3.0T MRI对四肢神经鞘瘤的诊断价值(附12例报告)

Diagnostic Value of 3.0 T MRI in Nerve Sheath Tumor of Extremities: Report of 12 Cases

目的分析3.0 T MRI对四肢神经鞘瘤的诊断价值。方法回顾性分析12例经手术和病理证实的四肢神经鞘瘤病例资料,12例行MRI平扫,6例行MRI增强。总结四肢神经鞘瘤的MRI表现。结果病灶位于大腿5例,小腿后部1例,踝关节后部1例,前臂2例,肘部1例,上臂1例,手掌1例。单发10例,多发2例,12例共14个病灶。14个病灶均位于四肢肌间神经血管束走行区内,表现为沿神经干走行的梭形或椭圆形肿块(14/14),"靶征"(12/14),"神经出入征"(12/14),"脂肪分离征"及"脂肪尾征"(14/14)。T1WI病灶呈等或稍高信号。T2WI呈不均匀高信号,12个病灶见靶征。增强后4个病灶见靶征;2个病灶不均匀强化;1例呈环状强化。14个病灶均包膜完整。结论沿神经干走行的梭形或椭圆形肿块、"神经出入征"、"靶征"、"脂肪分离征"和"脂肪尾征"是MRI四肢神经鞘瘤的特征性表现,MRI对四肢神经鞘瘤的诊断和治疗具有重要价值,是四肢神经鞘瘤的首选检查方法。

Objective To investigate the diagnostic value of 3.0 T MRI in nerve sheath tumor of extremities. Methods A retrospectively study of the medical records of was performed in twelve patients with nerve sheath tumor of extremities proved by surgery and pathology. 12 patients underwent MRI plain scanning, of which 6 patients had contrast enhanced MRI scanning. The features of 12 patients were analyzed. Results The anatomic locations of 12 patients included thigh（ n = 5）, back of leg （ n = 1 ）, back of ankle （ n = 1 ）, forearm （ n = 2 ）, elbow （ n = 1 ）, upper arm （ n = 1 ）, palm （ n = 1 ）. The tumors were solitary in ten patients, two multiple. There were fourteen tumors in twelve patients. Fourteen tumors were lo-cated in neurovascular bundles extending along the nerve distribution. The tumors presented as spindle or ovoid masses （n = 14）, target signs （n = 12）, entering and exiting nerve signs （n = 12）, the split fat sign （n = 14） and fat tail sign （n = 14 ）. The tumors were iso - intense or slightly hyper - intense on T1 WI, heterogeneously hyper - intense on T2WI compared to the adjacent muscle. The target signs were seen in twelve tumors on T2WI. Four tumors target signs were found on con-trast-enhanced MRI, two tumors were heterogeneously enhanced, one tumor was circular enhanced. Fourteen tumors showed whole capsule. Conclusion Spindle or ovoid shape of the tumor extending along the nerve distribution, entering and exiting nerve sign, target sign, the split fat sign and fat tail sign are characteristic signs of nerve sheath tumor of ex-tremities. MRI can provide significant information for the diagnosis and treatment of the nerve sheath tumor of extremities. MRI is the preferred examination of the nerve sheath tumor of extremities.