29例头颈部炎性肌纤维母细胞肿瘤的CT及MRI影像学特征分析

doi:10.19438/j.cjoms.2022.05.014

摘要/Abstract

摘要： 目的: 探讨头颈部炎性肌纤维母细胞肿瘤 (inflammatory myofibroblastic tumor,IMT)的CT及MRI影像学特征,以提高该肿瘤的术前正确诊断。方法: 回顾性收集2012年1月——2018年12月上海交通大学医学院附属第九人民医院初诊并经术后病理检查证实的29例头颈部IMT患者,总结分析患者术前CT及MRI影像学表现。结果: 29例头颈部IMT患者中,67.0%（20/29）的患者术前被误诊为恶性肿瘤。头颈部IMT的影像学表现多样,局限性软组织内肿块7例,软组织肿块伴邻近骨质破坏12例（颞下窝5例,上颌窦6例,颌面部广泛软组织病变1例）,骨内肿块10例（上颌骨5例,下颌骨4例,颞骨1例）。89.7%（26/29）病灶边界不清楚;75.9%（22/29）病灶有骨质破坏,34.5%（10/29）病灶骨质破坏与骨质增生硬化并存。8例患者沿神经孔道侵犯邻近结构（6例发生于颞下窝,其中4例侵犯翼腭窝,沿圆孔、卵圆孔累及颅内,2例侵犯眶尖视神经管;2例发生于下颌骨,侵犯下颌神经管）。头颈部IMT在CT平扫时呈等或稍低密度, 未见钙化,增强扫描呈中度至明显强化。在MRI上,9例T1WI呈等或稍低信号;7例T2WI呈低信号;9例DWI呈高信号,ADC值约（0.6~1.0）×10^-3mm²/s。TIC曲线Ⅰ型7例,Ⅱ型2例。均未出现颈淋巴结及远处转移。结论: 头颈部IMT的影像学特征与恶性肿瘤相近,但骨质破坏的同时伴有骨质增生硬化,T2WI呈低信号,TIC曲线以Ⅰ型为主,极少发生颈淋巴结及远处转移。结合CT、MRI及功能学检查,可在一定程度上反映病灶的组织构成,为术前正确诊断提供重要依据。

关键词: 炎性肌纤维母细胞瘤, 头颈部, CT, 磁共振成像

Abstract: PURPOSE: To analyze the imaging features of inflammatory myofibroblastic tumor (IMT) in the head and neck through CT and MRI, and improve the correct diagnosis of the tumor before operation. METHODS: From January 2012 to December 2018, a total of 29 patients with IMT in the head and neck who were initially diagnosed and confirmed by postoperative pathology were retrospectively collected in Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. Their preoperative CT and MRI findings were analyzed. RESULTS: Of the 29 patients with IMT in the head and neck, 67.0%(20/29) were misdiagnosed as malignant tumors before operation. The imaging findings of IMT in the head and neck were varied, 7 cases were identified as localized soft tissue mass, 12 cases with soft tissue mass and adjacent bone destruction (5 in the infratemporal fossa, 6 in the maxillary sinus, 1 in the wide maxillofacial region), and 10 cases with intraosseous mass (5 in the maxilla, 4 in the mandible, 1 in the temporal bone). 89.7%（26/29）were presented as uneven margins. 75.9%（22/29）showed bone destruction, 34.5%（10/29）with hyperostosis and remodeling. Eight cases had a peri-neural infiltration(6 cases occurred in the infratemporal fossa, with 4 cases suffered from invasion through foramen rotundum and foramen ovale, 2 cases invaded the optic canal, 2 cases occurred in the mandible and invaded the mandibular nerve canal). The IMT in the head and neck showed isodense or slightly hypodense, with no calcification on CT plain scan, and moderate/marked enhancement after contrast-enhanced scanning. MRI showed 9 cases with isointense or hypointense on T1 weighted images, 7 cases with hypointense on T2 weighted images, 9 cases with hyperintense on DWI. The range of ADC value of IMT (9 cases) was about (0.6-1.0)×10^-3mm²/s. The TIC type of 7 cases was typeⅠ, and 2 cases with typeⅡ. There were no cervical lymph node metastasis and distant metastasis. CONCLUSIONS: IMT in the head and neck has certain imaging characteristics that are commonly found in malignant tumors. However, IMT in the head and neck can erode and remodel bone, with striped hypointense on T2 weighted image, mostly type I, few cervical lymph node metastasis and distant metastasis. CT, MRI and functional examination can reflect the tissue composition of the lesion to a certain extent, and provide an important basis for the correct preoperative diagnosis.

Key words: Inflammatory myofibroblastic tumor, Head and neck, CT, MR imaging

中图分类号:

R739.8

王灿, 张春叶, 陶晓峰, 王博成, 朱凌. 29例头颈部炎性肌纤维母细胞肿瘤的CT及MRI影像学特征分析[J]. 中国口腔颌面外科杂志, 2022, 20(5): 494-499.

WANG Can, ZHANG Chun-ye, TAO Xiao-feng, WANG Bo-cheng, ZHU Ling. CT and MRI features of 29 patients with inflammatory myofibroblastic tumor in the head and neck[J]. China J Oral Maxillofac Surg, 2022, 20(5): 494-499.

参考文献

[1] Park SB, Lee JH, Weon YC.Imaging findings of head and neck inflammatory pseudotumor[J]. AJR Am J Roentgenol, 2009,193(4):1180-1186.
[2] Yabuuchi H, Matsuo Y, Kamitani T, et al.Parotid gland tumors: can addition of diffusion weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization?[J]. Radiology, 2008, 249(3): 909-916.
[3] Yuan Y, Yue XH, Tao XF.The diagnostic value of dynamic contrast-enhanced MRI for thyroid tumors[J]. Eur J Radiol, 2012, 81(11): 3313-3318.
[4] Yuan Y, Kuai XP, Chen XS, et al.Assessment of dynamic contrast-enhanced magnetic resonance imaging in the differentiation of malignant from benign orbital masses[J]. Eur J Radiol, 2013, 82(9): 1506-1511.
[5] 朱岩,丁颖,宋国新,等.炎性肌纤维母细胞肿瘤临床病理学分析[J]. 中华病理学杂志,2021,50(3):194-200.
Zhu Y, Ding Y, Song GX, et al.Clinicopathological features of inflammatory myofibroblastic tumor[J]. Chinese Journal of Pathology, 2021,50(3):194-200.
[6] WHO Classification of Tumours Editorial Board. WHO classification of tumours. Soft tissue and bone tumours [M]. 5th ed. Lyon: IARC Press, 2020:109-111.
[7] Mariño-Enríquez A, Wang WL, Roy A, et al.Epithelioid inflammatory myofibroblastic sarcoma: an aggressive intra-abdominal variant of inflammatory myofibroblastic tumor with nuclear membrane or perinuclear ALK[J]. Am J Surg Pathol, 2011, 35(1): 135-144.
[8] Yu L, Liu J, Lao IW, et al.Epithelioid inflammatory myofibroblastic sarcoma: a clinicopathological, immunohistochemical and molecular cytogenetic analysis of five additional cases and review of the literature[J]. Diagn Pathol, 2016, 11(1): 67.
[9] Tao J, Zhou ML, Zhou SH.Inflammatory myofibroblastic tumors of the head and neck[J]. Int J Clin Exp Med, 2015, 8(2): 1604-1610.
[10] Ong HS, Ji T, Zhang CP, et al.Head and neck inflammatory myofibroblastic tumor(IMT): evaluation of clinicopathologic and prognostic features[J]. Oral Oncol, 2012, 48(2):141-148.
[11] 王丽,余梦菊,向之明,等.肺外炎性肌纤维母细胞瘤的影像学表现与病理对照[J].中华介入放射学电子杂志, 2014, 2(2): 50-53.
Wang L, Yu MJ, Xiang ZM, et al.Extrapulmonary inflammatory myofibroblastic tumor: comparation of CT and MRI findings and pathology[J]. Chinese Journal of Interventional Radiology (Electronic Edition), 2014, 2(2): 50-53.
[12] Surabhi VR, Chua S, Patel RP, et al.Inflammatory myofibroblastic tumors: current update[J]. Radiol Clin North Am, 2016, 54(3): 553-563.
[13] 陈兴明,高志强,姜鸿,等. 原发于眶外的头颈部炎性肌纤维母细胞瘤14例临床分析[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(4): 307-310.
Chen XM, Gao ZQ, Jiang H, et al.Clinical analysis of 14 patients with extraorbital inflammatory myofibroblastic tumor of the head and neck[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2013, 48(4): 307-310.
[14] Kandukuri R, Phatak S. Evaluation of sinonasal diseases by computed tomography[J]. J Clin Diagn Res, 2016, 10(11): TC09-TC12.
[15] De Vuysere S, Hermans R, Sciot R, et al.Extraorbital inflammatory pseudotumor of the head and neck: CT and MR findings in three patients[J]. AJNR Am J Neuroradiol, 1999, 20(6): 1133-1139.
[16] George V, Tammisetti VS, Surabhi VR, et al.Chronic fibrosing conditions in abdominal imaging[J]. Radiographics, 2013, 33(4): 1053-1080.
[17] Agrons GA, Rosado-de-Christenson ML, Kirejczyk WM, et al. Pulmonary inflammatory pseudotumor: radiologic features[J]. Radiology, 1998, 206(2): 511-518.
[18] Patankar T, Prasad S, Shenoy A, et al.Pulmonary inflammatory pseudotumour in children[J]. Australas Radiol, 2000, 44(3): 318-320.
[19] 邓德茂, 孟悛非, 杨峥, 等. 软组织炎性成肌纤维细胞瘤的MRI表现[J]. 中华放射学杂志, 2008,42(5):507-511.
Deng DM, Meng JF, Yang Z, et al.MRI findings of inflammatory myofibroblastic tumor of the soft tissue[J]. Chinese Journal of Radiology, 2008,42(5):507-511.
[20] Kim JH, Chang KH, Na DG, et al.Imaging features of meningeal inflammatory myofibroblastic tumor[J]. AJNR Am J Neuroradiol, 2009, 30(6): 1261-1267.
[21] McKinney AM, Short J, Lucato L, et al. Inflammatory myofibroblastic tumor of the orbit with associated enhancement of the meninges and multiple cranial nerves[J]. AJNR Am J Neuroradiol, 2006, 27(10): 2217-2220.
[22] Lee EJ, Jung SL, Kim BS, et al.MR imaging of orbital inflammatory pseudotumors with extraorbital extension[J]. Korean J Radiol, 2005, 6(2): 82-88.
[23] Pire A, Orbach D, Galmiche L, et al.Clinical, pathologic, and molecular features of inflammatory myofibroblastic tumors in children and adolescents[J]. Pediatr Blood Cancer, 2022, 69(5): e29460.
[24] Lee YY, Wong KT, King AD, et al.Imaging of salivary gland tumours[J]. Eur J Radiol, 2008, 66(3): 419-436.
[25] Christe A, Waldherr C, Hallett R, et al.MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease[J]. AJNR Am J Neuroradiol, 2011, 32(7): 1202-1207.