软组织神经鞘肿瘤的MRI 诊断

饶圣祥 曾蒙苏 王冬青 陈财忠 沈继章 施伟斌
【摘要】 目的 评价MR 平扫及动态增强扫描对软组织神经鞘肿瘤的诊断价值。方法 回顾
分析23 例30 个经病理证实软组织神经鞘肿瘤的MRI 特征, 其中15 个良性神经鞘肿瘤, 包括许旺瘤
( 神经鞘膜瘤) 13 个( 12 例) , 神经纤维瘤2 个( 2 例) ; 15 个为恶性外周神经鞘肿瘤。23 例均行常规
MR 扫描, 包括自旋回波( SE ) T1WI, 快速自旋回波( FSE) T2WI 以及快速多平面扰相梯度回波序列
( FMPSPGR) 平扫和动态增强扫描。结果 ( 1 ) 23 例患者共30 个病灶, 软组织神经鞘肿瘤表现为梭
形( 15 个) , 靶征( 9 个) , 神经出入征( 10 个) , 脂肪分离征( 10 个) ; 2 个( 2 例) 恶性神经鞘膜肿瘤显
示周围水肿。( 2) 12 个良性神经鞘肿瘤中9 个表现为延迟强化, 3 个无明显强化或轻度强化; 所有15
个恶性外周神经鞘肿瘤及3 个良性神经鞘肿瘤表现为第1 期明显或中度强化, 第2 期和第3 期持续
强化或强化程度稍有下降。结论 梭形肿块、靶征、与神经关系密切及脂肪分离征是软组织神经鞘肿
瘤较特征性的表现, 而肿瘤的MR 动态增强强化方式和周围有无水肿对神经鞘肿瘤良、恶性鉴别有
一定价值。
【关键词】 软组织肿瘤; 神经鞘瘤; 磁共振成像
MRI diagnosis of nerve shea th tumors in soft tissue RAO Sheng-xiang, ZENG Meng-su, WANG
Dong-qing, CHEN Ca i-zhong, SHEN J i-zha ng, SHI Wei-bin. Depa rtment of Radiology, Zhongshan Hospital,
Fuda n University, Sha ngha i 200032 , China
Corresponding authors: ZENG Meng-su, Email: zms@zshospital. net
【Abstra ct 】 Object ive To evaluate MRI and dynamic enhancement scanning in the diagnosis of
nerve sheath tumors( NSTs ) in soft tissue. Methods Thirty histopathologically proved soft-tissue NSTs were
analyzed by MRI in 23 patients . They were divided into 15 benign NSTs which included 13 Schwannomas,
2 neurofibromas and 15 malignant peripheral nerve sheath tumors ( MPNSTs) . Scan sequences included SE
T1WI, FSE T2WI, Fast multiplanar spoiled gradient recalled technique ( FMPSPGR) before and after
injection of Gd-DTPA. Results There were 30 NSTs in 23 patients. Soft-tissue NSTs presented as an
fusiform mass( 15 / 30) ,“target”signs( 9 /30) , the tubular entering and exiting nerve ( 10 /30) , the splitfat
sign ( 10 /30 ) . Two MPNSTs showed associated surrounding edema. Twelve benign NSTs manifested
delayed enhancement( n = 9) and no enhancement ( n = 3) . All MPNSTs and 3 benign NSTs demonstrated
early enhancement with slow washout or without obvious washout. Conclusion Fusiform shape, “ target ”
sign, the relationship to the nerve and“ split-fat ”sign were characteristic signs of soft-tissue NSTs and
dynamic contrast-enhanced MRI may be useful and helpful to differentiate malignant from benign NSTs.
【Key wor ds】 Soft tissue neoplasms ; Neurilemmoma; Magnetic resonance imaging

软组织神经鞘肿瘤的MRI 诊断.rar