SCIENTIFIC ARTICLE Soft-tissue inflammatory myofibroblastic tumors (IMTs) of the limbs: potential and limits of diagnostic imaging Carlo Masciocchi & Giuseppe Lanni & Laura Conti & Armando Conchiglia & Eva Fascetti & Stefano Flamini & Gino Coletti & Antonio Barile Received: 21 April 2011 /Revised: 6 July 2011 /Accepted: 21 August 2011 # ISS 2011 Abstract Objective The objective of this work was to evaluate the potential of diagnostic imaging in the identification, localiza- tion, and characterization of soft-tissue inflammatory myofi- broblastic tumors (IMTs) of limbs with correlation to differential diagnosis and therapy. Materials and methods From a retrospective analysis of 324 histologically verified soft-tissue lesions of limbs and extrem- ities diagnosed in our institute from January 2002 to July 2010, we selected seven cases of histologically proven IMT. These included six males and one female, aged between 28 and 81 years (mean age, 57 years). Lesions were localized in three cases to the thigh, in two cases to the popliteal space, and in the remaining two cases, to the shoulder girdle. All patients were evaluated on the basis of US, CT, and MRI. Results Ultrasound detected the presence of a non- homogeneous solid formation in all cases and calcifications in three cases. CT showed the presence and type of calcification/ossification and bone reaction. On MRI, all cases had low signal intensity on SE T1-weighted sequences and an intermediate–low signal intensity on SE and FSE T2- weighted sequences in six of them; only one case had an intermediate–high signal intensity on SE and FSE T2- weighted sequences. Both contrast-enhanced CT and MRI showed precocious enhancement in association with multiple peripheral hypertrophic blood vessels. Conclusions On the basis of integrated imaging data obtained by US, CT, and MRI, it is possible to evaluate the lesion extension to provide a loco-regional staging, to characterize IMTs, and to allow an optimal therapeutical planning. Keywords Soft-tissue tumors . Inflammatory myofibroblastic tumors . Diagnostic imaging modalities . Ultrasound . Computed tomography . Magnetic resonance imaging Introduction Inflammatory myofibroblastic tumors (IMTs) or inflammatory pseudotumors include a heterogeneous group of lesions, first described in 1954 by Umiker [1], histologically characterized by a dominant spindle cell proliferation with a variable inflammatory and fibrotic component [2–8], and have been defined as inflammatory lesions [8–10]. The histological origin of IMTs is controversial and both diagnostic approaches and therapeutic strategies remain the subject of debate. As reported in the literature, IMTs most commonly occur in the lung and retroperitoneum [11–13]. However, other locations are observed causing serious diagnostic difficulties and, due to their locally aggressive nature, make for difficult therapeutic choices [14–17]. Little attention has been paid to IMTs’ localization in limbs and extremities [ 18, 19]. At these sites, the identification of an expansive lesion combined with locally C. Masciocchi : G. Lanni : L. Conti : A. Conchiglia : E. Fascetti : A. Barile (*) Department of Radiology, University of L ’Aquila, S. Salvatore Hospital, Coppito 67100 L ’Aquila, Italy e-mail: abarile63@me.com S. Flamini Department of Orthopaedic Surgery, S. Salvatore Hospital, Coppito, L ’Aquila, Italy G. Coletti Department of Pathology, S. Salvatore Hospital, Coppito, L ’Aquila, Italy Skeletal Radiol DOI 10.1007/s00256-011-1263-7