儿童腹部炎性肌纤维母细胞瘤磁共振影像表现及鉴别诊断

Differential diagnosis of MRI for inflammatory myofibroblastoma tumor of abdomen in children

目的回顾分析5例儿童腹部炎性肌纤维母细胞瘤磁共振成像(MRI)影像学表现,以提高对本病MRI影像诊断认识。方法收集包头市第四医院2012年1月至2019年8月经手术及病理检查确诊的5例儿童炎性肌纤维母细胞瘤(IMT)患者的MRI影像资料及临床资料。结果本组5例炎性肌纤维母细胞瘤1例盆腔、1例腹膜后、1例空肠系膜病变边界清楚,肿块均为T1WI呈等略低信号为主,T2WI呈高低混杂信号,边缘可见低信号环,DWI呈高低混杂信号,表观扩散系数(ADC)值略低,2例行增强患者增强后示肿块呈渐进性明显不均匀强化,边缘强化为著,部分肿瘤内部可见不强化囊变区。肝脏2例平扫呈实性,边界清楚,呈圆形或类圆形,肿块均为T1WI呈略低信号,T2WI呈稍高信号,扩散加权成像(DWI)呈高低混杂信号,ADC值略低;增强后呈渐进性不均匀强化。结论儿童腹部IMT的临床症状不典型,IMT的MRI表现具有一定特征性,腹腔占位呈实性或囊实性包块,边界较清,DWI呈稍高信号,增强后渐进性强化,鉴别诊断应考虑IMT的可能性,但确诊依赖于病理及免疫组织化学检查。

Objective To retrospectively analyze the MRI imaging features of 5 cases of inflammatory myofibroblastoma tumor(IMT)of abdomen in children,so as to improve the diagnosis of this disease.Methods Five cases of inflammatory myofibroblastoma tumor in children diagnosed by operation and pathology in Baotou Children′s Hospital from January 2012 to August 2019 were collected.Results There were 5 cases of inflammatory myofibroblastoma tumor,1 case of pelvic,1 case of retroperitoneal and 1 case of mesenteric lesion with clear margin.The tumors were mainly iso-low signal on T1WI,mixed signal on T2WI,low signal ring on the margin,mixed signal on DWI,low ADC value,and progressive mass on 2 cases of enhanced myofibroblastoma.Sex showed marked heterogeneous enhancement,margin enhancement was prominent,and some of the tumors showed non-enhanced cystic degeneration areas.Two cases of liver showed solid,clear margin,round or quasi-circular on plain scan,slightly low signal on T1WI,slightly high signal on T2WI,mixed signal on DWI,slightly low ADC value,and gradual heterogeneous enhancement.Conclusion The clinical symptoms of abdominal IMT in children are atypical.The MRI manifestations of IMT are characteristic.The abdominal mass is solid or cystic,the boundary is clear,and the DWI is slightly high signal.The possibility of IMT should be considered in differential diagnosis,but the diagnosis depends on pathological and immunohistochemical examination.