Abstract
Objective: To evaluate signal characteristics, soft tissue signs and
contrast enhancement patterns of extremity schwannomas with Magnetic Resonance
Imaging (MRI).
Material and Methods: The study was comprised of 16 patients with a pathological diagnosis of benign
peripheral nerve sheath tumor (schwannoma) originated from different extremity
regions. All patients had MRI exams. MRIs were evaluated for the signal
characteristics, the presence of special signs described for soft tissue
tumors, and contrast enhancement patterns of the lesions.
Results: Schwannomas were
originated from median nerve (n=7), radial nerve (n=4), femoral nerve (n=2),
axillary nerve (n=1), common peroneal nerve (n=1), and posterior tibial nerve
(n=1). Four types of signal characteristic were described according to the T1W
and T2W MR images. All schwannomas (n=16) had split fat sign,15 of them showed
entering-exiting nerve sign, 10 had target sign and 10 had fascicular sign. On
contrast enhanced images, 12 of the cases showed peripheral heterogenous
enhancement with centrally unenhanced curvilinear areas. Four cases had
homogenous contrast enhancement.
Conclusion: Most
of the extremity schwannomas have diagnostic signal characteristics, soft
tissue signs and contrast enhancement patterns on MRI. Preoperative MRI
diagnosis of these lesions can reduce the necessity of biopsy and prevent the
possibility of nerve fascicle injury.
References
- 1. Forthman CL, Blazar PE. Nerve tumors of the hand and upper extremity. Hand Clin 2004;20:233–242.
- 2. Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: Radiologic-pathologic correlation. Radiographics 1999;19:1253–1280.
- 3. Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer 1986;57:2006–2021.
- 4. Zhang Z, Deng L, Ding L, Meng Q. MR imaging differentiation of malignant soft tissue tumors from peripheral schwannomas with large size and heterogeneous signal intensity. Eur J Radiol 2015;84:940–946.
- 5. Hems TEJ, Burge PD, Wilson DJ. The role of magnetic resonance imaging in the management of peripheral nerve tumors. J Hand Surg 1997;22:57–60.
- 6. Park MJ, Seo KN, Kang HJ. Neurological deficit after surgical enucleation of schwannomasof the upper limb. J Bone Joint Surg Br 2009;91:1482–1486.
- 7. Isobe K, Tominaga S, Tsutomu A, Hiroyuki K. Imaging of ancient schwannoma. Am J Radiol 2004;183:331–336.
- 8. Adani R, Tarallo L, Mugnai, Colopi S. Schwannomas of the upper extremity: analysis of 34 cases. Acta Neurochir 2014;156:2325-2330.
Abstract
Amaç: Ekstremite şıvannomalarının sinyal
karakteristiklerinin, yumuşak doku işaretlerinin ve kontrast tutulum
paternlerinin Manyetik Rezonans Görüntüleme ile değerlendirilmesi.
Yöntem: Çalışma grubu, değişik ekstremite bölgelerinden
kaynaklı, patolojik tanısı periferik sinir kılıf tümörü (şıvannoma) olan 16
hastadan oluşturuldu. Bütün hastaların MR incelemeleri mevcuttu. MR
incelemeleri; lezyonların sinyal karakteristikleri, yumuşak doku tümörleri için
tanımlanmış bazı işaretler ve kontrast tutulum paternleri yönünden
değerlendirildi.
Bulgular: Şıvannomalar; medyan sinir (n=7), radyal sinir (n=4),
femoral sinir (n=2), aksiller sinir (n=1), ortak peroneal sinir (n=1), ve
posterior tibial sinir (n=1) orijinli idi. T1 ve T2 ağırlıklı MR görüntülere
göre; lezyonlara ait dört farklı sinyal karakteristiği tanımlandı. Bütün
şıvannomalarda ayrışmış yağ işareti, 15’inde giren-çıkan sinir işareti. 10’unda
hedef işareti ve 10’unda fasiküler işaret mevcuttu. Kontrastlı görüntülerde,
olguların 12’sinde kontrast tutulumu göstermeyen santral alana eşlik eden
çevresel ağırlıklı heterojen kontrastlanma saptandı. Dört olguda ise homojen
kontrast tutulumu mevcuttu.
Sonuç: Ekstremite şıvannomalarının çoğunluğu, MR
görüntülemede kendine ait sinyal karakteristikleri, yumuşak doku işaretleri ve
kontrast tutulum paterni gösterir. Bu lezyonların cerrahi öncesi MR görüntüleme
ile tanı alması, gereksiz biyopsi işlemlerini ve ilişkili olarak olası sinir
fasikül hasarını önler.
References
- 1. Forthman CL, Blazar PE. Nerve tumors of the hand and upper extremity. Hand Clin 2004;20:233–242.
- 2. Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: Radiologic-pathologic correlation. Radiographics 1999;19:1253–1280.
- 3. Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer 1986;57:2006–2021.
- 4. Zhang Z, Deng L, Ding L, Meng Q. MR imaging differentiation of malignant soft tissue tumors from peripheral schwannomas with large size and heterogeneous signal intensity. Eur J Radiol 2015;84:940–946.
- 5. Hems TEJ, Burge PD, Wilson DJ. The role of magnetic resonance imaging in the management of peripheral nerve tumors. J Hand Surg 1997;22:57–60.
- 6. Park MJ, Seo KN, Kang HJ. Neurological deficit after surgical enucleation of schwannomasof the upper limb. J Bone Joint Surg Br 2009;91:1482–1486.
- 7. Isobe K, Tominaga S, Tsutomu A, Hiroyuki K. Imaging of ancient schwannoma. Am J Radiol 2004;183:331–336.
- 8. Adani R, Tarallo L, Mugnai, Colopi S. Schwannomas of the upper extremity: analysis of 34 cases. Acta Neurochir 2014;156:2325-2330.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Medical Science Research Articles |
| Authors | |
| Publication Date | June 5, 2018 |
| Acceptance Date | April 9, 2018 |
| Published in Issue | Year 2018Volume: 40 Issue: 2 |