軟組織神經鞘腫瘤的MRI 診斷

饒圣祥 曾蒙蘇 王冬青 陳財忠 沈繼章 施偉斌
【摘要】 目的 評價MR 平掃及動態增強掃描對軟組織神經鞘腫瘤的診斷價值。方法 回顧
分析23 例30 個經病理證實軟組織神經鞘腫瘤的MRI 特征, 其中15 個良性神經鞘腫瘤, 包括許旺瘤
( 神經鞘膜瘤) 13 個( 12 例) , 神經纖維瘤2 個( 2 例) ; 15 個為惡性外周神經鞘腫瘤。23 例均行常規
MR 掃描, 包括自旋回波( SE ) T1WI, 快速自旋回波( FSE) T2WI 以及快速多平面擾相梯度回波序列
( FMPSPGR) 平掃和動態增強掃描。結果 ( 1 ) 23 例患者共30 個病灶, 軟組織神經鞘腫瘤表現為梭
形( 15 個) , 靶征( 9 個) , 神經出入征( 10 個) , 脂肪分離征( 10 個) ; 2 個( 2 例) 惡性神經鞘膜腫瘤顯
示周圍水腫。( 2) 12 個良性神經鞘腫瘤中9 個表現為延遲強化, 3 個無明顯強化或輕度強化; 所有15
個惡性外周神經鞘腫瘤及3 個良性神經鞘腫瘤表現為第1 期明顯或中度強化, 第2 期和第3 期持續
強化或強化程度稍有下降。結論 梭形腫塊、靶征、與神經關系密切及脂肪分離征是軟組織神經鞘腫
瘤較特征性的表現, 而腫瘤的MR 動態增強強化方式和周圍有無水腫對神經鞘腫瘤良、惡性鑒別有
一定價值。
【關鍵詞】 軟組織腫瘤; 神經鞘瘤; 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

軟組織神經鞘腫瘤的MRI 診斷.rar