Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
Department of Radiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
Skeletal Radiol. 2021 Aug;50(8):1557-1565. doi: 10.1007/s00256-020-03689-1. Epub 2021 Jan 7.
To identify if morphology of the entering and exiting nerve involved by a nerve sheath tumour in the brachial plexus can help differentiate between benign (B) and malignant (M) peripheral nerve sheath tumours (PNSTs).
Retrospective review of 85 patients with histologically confirmed primary PNSTs of the brachial plexus over a 12.5-year period. Clinical data and all available MRI studies were independently evaluated by 2 consultant musculoskeletal radiologists blinded to the final histopathological diagnosis assessing for maximal lesion dimension, visibility and morphology of the entering and exiting nerve, and other well-documented features of PNSTs.
The study included 47 males and 38 females with mean age 46.7 years (range, 8-81 years). There were 73 BPNSTs and 12 MPNSTs. The entering nerve was not identified in 5 (7%), was normal in 17 (23%), was tapered in 38 (52%) and showed lobular enlargement in 13 (18%) BPNSTs compared with 0 (0%), 0 (0%), 2 (17%) and 10 (83%) MPNSTs respectively. The exiting nerve was not identified in 5 (7%), was normal in 20 (27%), was tapered in 42 (58%) and showed lobular enlargement in 6 (8%) BPNSTs compared with 4 (33%), 0 (0%), 2 (17%) and 6 (50%) MPNSTs respectively. Increasing tumour size, entering and exiting nerve morphology and suspected MRI diagnosis were statistically significant differentiators between BPNST and MPNST (p < 0.001). IOC for nerve status was poor to fair but improved to good if normal/tapered appearance were considered together with improved specificity of 81-91% for BPNST and sensitivity of 75-83%.
Morphology of the adjacent nerve is a useful additional MRI feature for distinguishing BPNST from MPNST of the brachial plexus.
探讨臂丛神经鞘瘤（Brachial plexus nerve sheath tumor，PNST）进出神经的形态学特征是否有助于鉴别良性（benign，B）和恶性（malignant，M）外周神经鞘瘤。
回顾性分析 12.5 年间经组织学证实的 85 例臂丛 PNST 患者的临床资料和所有可获得的 MRI 资料。2 名顾问肌肉骨骼放射科医生对这些资料进行独立评估，他们对最终的组织病理学诊断不知情，评估内容包括最大病变维度、进出神经的可视性和形态以及其他已记录的 PNST 特征。
研究对象包括 47 名男性和 38 名女性，平均年龄 46.7 岁（8-81 岁）。73 例为良性神经鞘瘤，12 例为恶性神经鞘瘤。5 例（7%）患者的进入神经无法识别，17 例（23%）患者的进入神经正常，38 例（52%）患者的进入神经变细，13 例（18%）患者的进入神经呈分叶状肿大；而 0 例（0%）、0 例（0%）、2 例（17%）和 10 例（83%）的恶性神经鞘瘤患者的相应数据分别为进入神经无法识别、进入神经正常、进入神经变细和进入神经呈分叶状肿大。5 例（7%）患者的传出神经无法识别，20 例（27%）患者的传出神经正常，42 例（58%）患者的传出神经变细，6 例（8%）患者的传出神经呈分叶状肿大；而 4 例（33%）、0 例（0%）、2 例（17%）和 6 例（50%）的恶性神经鞘瘤患者的相应数据分别为传出神经无法识别、传出神经正常、传出神经变细和传出神经呈分叶状肿大。肿瘤大小、进出神经形态以及可疑的 MRI 诊断是区分良性和恶性神经鞘瘤的统计学上显著差异因素（p<0.001）。神经状态的 IOC 较差到中等，但如果将正常/变细的外观与良性神经鞘瘤的特异性 81-91%和敏感性 75-83%结合起来，特异性和敏感性则会提高到良好。
进出神经的形态是鉴别臂丛神经良性和恶性神经鞘瘤的有用的 MRI 附加特征。
