肌肉骨骼系统中施万细胞瘤与神经纤维瘤的超声鉴别
Sonographic Differentiation Between Schwannomas and Neurofibromas in the Musculoskeletal System.
作者信息
Ryu Jeong Ah, Lee Sang Hoon, Cha Eun-Young, Kim Tae Yeob, Kim Sung Moon, Shin Myung Jin
机构信息
Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.).
出版信息
J Ultrasound Med. 2015 Dec;34(12):2253-60. doi: 10.7863/ultra.15.01067. Epub 2015 Nov 5.
OBJECTIVES
The purpose of this study was to determine key features and define a strategy for differentiation between schwannomas and neurofibromas using sonography.
METHODS
This retrospective study was approved by the Institutional Review Board at our hospital, and informed consent was waived. We reviewed sonograms of pathologically proven schwannomas and neurofibromas of the extremities and body wall. On grayscale images, tumors were evaluated on the basis of their size, maximum-to-minimum diameter ratio, shape, contour, margin, location, encapsulation, echogenicity, echo texture, cystic changes, presence of intratumoral calcifications, presence of a target sign, and presence of an entering or exiting nerve. If an entering or exiting nerve was identified, the nerve-tumor position and nerve-tumor transition were characterized. On color Doppler images, the presence and amount of vascularity were evaluated. Student t tests were used for analysis of continuous variables (size, maximum-to-minimum diameter ratio, and age); χ(2) and Fisher exact tests were used for analysis of categorical variables.
RESULTS
A total of 146 pathologically proven tumors, including 115 schwannomas and 31 neurofibromas of the extremities and body wall, were included. The maximum diameter, maximum-to-minimum diameter ratio, contour, cystic portion, nerve-tumor position, nerve-tumor transition, and vascularity were significantly different in schwannomas versus neurofibromas (P < .05), and a lobulated contour, fusiform shape, and hypovascularity of neurofibromas could be helpful for differentiation when a prediction model is considered. The nerve-tumor position, nerve-tumor transition, and maximum-to-minimum diameter ratio were also significantly different between groups (P < .05) and thus could be useful for differentiation of neurogenic tumors.
CONCLUSIONS
Sonographic findings are helpful in differentiating between schwannomas and neurofibromas.
目的
本研究旨在确定使用超声鉴别神经鞘瘤和神经纤维瘤的关键特征并制定鉴别策略。
方法
本回顾性研究经我院机构审查委员会批准，且豁免了知情同意。我们回顾了经病理证实的四肢及体壁神经鞘瘤和神经纤维瘤的超声图像。在灰阶图像上，根据肿瘤的大小、最大径与最小径之比、形状、轮廓、边缘、位置、包膜、回声性、回声纹理、囊性改变、瘤内钙化情况、靶征情况以及有无进出神经来评估肿瘤。若识别出进出神经，则对神经与肿瘤的位置关系及神经 - 肿瘤移行情况进行特征描述。在彩色多普勒图像上，评估血管的有无及数量。采用学生t检验分析连续变量（大小、最大径与最小径之比及年龄）；采用χ²检验和Fisher精确检验分析分类变量。
结果
共纳入146例经病理证实的肿瘤，包括115例四肢及体壁神经鞘瘤和31例神经纤维瘤。神经鞘瘤与神经纤维瘤在最大直径、最大径与最小径之比、轮廓、囊性部分、神经与肿瘤的位置关系、神经 - 肿瘤移行情况及血管情况方面存在显著差异（P < 0.05），当考虑建立预测模型时，神经纤维瘤的分叶状轮廓、梭形形状及低血供有助于鉴别。神经与肿瘤的位置关系、神经 - 肿瘤移行情况及最大径与最小径之比在两组间也存在显著差异（P < 0.05），因此对神经源性肿瘤的鉴别可能有用。
结论
超声检查结果有助于鉴别神经鞘瘤和神经纤维瘤。
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