肝脏炎性肌纤维母细胞瘤组织学分型及应用CT、MRI诊断的价值

Histological classification of hepatic inflammatory myofibroblastoma and the value of CT and MRI diagnosis

目的分析肝脏炎性肌纤维母细胞瘤组织学分型,掌握其临床病理特征,探讨CT、MRI与病理检查的关系,提高临床肝脏炎性肌纤维母细胞瘤的诊断准确率,为临床治疗提供指导。方法选取我院2013年1月至2018年12月在我院接受治疗的15例肝脏炎性肌纤维母细胞瘤患者作为研究对象。15例均行CT平扫及增强扫描,其中7例同时行MRI平扫及增强扫描。观察肝脏肿块部位、形态、CT密度及增强表现、MRI密度及增强表现,以组织学病理检查结果为参照进行对比分析。结果所有患者中,单发病灶11例,多发病灶4例,总病灶15个,其中肝左叶3个,肝右叶12个。组织学分型:黄色肉芽肿型10例,浆细胞肉芽肿型4例,硬化型1例。黄色肉芽肿型10例:CT平扫低密度影8例,等密度影2例;4例MRI平扫T1WI稍低信号3例,等或略低信号1例,T2WI高信号3例,等或稍高信号1例;CT增强扫描动脉期明显强化12例,门静脉期轻度强化2例,平衡期轻度强化1例;MRI增强扫描动脉期强化0例,门静脉期轻度强化2例,平衡期轻度强化2例。浆细胞肉芽肿型4例:CT平扫低密度影3例,等密度影1例;2例MRI平扫T1WI稍低信号1例,等或略低信号1例,T2WI高信号2例;CT增强扫描动脉期无明显强化、门静脉期轻度强化、平衡期轻度强化各有0、12、3例,MRI增强扫描均呈壁结节强化。硬化型1例:CT平扫等、低混合密度影,MRI平扫T1WI等信号,T2WI高信号;CT增强动脉期无强化,门静脉期均匀强化,平衡期病灶密度减低,MRI增强动脉期无强化,门静脉期轻度强化,延迟期强化明显。结论肝脏炎性肌纤维母细胞瘤CT、MRI诊断对于组织学变化的特点可以较为清晰地反映出来,但对于不同类型的病变,鉴别诊断存在一定的难度,需要不断加以改进,进一步提高诊断的价值。

Objective To analyze the histological classification of hepatic inflammatory myofibroblastoma, master its clinical and pathological features, and to explore the relationship between CT and MRI and pathological examination, so as to improve the clinical diagnostic accuracy of hepatic inflammatory myofibroblastoma, then provide guidance for clinical treatment. Methods A total of 15 patients with hepatic inflammatory myofibroblastoma treated in our hospital from January 2013 to December 2018 were selected as the study objects. All 15 cases underwent CT plain scan and enhanced scan, while 7 cases underwent both MRI plain scan and enhanced scan. The location, shape, CT density and enhancement, MRI density and enhancement of liver masses were observed and compared with the results of histopathological examination. Results Among all the patients, there were 11 single lesions, 4 multiple lesions and 15 total lesions, including 3 in left lobes and 12 in right lobes. In the histological type: there were 10 cases of xanthogranuloma, 4 cases of plasma cell granuloma and 1 case of sclerosis. In the 10 cases of xanthogranulomatous type: 8 cases of low-density shadow and 2 cases of isodensity shadow on CT plain scan. In 4 cases, there were 3 cases with slightly low signal, 1 case with equal or slightly low signal on T1WI, 3 cases with high signal and 1 case with equal or slightly high signal on T2WI. Enhanced CT scan showed obvious enhancement in arterial phase in 12 cases, mild enhancement in portal vein phase in 2 cases, and mild enhancement in balanced phase in 1 case. Enhanced MRI scan showed, 0 cases had enhancement in arterial phase, 2 cases had mild enhancement in portal vein phase, and 2 cases had mild enhancement in balanced phase. In the 4 cases of plasmacytic granulomatous type: 3 cases of low density and 1 case of isodensity on CT plain scan. In MRI plain scan, 1 case had slightly low signal, 1 case had equal or slightly low signal on T1WI, and 2 cases had high signal on T2WI. Enhanced CT scan showed no obvious enhancement in arterial phase, slight enhancement in portal vein phase and slight enhancement in balanced phase in 0, 12 and 3 cases respectively, and enhanced MRI scan showed mural nodule enhancement in all cases. In the 1 case of sclerosis type: CT plain scan, equivalent and low mixed density image, MRI plain scan, T1WI equal signal, T2WI high signal. Enhanced CT arterial phase without enhancement, portal vein phase with uniform enhancement, balance phase with decreased focus density, enhanced MRI arterial phase without enhancement, portal vein phase with mild enhancement, delayed phase with obvious enhancement. Conclusion CT and MRI diagnosis of hepatic inflammatory myofibroblastoma can clearly reflect the characteristics of histological changes, but for different types of lesions, differential diagnosis is difficult, and need to be improved continuously to further improve the diagnostic value.