肝炎性肌纤维母细胞瘤的MRI及CT表现  

CT and MRI Findings of Hepatic Inflammatory Myofibroblastic Tumor

作　　者：杨倩 张水霞 聂婷婷 刘玉林[1] YANG Qian;ZHANG Shuixia;NIE Tingting(Department of Radilogy,Hubei Cancer Hospital,Wuhan,Hubei Province 430079,P.R.China)

机构地区：[1]湖北省肿瘤医院放射科,武汉430079

出　　处：《临床放射学杂志》2022年第12期2241-2245,共5页Journal of Clinical Radiology

摘　　要：目的探讨MRI、CT对肝脏炎性肌纤维母细胞瘤(IMT)的诊断价值。方法回顾性分析15例经病理证实为肝脏IMT的病例资料、影像学检查结果,分析其MRI、CT检查图像,讨论并总结肝脏IMT的影像学表现及特点,尤其是病灶的强化特点。结果15例患者,其典型的病理学表现为以浆细胞为主导的炎性细胞浸润及梭形细胞增生。免疫组织化学分析显示抗平滑肌肌动蛋白抗体阳性,提示上述梭形细胞为肌成纤维细胞。所有患者行MRI、CT检查,共发现31处病灶(其中4例多发)。所有病灶均位于肝脏边缘或包膜下。病灶形态多不规则,基本显示为结节或肿块状(12例),少数呈斑片状并合并胆管扩张(3例)。CT平扫大部分为低密度影,少数为等密度影;MRI病灶呈T_(1)WI低信号、T_(2)WI高信号(15例),信号强度可均匀亦可不均匀,边界不清,病灶中心可见显著的T_(1)WI低信号、T_(2)WI高信号(3例),提示为中心坏死区,部分病灶周边可见显著的T_(1)WI低信号、T_(2)WI“壳状”高信号(3例)。增强扫描动脉期通常无明显强化或轻度强化,根据门静脉期、延迟期病灶强化方式,表现无明显强化(3例)、周边环形强化(3例)、中心强化(3例)、分隔状强化(2例)、整体强化(4例);门静脉期病变内部有门静脉分支穿过(5例);强化特点为渐进性强化或持续强化及延迟强化(15例)。结论病灶位于肝脏边缘或包膜下,强化方式具有一定特征性,尤其是病灶边缘显著的延迟期强化,门静脉期病变内部有门静脉分支穿过,对于肝脏IMT的诊断及鉴别诊断具有一定的价值。Objective Evaluating the role of MRI and CT in diagnosing hepatic inflammatory myofibroblastic tumor(HIMT).Methods Clinic and imaging data of 15 patients with HIMT confirmed by histopathology were retrospectively analyzed.The imaging characteristics of HIMT were summarized and the enhancement features of HIMT lesions on CT or MRI were especially extracted.Results 31 lesions were found in 15 patients,4 of them contains multiple lesions.All lesions locate on the edge of liver or under hepatic capsule.The shapes were irregular for most lesions.Most lesions were in the form of nodule or mass,3 lesions were in the form of patchy with biliary dilatation.Most lesions showed low density of CT,only few lesions showed isodense on CT.All lesions showed T_(1)WI hypointensity and T_(2)WI hyperintensity.Among them,3 lesions had lower T_(1)WI and higher T_(2)WI in their center,indicating necrosis there.Besides that,3 lesions had lower T_(1)WI and higher T_(2)WI on their edge.In arterial phase,the lesions showed no enhancement or mild enhancement.The enhancement in portal phase and delayed phase can be classified into the following types:no obvious enhancement(3 cases),ring-enhancement(3 cases),center-enhancement(3 cases),grid-enhancement(2 cases),whole enhancement(4 cases).Branches of portal vein through lesion were found in 5 cases.In general,the lesions showed progressive enhancement,continuous enhancement or delayed enhancement.Conclusion Locating on the edge of liver or under hepatic capsule,significantly delayed enhancement,and branch of portal vein going through the lesion,these finding can provide helpful information for the diagnosis and differential diagnosis of HIMT.

关 键 词：肝脏 炎性肌纤维母细胞瘤 磁共振成像 体层摄影术 X线计算机 

分 类 号：R735.7[医药卫生—肿瘤]