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肝脏炎性肌纤维母细胞瘤影像学表现与病理学对比研究

作者:金 军1 汤小俐1 香 辉2 王小宜3

所属单位:1.中南大学湘雅二医院深圳医院(深圳市蛇口人民医院)放射科(广东 深圳 518067) 2.甘肃省兰州市西固区兰州石化总医院西区放射科(甘肃 兰州 730060) 3.中南大学湘雅医院放射科(湖南 长沙 410008)

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摘要

目的探讨肝脏炎性肌纤维 母细胞瘤 ( h e p a t i c i n f l a m m a t o r y myofibroblastic tumor,HIMT)的CT、MRI 表现, 并与术后病理学改变进行对比,以 加强对本病的认识,提高诊断准确率。方 法 回顾性分析9例经手术或穿刺活检病理 证实的肝脏HIMT影像学表现与病理特点, 9例均行CT平扫和增强多期扫描,其中4例 同时行CT、MRI平扫和增强多期扫描。结 果 9例中8例为单发病灶,1例多发,共10 个病灶,位于肝左叶2个,肝右叶8个。CT 平扫:全部病例显示为低密度影;MRI平 扫:T1WI为稍低信号(3例)、等或略低信 号(1例),T2WI为高信号(2例)、等或稍高 信号(2例);动态增强扫描表现:边缘强 化5例,分隔强化2例,全瘤强化1例,无 强化1例;除1例动脉期明显不均匀边缘强 化,门静脉期和延迟期仍见强化,以及1 例无强化外,其余7例动态增强均表现为动 脉期未见明显强化,门静脉期轻度强化,延 迟期强化较前明显。病理主要表现为不同 程度的凝固性坏死、周边纤维组织包绕和 炎症细胞浸润。结论 肝脏HIMT影像表现 具有一定的特征性, CT、MRI平扫及动态 增强扫描能够反映HIMT血供特点和病理特 征,结合临床可与肝内其它疾病鉴别。

Objective To investigate the CT and MRI findings of hepatic inflammatory myofibroblastic tumor (HIMT) and to improve the diagnostic accuracy. Methods The imaging findings and pathological features of 9 patients with HIMT confirmed by operation and biopsy pathological examination were reviewed retrospectively. All patients underwent both the plain and contrast enhanced CT scans; 2 patients underwent both CT and MRI examination. Results Eight patients had a single lesion, 1 patient had multiple lesions and a total of 10 lesions were found. Among them, one lesion was in the left lobe, 9 lesions were in the right lobe. On plain CT scan the lesion appeared as a hypo-dense mass. 2 of the lesions on MRI T1WI had a hypo-intense appearance, on T2WI it had a hyper-intense appearance and was iso-intense in appearance in 7 lesions. Upon contrast enhanced T1WI, 5 lesions demonstrated enhancement of the borders, intra-lesional septal enhancement was seen in 2 lesions and one of lesion had uniform enhancement. One of the lesions demonstrated complete lack of enhancement. One of the lesions had heterogeneous enhancement of the margins in the arterial phase while it demonstrated uniform enhancement in delayed and portal phase. One of the lesions had no enhancement in any phase. The remaining 7 lesions demonstrated no enhancement in arterial phase, minimal enhancement during the portal phase and had intense enhancement in delayed phase. On pathological examination the lesions demonstrated coagulative necrosis, the borders had plenty of fibrosis and plenty of inflammatory infiltrate. Conclusion HIMT has a characteristic appearance on imaging. CT and MRI appearance correlates with the lesions vascularity and pathological appearance. Clinical correlation can be helpful in differentiating it from other liver lesions.

【关键词】肝脏;炎性肌纤维母细胞瘤; 体层摄影术;X线计算机

【中图分类号】R735.7; R445.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2015.05.025

前言

炎性肌纤维母细胞瘤 ( i n f l a m m a t o r y m y o f i b r o b l a s t i c tumor,IMT)是一种少见的间叶性肿瘤,目前被认为是一种独立的组织 学类型,病理组织学上是由一种主要由分化的肌纤维母细胞性梭形细 胞组成、常伴有大量浆细胞和(或)淋巴细胞的少见肿瘤[1]。IMT好发部 位在肺部,发生于腹部脏器则较为罕见[2,3],笔者回顾性分析2010年3 月~2013年3月经穿刺活检或手术病理证实,并有完整CT、MRI检查资 料的9例HIMT病例,对其影像表现与病理特征进行对照分析,以提高对 本病影像表现的认识、从而提高诊断准确率。