不典型外周神经鞘瘤的影像诊断

Imaging diagnosis of atypical peripheral schwannoma

目的探讨不典型神经鞘瘤的影像学特征,以提高诊断和鉴别诊断水平。方法回顾性分析2016年7月—2019年8月安徽省合肥市庐江县人民医院收治的17例经术后病理证实的不典型神经鞘瘤患者的MRI或CT检查结果,分析其影像学表现和特征。结果肿瘤位于腹膜后5例,四肢软组织4例,头颈颌面部4例,胃部、胸腹壁肌肉间隙各2例。1例为腹膜后囊性神经鞘瘤,CT表现囊壁强化及分隔强化;13例为实性病灶,MRI表现T1WI呈等或稍低信号,T2WI呈稍高信号,CT平扫呈稍低密度,CT、MRI增强扫描呈渐进性中度强化;1例恶性神经鞘瘤MRI表现厚壁囊实性病灶;2例良性神经鞘瘤,其中1例MRI呈不均匀囊实性结节,1例CT呈巨大肿块,实性部分呈结节样、斑片状状强化。结论认识到不典型神经鞘瘤影像学表现,可以提高神经鞘瘤诊断和鉴别诊断的准确率。

Objective To investigate the imaging features of atypical peripheral schwannoma in order to improve the capability of diagnosis and differential diagnosis.Methods Seventeen patients with postsurgically pathology-proved atypical schwannoma were included in the study.The MR and CT data were collected to analyze their features.Results The tumoral masses were located in retroperitoneal space(n=5),soft tissues of extremities(n=4),head and neck region(n=4),stomach(n=2)and intermuscular space in thoracic and abdominal wall(n=2),respectively.Except one case being diagnosed with malignant schwannoma in thigh,all were considered as benign.One case of retroperitoneal schwannoma presented as cystic lesion on CT,coupled with wall and septum enhancement.Thirteen cases of solid tumors presented as iso-or slight hypo-intensity on T1 WI,slight hyper-intensity on T2 WI,or slight low-density on CT,and as moderate gradual enhancement on enhanced CT and MRI.One malignant schwannoma featured as cystic-solid lesion with thickened wall on MRI.Of two benign schwannomas,one was as inhomogeneous cystic-solid lesion on MRI,and one as big mass,with tubular enhancement on CT.Conclusion Realizing the imaging features of atypical schwannoma can improve the accuracy of diagnosis and differential diagnosis.