Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China.
Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou, Fujian, China.
Cancer Imaging. 2021 Feb 15;21(1):23. doi: 10.1186/s40644-021-00390-x.
There is a paucity of existing literature centering on the magnetic resonance (MR) imaging features of pancreatic schwannomas, due to the neoplasm's nonspecific presentation and its rarity. We aimed to identify the characteristic imaging features of pancreatic schwannoma.
This retrospective search was conducted for histologically confirmed pancreatic schwannoma in multi-institutional database of pathology. Abdominal magnetic resonance imaging (MRI) was performed before histologic examination and their MR imaging studies were independently reviewed. The search yielded six adults (mean age, 46 years) with a definitive histologic postoperative diagnosis of single pancreatic schwannoma each. Additionally, a comprehensive English and Chinese literature review for pancreatic schwannoma and reported MR-imaging findings since 1961 was also conducted. MR imaging features of those cases in the literature were analyzed, summarized and compared with our case series.
This rare entity appeared to be a well-circumscribed, exophytic, oval or round pancreatic mass with a mean greatest diameter of 3.7 cm. Five schwannomas were located in the pancreatic head-neck and one in the pancreatic tail. On MRI, all cases appeared hypointense on T1-weighted images, inhomogeneous hyperintense on T2-weighted images, and hyperintense on diffusion-weighted images. The mean apparent diffusion coefficient (ADC) values of pancreatic schwannoma were 1.11 ± 0.29 × 10 mm/s and significantly lower than the surrounding pancreas. The lesion-to-pancreas signal intensity ratio (SIR) at unenhanced T1-weighted images was 0.53 ± 0.07. On dynamic contrast-enhanced MRI, most of the lesions (67%, 4/6) showed homogeneously iso- or hypointense on arterial and portal venous phases, and hyperenhancement on delayed phase compared with the surrounding pancreas. In our analysis of the time intensity curves, all cases exhibited a gradual enhancement pattern.
A well-circumscribed mass displaying inhomogeneous hyperintensity on T2, marked hypointensity on T1, hyperintensity on DWI, and with early slight enhancement at arterial phase and progressive enhancement at portal venous and delayed phase, may suggest the diagnosis of pancreatic schwannoma.
由于神经鞘瘤的非特异性表现和罕见性，目前关于胰腺神经鞘瘤磁共振成像（MRI）特征的文献相对较少。我们旨在确定胰腺神经鞘瘤的特征性影像学特征。
本回顾性研究在多机构病理学数据库中搜索经组织学证实的胰腺神经鞘瘤。在组织学检查前进行腹部 MRI 检查，并对其 MRI 研究进行独立回顾。该研究共纳入 6 名成年人（平均年龄 46 岁），每位患者均经组织学检查诊断为胰腺神经鞘瘤。此外，还对 1961 年以来发表的关于胰腺神经鞘瘤和报告的 MRI 成像结果的英文和中文文献进行了全面综述。分析、总结并比较了文献中这些病例的 MRI 特征与我们的病例系列。
这种罕见的实体似乎是一个边界清楚的外生性、椭圆形或圆形胰腺肿块，最大直径平均为 3.7cm。5 个神经鞘瘤位于胰头颈部，1 个位于胰尾部。在 MRI 上，所有病例在 T1 加权图像上呈低信号，在 T2 加权图像上呈不均匀高信号，在弥散加权图像上呈高信号。胰腺神经鞘瘤的平均表观扩散系数（ADC）值为 1.11±0.29×10mm/s，明显低于周围胰腺。未增强 T1 加权图像上病变与胰腺的信号强度比（SIR）为 0.53±0.07。在动态对比增强 MRI 上，大多数病变（67%，4/6）在动脉期和门静脉期呈均匀等或低信号，与周围胰腺相比，在延迟期呈高强化。在我们对时间强度曲线的分析中，所有病例均表现为逐渐增强的模式。
边界清楚的肿块在 T2 上呈不均匀高信号，T1 上呈明显低信号，DWI 上呈高信号，动脉期轻度早期强化，门静脉期和延迟期渐进性强化，可能提示胰腺神经鞘瘤的诊断。
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