Kim Ha Youn, Hwang Ji Young, Kim Hyung-Jin, Kim Yi Kyung, Cha Jihoon, Park Gyeong Min, Kim Sung Tae
1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2 Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2017 Oct;58(10):1222-1230. doi: 10.1177/0284185116684674. Epub 2017 Jan 9.
Background Malignant peripheral nerve sheath tumor (MPNST) is a highly malignant tumor and rarely occurs in the head and neck. Purpose To describe the imaging features of MPNST of the head and neck. Material and Methods We retrospectively analyzed computed tomography (CT; n = 14), magnetic resonance imaging (MRI; n = 16), and F-FDG PET/CT (n = 5) imaging features of 18 MPNSTs of the head and neck in 17 patients. Special attention was paid to determine the nerve of origin from which the tumor might have arisen. Results All lesions were well-defined (n = 3) or ill-defined (n = 15) masses (mean, 6.1 cm). Lesions were at various locations but most commonly the neck (n = 8), followed by the intracranial cavity (n = 3), paranasal sinus (n = 2), and orbit (n = 2). The nerve of origin was inferred for 11 lesions: seven in the neck, two in the orbit, one in the cerebellopontine angle, and one on the parietal scalp. Attenuation, signal intensity, and enhancement pattern of the lesions on CT and MRI were non-specific. Necrosis/hemorrhage/cystic change within the lesion was considered to be present on images in 13 and bone change in nine. On F-FDG PET/CT images, all five lesions demonstrated various hypermetabolic foci with maximum standard uptake value (SUV) from 3.2 to 14.6 (mean, 7.16 ± 4.57). Conclusion MPNSTs can arise from various locations in the head and neck. Though non-specific, a mass with an ill-defined margin along the presumed course of the cranial nerves may aid the diagnosis of MPSNT in the head and neck.
背景 恶性外周神经鞘瘤（MPNST）是一种高度恶性肿瘤，很少发生于头颈部。目的 描述头颈部MPNST的影像学特征。材料与方法 我们回顾性分析了17例患者中18个头颈部MPNST的计算机断层扫描（CT；n = 14）、磁共振成像（MRI；n = 16）及F-FDG PET/CT（n = 5）的影像学特征。特别关注确定肿瘤可能起源的神经。结果 所有病灶均为边界清晰（n = 3）或边界不清（n = 15）的肿块（平均大小6.1 cm）。病灶位于不同部位，但最常见于颈部（n = 8），其次是颅内腔（n = 3）、鼻窦（n = 2）和眼眶（n = 2）。推断出11个病灶的起源神经：7个在颈部，2个在眼眶，1个在桥小脑角，1个在顶头皮。CT和MRI上病灶的衰减、信号强度及强化方式无特异性。13例图像上可见病灶内坏死/出血/囊性改变，9例可见骨质改变。在F-FDG PET/CT图像上，所有5个病灶均显示不同程度的高代谢灶，最大标准摄取值（SUV）为3.2至14.6（平均7.16±4.57）。结论 MPNST可起源于头颈部的不同部位。虽然无特异性，但沿颅神经推测走行边界不清的肿块可能有助于头颈部MPNST的诊断。
