CAJ | 학술논문

目的：分析恶性周围神经鞘膜瘤（ MPNST）的MSCT、MRI及病理学表现，以提高诊断准确性。方法收集17例经手术病理证实的MPNST，将其MSCT、MRI表现并与病理进行对照分析。结果17例中，上肢4例，下肢4例，颈背部3例，骶髂关节区3例，椎管内2例，食管1例。肿瘤巨大，瘤内坏死出血常见，钙化较少。 MSCT平扫多为等、低混杂密度影，MRI平扫T1 WI多呈等、略低信号，T2 WI及STIR序列多呈高、低混杂信号，增强扫描瘤体多呈边缘环形明显强化，瘤内实性部分结节状、斑索状不均匀明显强化。病理：肿瘤多呈球形或纺锤形，有假包膜，与神经干粘连，瘤内常坏死、出血，可囊变，钙化少见。镜下肿瘤细胞多形性，以梭形细胞为主；NSE、S-100、CD56、Vimentin标记物多呈阳性。结论恶性周围神经鞘膜瘤多位于较大神经干走行区。 CT、MRI表现与病理成分有较强相关性，结合二者有助于提高诊断与鉴别诊断水平。
목적：분석악성주위신경초막류（ MPNST）적MSCT、MRI급병이학표현，이제고진단준학성。방법수집17례경수술병리증실적MPNST，장기MSCT、MRI표현병여병리진행대조분석。결과17례중，상지4례，하지4례，경배부3례，저가관절구3례，추관내2례，식관1례。종류거대，류내배사출혈상견，개화교소。 MSCT평소다위등、저혼잡밀도영，MRI평소T1 WI다정등、략저신호，T2 WI급STIR서렬다정고、저혼잡신호，증강소묘류체다정변연배형명현강화，류내실성부분결절상、반색상불균균명현강화。병리：종류다정구형혹방추형，유가포막，여신경간점련，류내상배사、출혈，가낭변，개화소견。경하종류세포다형성，이사형세포위주；NSE、S-100、CD56、Vimentin표기물다정양성。결론악성주위신경초막류다위우교대신경간주행구。 CT、MRI표현여병리성분유교강상관성，결합이자유조우제고진단여감별진단수평。
Objective To analyze the maligant peripheral nerve sheath tumors ( MPNST)′MSCT, MRI ima-ging and pathological features in order to improve its diagnostic accuracy .Methods The retrospective analysis of 17 cases of MPNST confirmed by operation and pathology were performed .Results There were 4 cases in the upper limb, 4 cases in the lower extremity , 3 cases in the neck and back , 3 cases in the sacroiliac joint area , 2 cases in in-traspinal area , 1 case in the esophagus .The huge tumor usually showed necrosis and haemorrhage but rare calcifica-tion.MSCT scan was mainly manifested as mixed hypodensity and isodensity irregular huge mass shadow , T1 WI mainly showed iso-/slight hypo-intensities, T2 WI and STIR mostly showed mixed hyper-/hypo-intensities.Contrast enhanced scan showed obvious ringlike enhancement about the edge of tumor and displayed nodous or patchy funicular heterogeneous enhancement of solid component within tumor .Pathology: the tumor had pseudocapsule and mainly showed the ball or spindle form .It showed more haemorrhage necrosis than cystic change and infrequent calcification . The tumor cell showed the varied forms and mainly was the spindle cell .The sensitive makers of the tumor were NSE , S-100, CD56, Vimentin, which showed more positive .Conclusion MPNST often occur in the thick neural stem′s walk line area ,there is a strong correlation between the manifestations of MSCT and MRI and the pathological fea -tures, The combination of the theirs is helpful in improving the level of diagnosis and differential diagnosis .