脊柱区良恶性神经鞘瘤的影像表现及鉴别诊断

Imaging Appearances of Benign and Malignant Schwannoma of Spine and Differential Diagnosis

目的探讨脊柱区良恶性神经鞘瘤的影像表现,以提高对此类肿瘤的认识。方法对21例临床病理确诊的神经鞘瘤和16例恶性外周神经鞘瘤(MPNST)的影像表现进行对比分析并对影像特点采用非参数检验进行统计分析。结果 21例神经鞘瘤和16例MPNST分别位于颈椎(12例,57.1%;9例,56.3%)、胸椎(5例,23.8%;2例,12.5%)和腰骶椎(4例,19%;5例,31.3%);21例神经鞘瘤均伴骨破坏,19例边界清晰,14例伴硬化边形成,19例伴骶孔或椎间孔扩大;16例MPNST中13例伴骨破坏,4例边界清晰,2例伴硬化边,8例伴骶孔或椎间孔扩大;二组肿瘤在边界(χ~2=4.7,P=0.001)、硬化边(χ~2=10.9,P=0.001)、骶孔或椎间孔扩大(χ~2=7.5,P=0.006)存在统计学差异;MRI信号及增强特点无统计学差异(P>0.05)。结论神经鞘瘤和MPNST均可伴骨破坏,其骨破坏特点存在一定差异;MRI信号及增强特点相似,对二者的鉴别诊断意义有限。

Objective To explore the imaging appearances of benign schwannoma and malignant peripheral nerve sheath tumor（ MPNST） and improve the awareness of these tumors. Methods Imaging data of 21 Schwannomas and 16 MPNSTS with clinical and pathological confirmation was retrospectively analyzed. The imaging characteristics were assessed with a nonparametric test. Results Twenty-one Schwannomas and 16 MPNSTS were located in the cervical spine（ 12,57. 1%; 9,56. 3%）,thoracic spine（ 5,23. 8%; 2,12. 5%） and lumbar and sacral spine（ 4,19%; 5,31. 3%）; Twenty-one Schwannomas caused bone destruction and 19 cases with clear rim,14 cases with sclerotic rim,19 with sacral or intervertebral foreman enlargement. Thirteen MPNSTS displayed bone destruction and 4 with clear rim,2 with sclerotic rim,8 with sacral or intervertebral foreman enlargement. There were significant differences between tumor boundary（ χ^2= 4. 7,P =0. 001）,sclerotic rim（ χ^2= 10. 9,P = 0. 001）,enlargement of sacral or intervertebral foramen（ χ^2= 7. 5,P = 0. 006）.There was no significant difference in MRI signal and enhancement characteritics（ P〈0. 05）. Conclusion Both Schwannoma and MPNST can lead to bone destruction and characteritics of bone destruction were different. MRI signal and enhancement were similar and have limited value in distinguishing these two tumors.