恶性外周神经鞘膜瘤的MRI征象

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摘要目的：观察恶性外周神经鞘膜瘤（Malignant peripheral nerve sheath tumor，MPNST）的MRI特殊征象和一般征象，提高本病的术前诊断准确率。方法：回顾性分析26例经病理证实的MPNST的MRI表现，其中20例行增强扫描。结果：①特殊征象：不典型“靶征”12例，9例位于四肢处，2例位于腰椎椎管内，1例位于髋关节周围软组织；“神经出入征”6例，均位于四肢坐骨神经走行区；“束征”6例，均位于四肢处。②动态强化方式及增强：动态强化呈Ⅱ型强化方式8例（40%），Ⅰ型强化方式10例（50％），对应表现为环形、片状、结节状不均匀强化；Ⅲ型强化方式2例（10%），对应表现为较均匀强化。③一般征象：12例形态不规则，边缘毛糙，14例形态较规则，边缘光滑；5例没有侵犯周围组织，21例侵犯周围组织；22例（84.6％）T1WI表现为等或低信号，25例（96.2％）T2WI主要表现为等或稍高或混杂高信号。结论：MPNST的影像学表现具有一定的特征性，其中特殊征象不典型“靶征”、“神经出入征”、“束征”及Ⅰ、Ⅱ型动态强化方式对诊断有较大的帮助。

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	王乾
	任翠萍
	王姗
	李飞
	孙囡
	程敬亮

关键词 ：神经髓鞘瘤, 磁共振成像

Abstract：Objective: To explore the typical and common MRI features of malignant peripheral nerve sheath tumor(MPNST) in order to improve the preoperative diagnostic accuracy． Methods: A total of 26 patients MRI with MPNST confirmed by pathology were analyzed retrospectively(n=26, 20 patients underwent enhanced scan). Results: ①Typical features: atypical“target sign”(n=12), 9 cases in the limbs, 2 cases in lumbar spinal canal, 1 case in the soft tissues around the hip joint； “entering or exiting nerve sign”(n=6), all were located in the region of the sciatic nerve; “fascicular sign”(n=6), all were located in the limbs. ②Dynamic enhancement modes: 8 lesions(40%) showed type Ⅱ, 10 lesions(50%) showed type Ⅰ, the solid parts showed annular or patchy or nodular inhomogeneous enhancement; 2 lesions(10%) showed type Ⅲ　enhancement, the solid parts showed homogeneous enhancement.③Common features: 2 cases showed irregular shape, rough edge, 14 cases showed regular shape, smooth edge; Five cases did not infiltrate to the soft tissue, 21 cases were infiltrative; Twenty-two cases(84.6%) T1WI showed equal or low signal, 25 cases(96.2%) T2WI showed equal ormixed high signal. Conclusion: There were typical MRI features in most of the MPNST, the special signs such as atypical “target sign”, “entering or exiting nerve sign”, “fascicular sign”, the type　Ⅰ, type　Ⅱ dynamic enhancemant modes have helpful to make the diagnosis．

Key words： Nerve sheath tumors Magnetic resonance imaging

收稿日期: 2017-04-10

PACS:	Ｒ730.264
	Ｒ445.2

通讯作者: 任翠萍，郑州大学第一附属医院磁共振科，450052。E-mail：rcp810@soho.com

作者简介: 王乾（1992-），女，河南安阳人，在读硕士研究生。E-mail：mmqian119@163.com

引用本文:

王乾，任翠萍，王姗，李飞，孙囡，程敬亮. 恶性外周神经鞘膜瘤的MRI征象[J]. 中国临床医学影像杂志, 2018, 29(2): 121-125.
WANG Qian, REN Cui-ping, WANG Shan, LI Fei, SUN Nan, CHENG Jing-liang. MRI features of malignant peripheral nerve sheath tumor. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(2): 121-125.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I2/121

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