炎性肌纤维母细胞瘤的影像表现与病理分析

The Radiology Feathers and Pathological Analysis of Iflammatory Myofibroblastic Tumor

目的分析炎性肌纤维母细胞瘤(IMT)的影像表现。方法回顾性分析经手术病理证实的IMT患者(n=11)的临床、影像及病理资料,含CT平扫(n=2)、CT增强(n=1)、CT平扫增强(n=6)、MRI平扫增强(n=2),探讨影像与病理特征的关系。结果 IMT均单发,边界清晰3例、不清8例(1例侵犯左肾),囊实性6例、实性5例。实性部分呈平扫稍低密度、"慢进慢出"样强化为主,囊性部分呈平扫低密度且无强化,并见囊壁规则环形线状强化(n=1)、边缘动脉期显著强化结节(n=1)、内部强化血管影(n=1)及"血管抱球征"(n=2)。T1WI呈等或稍低信号,T2WI、DWI呈稍高信号,增强扫描呈渐进性不均匀强化并小囊变、小网膜囊积液(n=1)或均匀中度强化(n=1)。免疫组化为Vim(+)(n=6),ALK(+)(n=4),Ki76 1%-20%。结论 IMT缺乏典型临床影像特征,瘤周炎性浸润、"慢进慢出"强化及纤维组织密度或信号对诊断有重要提示价值。IMT的影像表现与ALK、Ki67可能存在某些相关性。

Objective To analyze imaging characteristics of inflammatory myofibroblastic tumor（ IMT） and to improve diagnosistic capacity. Methods The clinical and radiological matericals of patients（ n = 11） confirmed surgically and pathologically were analyzed retrospectively,and the correlations between radiology and pathology were discussed. Of all patients,CT pain scan（ n = 2）,CT enchanced（ n = 1）,CT pain and enchanced（ n = 6）,MRI pian and enchanced（ n = 2）,immunohistochemistry（ n= 6） were performed. Results All of the cases were singal lesion with Well-defined and ill-defined cases of 3 and 8（ 1 case with left kidney invasion） respectively. Mixed cystic or solid（ n = 6） and pure solid（ n = 5） IMT showed slightly low density mainly with slowly-in and out enchancement of solid margin and low density of cystic without enchancement,combing with cystic wall regularly liner enchancement（ n = 1）,marginal nodules obviously enchanced in arterial phase（ n = 1）,interner multiple blood vessels（ n = 1）,ball-holding sign（ n = 2）. On MRI,the masses revialed isointensity or slightly hypointensity on T1 WI,slightly hyperintensity on T2 WI and DWI,heterogenerously and progressively enchanced,combining with small cystics,omental bursa cyst（ n =1）,and homogenous moderately nchanced（ n = 1）. Immunohistochemistry revialed that the number of Vim（ ＋）,ALK（ ＋） cases was 6,4,respectively,Ki67 ranged from 1% - 20%. Conclusion The clinical and raodiology manifestation of IMT may not so characterized,but signs such as inflammatory infltration,slowly-in and out enchancement,fibrous density or singal,may show important value on diagnosing. Besides,the radiology feathers of IMT may correlate with Alk and Ki67.