脊柱区神经节细胞瘤的影像表现及与神经鞘瘤的鉴别诊断

Imaging Appearances of Spinal Ganglioneuroma and Distinguishing with Schwannoma

目的探讨脊柱区神经节细胞瘤(GN)的影像表现并与神经鞘瘤的影像表现进行对照分析,分析二者的鉴别点。方法对22例临床病理确诊的位于脊柱区的GN和31例神经鞘瘤的影像表现进行回顾性分析并对二者进行鉴别。结果 22例GN中11例位于颈段,3例位于颈胸段,5例位于胸段,3例位于腰骶段,其中5例位于椎旁,12例位于椎管内硬膜下,5例位于椎间孔区;4例为多发病变,5例双侧神经根对称性增粗;肿瘤边界均相对清晰,7例呈哑铃形,4例呈椭圆形,6例病变呈梭形,5例不规则;16例伴椎间孔扩大,1例伴骨质破坏;T_2WI呈等低信号2例,高信号4例,混杂信号16例;增强扫描GN呈轻度强化2例,中等强化9例,明显强化11例。GN与神经鞘瘤在骨质破坏及强化程度上有统计学差异。结论脊柱区的GN以颈段相对多见,可位于椎旁、椎管内硬膜下或椎间孔区;可单发或多发,可伴椎间孔扩大。强化程度及是否合并骨破坏与神经鞘瘤有鉴别诊断意义。

Objective To explore imaging appearance of ganglioneuroma and compare it with schwannoma. Methods To retrospectively analyze imaging appearances of 22 cases with clinically and pathologically confirmed GN. Results Of the 22 GN, eleven eases were located in cervical segments, 3 located in cervical-thoracial segments, 5 located in thoracic segments and 3 located in lumbar-sacrum. Five cases were located in the paraspinal area, 12 located intradural and 5 located in the intervertebral foramen. Four cases were shown as multiple lesions and 5 cases had bilateral symmetrical nerve thickening. The boundary of GNS were clear and 7 cases were dumbbell ,4 eases were ovoid ,6 cases were fusiform and five eases had irregular shapes. Enlarged vertebral foramina were seen in 16 cases and one with bone destruction. GNs were shown to be iso or low signal（2 eases） ,high signal （4 cases）or heterogenous signal（ 16 cases）. On post-contrast imaging two tumors were mildly, 9 moderately and 11 significantly enhanced. GN and schwannoma were significant in bone destruction and extent of enhancement . Conclusion Spinal GNs were mainly located in the cervical segment and may be located in the paraspinal area,intraspinal or intervertebral foramen; It may be solidary or multiple and may exhibit enlargement of intervertebral foramina. GN and sehwannoma were significantly different in enhancement and bone destruction.