高频超声对正中神经纤维脂肪错构瘤的诊断价值

The value of high-frequency ultrasound in the diagnosis of fibrolipomatous hamartoma of median nerve

目的分析高频超声图像中正中神经纤维脂肪错构瘤的特征,探讨高频超声对神经纤维脂肪错构瘤的诊断价值。方法本文回顾性纳入了2017年1月~2021年12月浙江省宁波市第六医院就诊的8例正中神经纤维脂肪错构瘤患者。分析患者的临床表现及超声图像特征,并对国内外含有正中神经纤维脂肪错构瘤超声图像的文献进行复习,探讨高频超声在正中神经纤维脂肪错构瘤诊断中的价值。结果高频超声下8例中7例神经内部结构清晰可辨,横切面显示为神经束间有大量的高回声脂肪组织浸润,以强回声为主,点状低回声束均匀嵌入高回声脂肪组织中,呈“莲藕状”,纵切面超声显示条状低回声束与高回声脂肪组织束呈“索状”交替出现,呈“电缆状”。其余1例为非典型神经纤维脂肪错构瘤,整体呈不规则团块。所有患者各部位患侧正中神经均有增粗,以掌腕段最明显。临床表现单纯巨指畸形2例(25.0%),单纯肿块1例(12.5%),巨指畸形合并肿块1例(12.5%),肿块合并腕管综合征3例(37.5%),巨指畸形、肿块合并腕管综合征1例(12.5%)。在已报道文献中进行超声检查的神经纤维脂肪错构瘤患者共有9例,与核磁共振诊断吻合比例为100%。结合回顾性分析病例,超声诊断正中神经FHN结果与组织学诊断结果吻合率为90.9%。结论高频超声能够呈现出正中神经纤维脂肪错构瘤的特征性图像模式,具有与磁共振成像相同的诊断价值,并且对正中神经有更好的评估,为进一步临床诊疗提供更多有效信息。

Objective To analyze the characteristics of fibrolipomatous hamartoma of median nerve in high-frequency ultrasound images,and to explore the value of high-frequency ultrasound in the diagnosis of fibrolipomatous hamartoma of median nerve.Methods Eight patients with fibrolipomatous hamartoma of median nerve admitted to Ninbo No.6 Hospital from January 2017 to December 2021 were included in this retrospective study.The clinical manifestations and ultrasound features of the patients were analyzed.The literature reports containing ultrasound images of median nerve fibrolipoma hamartoma in China and abroad were reviewed to explore the value of high-frequency ultrasound in the diagnosis of median nerve fibrolipo-ma hamartoma.Results Among the 8 patients,7 patients'the internal structure of the nerve was clearly identified by highfrequency ultrasound.The transverse section showed a large number of hyperechoic adipose tissue infiltration between the nerve bundles,mainly hyperechoic.The punctate hypoechoic bundles were evenly embedded in the hyperechoic adipose tissue,which was“lotus root”like.The remaining one case was atypical type,which presented as an irregular mass.The median nerve on the affected side of all patients was enlarged in all parts,especially in the metacarpal segment.There were 2 cases(25.0%)of simple macrodactyly,1 case(12.5%)of simple mass,1 case(12.5%)of macrodactyly combined with mass,3 cases(37.5%)of mass combined with carpal tunnel syndrome,and 1 case(12.5%)of macrodactyly combined with mass combined with carpal tunnel syndrome.Carpal tunnel syndrome was related to age,course of disease and nerve cross-sectional area.A total of 20 patients with neurofibrolipoid hamartoma who underwent ultrasound examination were reported in the literature.The coincidence rate of ultrasound diagnosis and pathological diagnosis was 100.0%,and the coincidence rate of MRI diagnosis was 90.9%.Conclusion High-frequency ultrasound can show the characteristic image pattern of fibrolipomatous hamartoma of median nerve,which has the same diagnostic value as magnetic resonance imaging.High-frequency ultrasound has a better evaluation of the involved nerve,and provides more effective information for further clinical diagnosis and treatment.