炎性肌纤维母细胞瘤的影像及病理对照分析

Imaging characteristics of inflammatory myofibroblastic tumor and correlation with pathology

目的:探讨炎性肌纤维母细胞瘤(IMT)的病理分型与CT、MRI特征性表现。方法:回顾性分析我院经手术病理证实的16例IMT患者的影像学资料,16例均行CT平扫及增强扫描,5例同时行MRI平扫及增强扫描,记录患者的一般临床资料、病理表现及基本影像学特征,比较不同病理分型的IMT影像形态学差异。结果:肺内、肝脏、胆囊、胃、腹腔及腹膜后区IMT各7例、3例、1例、1例、4例。病灶密度或信号多不均匀,5例伴少量点状钙化,出血及坏死少见。增强扫描胸部肿瘤表现为明显均匀强化,腹部肿瘤多表现为动脉期瘤内轻度片絮状强化,或边缘花环样明显强化,静脉期及延迟期强化范围持续扩大,强化程度无明显衰退。强化方式与瘤内组织成分比例有关,而恶性程度及预后转归与瘤细胞的核异型性有关。结论:IMT的影像表现具有特征性,CT能精准显示病灶的血供及解剖结构特征;MRI有助于评价病灶组成成分及预判病理分型。CT和MRI结合有利于提高IMT良恶性倾向诊断的符合率。

Objectives：To study the CT/MRI characteristics of inflammatory inflammatory myo fibroblastic tumor （IMT） and correlated with pathology. Methods：The imaging rnaterials of 16 cases with surgery and pathology proven IMT were retrospectively analyzed. All 16 cases underwent CT scanning, and 5 cases had MRI without and with contrast enhancement. The clinical materials,patholo gy and imaging findings were recorded and the differences of imaging features between different pa- thology types were compared. Results：The location of IMT was intra-pulmonary （n=7） ,liver （n：3）, gallbladder and stomach for one case each,intra-abdominal and retroperitoneal region （n=4）. Most of the lesions showed uneven either in density or signal intensity. Punctate calcifications could be revealed in 5 cases,hemorrhage and necrosis were not oftenly seen. Pulmonary IMT showed obvious homoge- nous enhancement on CT scan,while abdominal IMT showed slight fluffy enhancement or garland-like marked enhancement on arterial phase,and consistent enlargement of enhancement on venous phase as well as delayed phase with no obvious declination. The enhanced pattern was related with the intra-tu- moral components,while the grade of malignancy and prognosis depended on the degree of nuclear aty- pia. Conclusions：The imaging manifestations of IMT showed certain characteristics. CT provided pre- cise information of blood supply and accurate anatomical structural characteristics,while MRI is help- ful to evaluate the composition of tumor and to anticipate the pathology classification. CT in combina- tion with MRI provide helpful information to enhance the accuracy to judge the benign and malignancy tendency of IMT.