Nakaya Moto, Kurokawa Ryo, Watadani Takeyuki, Morisaka Hiroyuki, Higuchi Maika, Toda Yusuke, Kunichika Hideki, Kusakabe Masashi, Okada Yoshitaka, Ohgiya Yoshimitsu, Okada Masahiro, Anai Hiroshi, Abe Osamu, Minami Manabu
Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Radiology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
Abdom Radiol (NY). 2022 Jun;47(6):1917-1928. doi: 10.1007/s00261-022-03524-2. Epub 2022 Apr 30.
Schwannomas in and around the porta hepatis (porta hepatic schwannomas) are rare benign tumors easily misdiagnosed as other pathologies, including malignancies. We aimed to evaluate their imaging features on ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT).
We performed a multi-institutional retrospective study by reviewing the clinical and imaging findings of pathologically proven eight porta hepatic schwannomas (mean age, 55 years; range, 38-80 years; one male and seven females). Preoperative imaging included three ultrasonography, eight CT, eight MRI, and two FDG-PET/CT.
All patients were asymptomatic. The mean tumor size was 61.9 mm (range, 30-180 mm), and all tumors demonstrated well-defined lesions on ultrasonography and their solid components showed soft tissue attenuation on non-contrast CT. MRI showed two distinct components in all cases: the component with T1-weighted hypointensities and T2-weighted hyperintensities with poor enhancement (suggestive of Antoni B histology); the component with T2-weighted hypointensities with gradually increasing enhancement (suggestive of Antoni A histology), resulting in a heterogeneous pattern on post-contrast CT or MRI (8/8, 100%). The separated deviation of surrounding bile ducts and vessels without obstruction allowed the recognition of extrahepatic localization and their benign nature. A ginger root-like morphology (2/8, 25%) seemed to be suggestive of extension along the Glisson's sheath, although this finding was not seen frequently.
Recognizing imaging features such as extrahepatic location, benign nature with internal structures suggestive of Antoni A/B histology, and characteristic tumor extension may provide key diagnostic clues for porta hepatic schwannomas.
肝门部及其周围的神经鞘瘤（肝门部神经鞘瘤）是罕见的良性肿瘤，很容易被误诊为包括恶性肿瘤在内的其他病变。我们旨在评估其在超声、计算机断层扫描（CT）、磁共振成像（MRI）和F-氟脱氧葡萄糖正电子发射断层扫描/CT（FDG-PET/CT）上的影像特征。
我们通过回顾经病理证实的8例肝门部神经鞘瘤（平均年龄55岁；范围38 - 80岁；1例男性和7例女性）的临床和影像表现，进行了一项多机构回顾性研究。术前影像检查包括3次超声、8次CT、8次MRI和2次FDG-PET/CT。
所有患者均无症状。肿瘤平均大小为61.9毫米（范围30 - 180毫米），所有肿瘤在超声上均表现为边界清晰的病变，其实性成分在非增强CT上显示软组织密度。MRI在所有病例中均显示出两种不同成分：一种成分在T1加权像上呈低信号，在T2加权像上呈高信号，增强不佳（提示Antoni B组织学）；另一种成分在T2加权像上呈低信号，增强逐渐增加（提示Antoni A组织学），在增强CT或MRI上呈现不均匀模式（8/8，100%）。周围胆管和血管无梗阻的分离移位有助于识别肝外定位及其良性性质。姜根样形态（2/8，25%）似乎提示沿肝门管鞘延伸，尽管这一表现并不常见。
认识到诸如肝外定位、具有提示Antoni A/B组织学的内部结构的良性性质以及特征性肿瘤延伸等影像特征，可能为肝门部神经鞘瘤提供关键的诊断线索。
