良性和恶性神经鞘瘤的MRI影像学比较

The MR Imaging Comparison of Benign and Malignant Peripheral Nerve Sheath Tumour

目的:探究良性和恶性神经鞘瘤的核磁共振成像(MRI)影像学的异同。方法:回顾性分析南方医科大学第三附属医院和广州市第一人民医院2016年1月~2019年12月接诊的经病理检查证实的37例外周神经鞘瘤患者的临床MRI诊断资料,比较良性和恶性神经鞘瘤的MRI表现的差异。结果:分析MRI图像可知,恶性神经鞘瘤的边界不清晰,T2W1呈现混杂信号、T1W1呈现低混杂信号,囊变区的T2W1呈现高信号,信号不均匀,出现坏死和囊变;良性神经鞘瘤的边界清晰,T1和T2信号均较均匀,囊变区无较强的信号,肿瘤块较大的良性神经鞘瘤患者会出现囊变区信号。结论:良性神经鞘瘤的MRI表现为边界清楚,T2WI高信号T1WI低信号,T2W1上呈现薄的低信号边缘,而恶性与良性有明显的不同,一般呈现混杂信号,边缘不清晰,囊变区有信号指示等。良恶性神经鞘瘤的MRI表现能为临床诊断提供可靠的证据,有助于定性判断和早期治疗。

Objective:To evluate the similarities and differences of MRI imaging between benign and malignant nerve sheath tumour.Methods:Thirty-seven patients with malignant peripheral nerve sheath tumour confirmed by pathology in The Third Affiliated Hospital of Southern Medical University and Guangzhou First People’s Hospital from January 2016 to December 2019 were retrospectively analyzed.Results:By analyzing the MR images,malignant peripheral nerve sheath tumour showed obscure boundary, heterogeneous in T2 WI and T1 W1, necrosis and cyst which showed T2 hyperintense.However,the benign peripheral nerve sheath tumour are well-defined,homogeneity in T2 WI and T1 W1 and there is no strong signal in the cystic area. Patients with large benign peripheral nerve sheath tumour showed cyst.Conclusion:The MRI findings of benign peripheral nerve sheath tumour are well-defined,T2 hyperintense and T1 hypointense,a thin low signal in the high signal region on T2 WI.Malignant peripheral nerve sheath tumour are obviously different, which generally showed poorly-defined,heterogeneous in T1 WI and T2 WI, necrosis and cyst.The MRI features of benign and malignant schwannoma can provide reliable evidence for clinical diagnosis, which is helpful for qualitative judgment and early treatment.