology .The clinician＇s suspicion and histological diagnosis are necessary to make an accurate diagnosis .