Summers Spencer, Jose Jean, Barrera Carlos M, Pretell-Mazzini Juan, Subhawong Ty, Nguyen Nguyen V, Kerr Darcy, Nielsen G Petur, Rosenberg Andrew E
2 Department of Orthopedics, University of Miami Miller School of Medicine, USA.
1 Department of Radiology, University of Miami Miller School of Medicine, USA.
Neuroradiol J. 2018 Oct;31(5):531-540. doi: 10.1177/1971400918782321. Epub 2018 Jun 12.
Background and purpose Sacral intraosseous schwannomas represent a rare subset of schwannomas. The existing literature detailing the radiographic appearance of intraosseous schwannomas is limited. The aim of this study is to formally characterize the radiological appearance of sacral intraosseous schwannomas to differentiate them from other lytic lesions. Materials and methods Imaging studies of 13 pathologically proven intraosseous schwannomas were reviewed from multiple institutions by fellowship-trained radiologists. A PubMed search was performed and identified four papers pertaining to the imaging characteristics of sacral intraosseous schwannomas. The results of these papers were compared to findings from our cases. Results All tumors had heterogeneous signals and were predominately solid but cystic components with fluid-fluid levels were present. The tumors caused a mass effect but none infiltrated the surrounding soft tissues. Post-contrast T1-weighted images revealed heterogeneous enhancement in all 13 tumors and four possessed non-enhancing cysts. A literature review identified 16 other cases of sacral intraosseous schwannomas forming a total of 29 cases examined. Conclusions Sacral intraosseous schwannomas should be considered in the differential diagnosis for both radiologists and pathologists when dealing with large expansile, lytic lesions, with well-defined sclerotic margins involving the sacrum. This is particularly important in middle-aged adults presenting with pathology centered around S2-3.
背景与目的 骶骨骨内神经鞘瘤是神经鞘瘤中罕见的一种亚型。现有详细描述骨内神经鞘瘤影像学表现的文献有限。本研究的目的是正式描述骶骨骨内神经鞘瘤的放射学表现，以将其与其他溶骨性病变区分开来。材料与方法 由接受过专科培训的放射科医生对来自多个机构的13例经病理证实的骨内神经鞘瘤的影像学研究进行回顾。进行了PubMed检索，确定了4篇关于骶骨骨内神经鞘瘤影像学特征的论文。将这些论文的结果与我们病例的发现进行比较。结果 所有肿瘤均信号不均，主要为实性，但存在有液-液平面的囊性成分。肿瘤有占位效应，但均未侵犯周围软组织。增强后T1加权像显示13例肿瘤均有不均匀强化，4例有不强化的囊肿。文献回顾确定了另外16例骶骨骨内神经鞘瘤病例，共计29例进行了检查。结论 对于放射科医生和病理科医生而言，在处理累及骶骨、边界清晰硬化、呈大片状膨胀性溶骨性病变时，鉴别诊断应考虑骶骨骨内神经鞘瘤。这对于以S2-3为中心出现病变的中年成年人尤为重要。
