Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et Imagerie de l'Appareil Locomoteur, CHRU de Lille, 59037 Lille, France.
Eur J Radiol. 2013 Jan;82(1):38-50. doi: 10.1016/j.ejrad.2011.04.036. Epub 2011 May 10.
Neoplasms of neurogenic origin account for about 12% of all benign and 8% of all malignant soft tissue neoplasms. Traumatic neuroma, Morton neuroma, lipomatosis of a nerve, nerve sheath ganglion, perineurioma, benign and malignant peripheral nerve sheath tumors (PNST) are included in this group of pathologies. Clinical and radiologic evaluation of patients with neurogenic tumors and pseudotumors often reveals distinctive features. In this context, advanced imaging techniques, especially ultrasound (US) and magnetic resonance (MR) play an important role in the characterization of these lesions. Imaging findings such as location of a soft tissue mass in the region of a major nerve, nerve entering or exiting the mass, fusiform shape, abnormalities of the muscle supplied by the nerve, split-fat sign, target sign and fascicular appearance should always evoke a peripheric nerve sheath neoplasm. Although no single imaging finding or combination of findings allows definitive differentiation between benign from malign peripheric neurogenic tumors, both US and MR imaging may show useful features that can lead us to a correct diagnosis and improve patient treatment. Traumatic neuromas and Morton neuromas are commonly associated to an amputation stump or are located in the intermetatarsal space. Lipomatosis of a nerve usually appears as a nerve enlargement, with thickened nerve fascicles, embedded in evenly distributed fat. Nerve sheath ganglion has a cystic appearance and commonly occurs at the level of the knee. Intraneural perineuroma usually affects young people and manifests as a focal and fusiform nerve enlargement. In this article, we review clinical characteristics and radiologic appearances of these neurogenic lesions, observing pathologic correlation, when possible.
神经源性起源的肿瘤约占所有良性软组织肿瘤的 12%，占所有恶性软组织肿瘤的 8%。创伤性神经瘤、Morton 神经瘤、神经脂肪病、神经鞘瘤、神经周围细胞瘤、良性和恶性周围神经鞘肿瘤（PNST）都属于这组病变。对神经源性肿瘤和假性肿瘤患者的临床和影像学评估通常会揭示出独特的特征。在这种情况下，高级影像学技术，尤其是超声（US）和磁共振（MR）在这些病变的特征描述中发挥着重要作用。影像学表现，如软组织肿块位于主要神经区域、神经进出肿块、梭形形状、神经供应的肌肉异常、分裂脂肪征、靶征和束状外观，这些都应始终提示为外周神经鞘肿瘤。尽管没有单一的影像学表现或表现组合能够明确区分良性和恶性周围神经源性肿瘤，但 US 和 MR 成像都可能显示出有用的特征，可以帮助我们做出正确的诊断并改善患者的治疗效果。创伤性神经瘤和 Morton 神经瘤通常与截肢残端有关，或者位于跖骨间空间。神经脂肪病通常表现为神经增大，伴有增厚的神经束，嵌入均匀分布的脂肪中。神经鞘瘤呈囊性外观，常见于膝关节水平。神经内的神经周围细胞瘤通常发生于年轻人，表现为局灶性和梭形神经增大。在本文中，我们将回顾这些神经源性病变的临床特征和影像学表现，并观察可能的病理相关性。
