Cohen Stuart L, Miller Theodore T, Ellis Scott J, Roberts Matthew M, DiCarlo Edward F
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY USA.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA.
J Ultrasound Med. 2016 Oct;35(10):2191-5. doi: 10.7863/ultra.15.11022. Epub 2016 Aug 25.
To determine what accounts for the sonographic appearance of a Morton neuroma by correlating preoperative sonograms with the sonographic appearance of the resected surgical specimen, the surgical findings, and the pathologic examination.
Ten Morton neuromas that had preoperative sonograms underwent postoperative specimen sonography and histologic evaluation. The appearance and size of the neuromas were compared between the preoperative and postoperative specimen images and were compared to the surgical and pathologic appearances.
Preoperative images showed a fibrillar echogenic nerve coursing into a heterogeneous hypoechoic mass measuring 14.3 mm in average length (range, 9.0-24.0 mm) that contained a round, mildly echogenic mass within it measuring 7.6 mm in average length (range, 4.5-12.0 mm). Surgically, the specimens showed scarred intermetatarsal bursas and tangled vessels surrounding the nerve. Specimen sonography showed echogenic focal enlargement of the nerve at the site of the neuroma, measuring 6.8 mm in average length (range, 3.5-11.0 mm). The size of the resected neuroma was smaller than the hypoechoic mass on the presurgical images (P < .001). Within the hypoechoic mass, the small echogenic focus showed no difference in size compared to the specimen (P = .40), but the shape of the echogenic specimen was fusiform, whereas the preoperative appearance was round. Histologically, the resected specimens showed sclerosis and mucoid degeneration of the nerve fascicles and fibrotic thickening of the perineurium.
The hypoechoic heterogeneous mass that is referred to as a Morton neuroma sonographically is really a "neuroma-bursal complex" that is much larger than the actual neuroma itself.
通过将术前超声图像与切除的手术标本的超声表现、手术发现及病理检查结果相关联，以确定导致 Morton 神经瘤超声表现的原因。
对 10 例术前行超声检查的 Morton 神经瘤进行术后标本超声检查及组织学评估。比较术前和术后标本图像中神经瘤的外观和大小，并与手术及病理表现进行对比。
术前图像显示一条纤维状高回声神经延伸至一个不均质低回声肿块内，该肿块平均长度为 14.3 mm（范围 9.0 - 24.0 mm），其中包含一个圆形、轻度高回声肿块，平均长度为 7.6 mm（范围 4.5 - 12.0 mm）。手术中，标本显示跖间滑囊瘢痕形成及神经周围血管缠结。标本超声检查显示神经瘤部位神经呈高回声局灶性增粗，平均长度为 6.8 mm（范围 3.5 - 11.0 mm）。切除的神经瘤大小小于术前图像中的低回声肿块（P <.001）。在低回声肿块内，小的高回声灶与标本相比大小无差异（P = 0.40），但高回声标本的形状为梭形，而术前表现为圆形。组织学上，切除的标本显示神经束硬化和黏液样变性以及神经束膜纤维化增厚。
超声检查中被称为 Morton 神经瘤的低回声不均质肿块实际上是一个“神经瘤 - 滑囊复合体”，其比实际的神经瘤本身要大得多。
