CAJ | 학술논문

目的：探讨外周良性神经纤维瘤与神经鞘瘤的MRI表现并分析两者的鉴别诊断。方法回顾性分析18例经手术病理证实的外周良性神经源性肿瘤的MRI特点，其中神经纤维瘤7例，神经鞘瘤11例。结果18例肿瘤均为单发，位于四肢、腹壁、锁骨上肌间隙或肌肉内以及颈动脉鞘周围，肿瘤呈梭形或类圆形，肿块长轴与神经干走行一致。全部肿瘤中出现靶征4例，表现为肿瘤边缘部分呈环形T1WI等信号、T2WI高信号，中央呈T1WI与T2WI等或低信号，增强后中央部分明显不均匀强化；8例肿瘤呈T1WI等信号，T2WI高信号，夹杂散在斑点片状T1WI、T2WI低信号，增强后明显不均匀强化；囊实性3例，表现为肿瘤内见多发T1WI低信号、T2WI高信号囊变区，增强扫描可见囊壁及分隔强化。3例肿瘤信号均匀，T1WI呈等或低信号，T2WI呈稍高信号，增强后均匀强化。7例神经纤维瘤均无包膜，病灶与周围组织界限不清，而11例神经鞘瘤均可见完整或部分包膜，病灶与周围组织界限清晰，并可见脂肪包绕。结论 MRI能准确显示外周良性神经纤维瘤与神经鞘瘤发生部位、形态、边缘及信号特点。神经纤维瘤无包膜，位置表浅，位于神经中央；神经鞘瘤有完整或部分包膜，位于深部或四肢屈侧较大的神经干周围，易出现坏死、囊变等改变，根据以上特点可以在术前对两者做出鉴别诊断。
목적：탐토외주량성신경섬유류여신경초류적MRI표현병분석량자적감별진단。방법회고성분석18례경수술병리증실적외주량성신경원성종류적MRI특점，기중신경섬유류7례，신경초류11례。결과18례종류균위단발，위우사지、복벽、쇄골상기간극혹기육내이급경동맥초주위，종류정사형혹류원형，종괴장축여신경간주행일치。전부종류중출현파정4례，표현위종류변연부분정배형T1WI등신호、T2WI고신호，중앙정T1WI여T2WI등혹저신호，증강후중앙부분명현불균균강화；8례종류정T1WI등신호，T2WI고신호，협잡산재반점편상T1WI、T2WI저신호，증강후명현불균균강화；낭실성3례，표현위종류내견다발T1WI저신호、T2WI고신호낭변구，증강소묘가견낭벽급분격강화。3례종류신호균균，T1WI정등혹저신호，T2WI정초고신호，증강후균균강화。7례신경섬유류균무포막，병조여주위조직계한불청，이11례신경초류균가견완정혹부분포막，병조여주위조직계한청석，병가견지방포요。결론 MRI능준학현시외주량성신경섬유류여신경초류발생부위、형태、변연급신호특점。신경섬유류무포막，위치표천，위우신경중앙；신경초류유완정혹부분포막，위우심부혹사지굴측교대적신경간주위，역출현배사、낭변등개변，근거이상특점가이재술전대량자주출감별진단。
Objective To investigate the MRI features of peripheral neurofibroma and schwannoma.Methods MRI of 18 patients with pathologically proven neurofibromas(7)and schwannomas(11)was retrospectively analyzed.Results All 18 tumors were solitary and located in the limbs,abdominal wall,supraclavicular muscles or fascia,and in the carotid sheath.The lesions were fusiform or round parallel to the neural trunk.Of 18 tumors,4 were T1 isointense and T2 hyperintense peripherally with T1 and T2 iso-hypointense centers and heterogeneous contrast enhancement.Eight lesions were T1 isointense and T2 hyperintense intermixed with patchy areas of T1 and T2 hypointensities and heterogeneous enhancement.Three schwannomas were cystic or cystic-solid with T1 hypointensity and T2 hyperintensity and homogeneous enhancement of cyst wall and septa.The remaining 3 tumors were T1 hypo-isointense and slightly T2 hyperintense with homogeneous enhancement.All 7 neurofibromas were not capsulated and located superficially in close relationship with nerves whereas all 11 schwannomas had complete or partial capsules and located deeper. Conclusion MRI characteristics can aid in differentiating neurofibromas from schwannomas.Neurofibromas are superficial,non-encapsulated and slightly T2 hyperintense.Schwannomas are located deeper,encapsulated and T2 hyperintense with necrosis and cystic degeneration.