腹盆腔内炎性肌纤维母细胞瘤CT/MRI表现(附8例报告并文献复习)

CT and MRI Manifestations of Abdominal and Pelvic Inflammatory Myofibroblastic Tumor(8 Cases Reported with Literature Review)

目的探讨腹盆腔炎性肌纤维母细胞瘤（IMT）的CT/MRI表现,提高对本病的认识。方法回顾性分析经手术病理证实的8例IMT患者的影像资料,其中7例行CT平扫＋增强扫描,1例同时行CT及MR平扫＋增强扫描。观察病灶部位、大小、密度或信号、形态、边界、转移及侵犯、强化特点。结果发生于小肠系膜3例,结肠系膜2例,膀胱2例,左腹腔内1例。肿瘤最大径1.7~13.6 cm。8例均呈等-低密度,1例膀胱IMT边缘见点状、条状钙化影,1例结肠系膜IMT前缘见气体影,1例左腹腔IMT后上缘见囊性低密度影。不规则形6例,椭圆形2例。边界清楚2例,模糊6例。1例小肠系膜IMT在T1WI上呈等-稍高信号,T2WI上呈稍高信号,DWI上呈高信号,ADC图为明显低信号。增强不均匀明显且持续强化8例,其中3例IMT见多发结节状强化影,1例呈多发环形强化,1例侵犯脾门、胰腺及横结肠,术后发生肝脏转移,门静脉右前上支见负影。结论小肠及结肠系膜不均匀明显且持续强化的肿块需要考虑IMT可能,但确诊有赖于病理证实。

Objective To analyze and study the CT and MRI manifestations of inflammatory myofibroblastic tumor（ IMT） of abdominal and pelvic cavity and improve the understanding ofthe disease. Methods Imaging information of 8IMT patients confirmed by surgery and pathology from 2009- 2014 are reviewed. 7 patients underwent plain and contrastenhanced CT scans. CT in combination with MR plain and enhanced scan were performed in 1 patient. Imaging feature including location,size,CT density / MR signal intensity,morphology,margin,metastasis and invasion,enhancement feature were evaluated. Results 3 were located in mesentery,2 in mesocolon,2 in bladder,1 in left abnominal cavity. The maximum diameter of tumor ranged from 1. 7cm to 13. 6cm. The intensity of 8 cases were all isointensity to hypointensity.Punctate and strip calcification is seen on the edge of 1 bladder IMT. Air shadowing was observed in the anterior portion of1 mesentery IMT. Cystic low density was displayed in the superoposterior margin of 1 left abdominal cavity IMT. The shapes of the lesions were irregular（ n = 6） and oval（ n = 2）. 2 cases displayed clear marginsand 6 cases were blur. The mesentery IMT showed isointensity and slight hyperintensity on T1-weighted image and slight hyperintensity on T2-weighted image. And high signal on DWI and obvious low signal on ADC. Heterogeneous,obvious and persistent enhancement was demonstrated on 8 cases after injection. Among them 3 cases showed multiple nodular enhancement and1 showed multiple ring enhancement. 1 invasts invasion of spleen,pancreas and transverse colon. Liver metastasis and filling defect shadow in the right anterior superior branch of portal vein were seen in the same case after operation. Conclusion When a mass from mesentery and mesocolon shows heterogeneous,obvious and persistent enhancement,one should consider the possibility of IMT. Ultimate diagnosis depends on pathology.