高频超声对四肢神经肿瘤样病变的诊断价值

Diagnostic value of high-frequency ultrasound for nerve tumor-like lesions in extremities

目的探讨高频超声对四肢神经肿瘤样病变的诊断价值。方法选择经手术及病理诊断的四肢神经肿瘤样占位患者30例,其中男性14例,女性16例;年龄6~81岁,平均年龄50.3岁;肿块直径0.4~11.2 cm,平均直径3.4 cm。患者均行高频超声检查,观察肿块的位置、形态、大小、边界、内部回声及血流情况,并与术中肿块定位及术后病理结果进行对照,对肿块超声特征进行分析。结果30例神经肿块中良性肿块27例,恶性肿块3例;其中神经鞘瘤19例,其余11例。超声定位诊断符合率73.3%(22/30),定性诊断符合率53.3%(16/30);其中创伤性神经瘤诊断符合率100.0%(2/2),神经鞘瘤诊断符合率73.7%(14/19),良性肿块中1例误诊为恶性肿块,术后病理诊断为结节性筋膜炎。超声表现为76.7%(23/30)肿块呈“鼠尾征”;83.3%(25/30)肿块为低回声;8例肿块有靶征,均为神经鞘瘤;76.7%(23/30)肿块形态规则,7例形态不规则,其中1例结节性筋膜炎呈多发“筋膜尾征”;53.3%(16/30)神经肿块内见1~2级血流。2例肿块出现相连神经干肿胀,1例淋巴瘤,1例神经鞘瘤。结论四肢神经肿瘤样病变中以神经鞘瘤最多见。超声对诊断四肢神经肿瘤样病变具有较高的准确度。

Objective To investigate the diagnostic value of high-frequency ultrasound for nerve tumor-like lesions in extremities.Methods A total of 30 extremities nerve tumor-like patients with space-occupying lesions diagnosed by surgery and pathology were enrolled,which included 14 males and 16 females,aged 6-81 years old with mean age of 50.3 years old.The diameter of mass was 0.4-11.2 cm with mean diameter of 3.4 cm.All of them performed high-frequency ultransound examination to observe the location,shape,size,boundary,internal echo and blood flow of mass,and further compared with intraoperative mass location and postoperative pathological results,the ultrasonic characteristics of mass were subsequently analyzed.Results Among 30 cases of nerve mass,27 were benign and 3 were malignant;19 cases were schwannomas and 11 were the others.The coincidence rate of ultrasound localization diagnosis was 73.3%(22/30),and coincidence rate of qualitative diagnosis was 53.3%(16/30);the diagnostic coincidence rate of traumatic neuroma was 100.0%(2/2),and schwannoma was 73.7%(14/19).One of the benign cases was misdiagnosed as malignant,and the postoperative pathological diagnosis was nodular fasciitis.The ultrasound showed 76.7%(23/30)masses with“mouse tail sign”;83.3%(25/30)of masses were hypoechoic;target sign was found in 8 cases,all of them were schwannomas;76.7%(23/30)of masses were regular and 7 were irregular in shape,and 1 case of nodular fasciitis showed multiple“fascial tail sign”;grade 1-2 blood flow was found in 53.3%(16/30)nerve masses.There were 2 cases of swelling mass-associated nerve trunk,1 of lymphoma and 1 of schwannoma.Conclusion It is demonstrated that schwannomas is the most common tumor-like lesions in extremities,and the ultrasound displays high accuracy in diagnosing nerve tumor-like lesions in extremities.