Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-471, Portland, OR, 97239, USA.
Skeletal Radiol. 2023 Apr;52(4):649-669. doi: 10.1007/s00256-022-04207-1. Epub 2022 Oct 25.
Peripheral nerve sheath tumors comprise a significant percentage of both benign and malignant soft tissue tumors. The vast majority of these lesions are schwannomas and neurofibromas, which most radiologists are familiar with including the well-described multimodality imaging features. However, numerous additional often under-recognized benign entities associated with nerves exist. These rarer entities are becoming increasingly encountered with the proliferation of cross-sectional imaging, particularly magnetic resonance imaging (MRI). It is important for the radiologist to have a basic understanding of these entities as many have near-pathognomonic MR imaging features as well as specific clinical presentations that when interpreted in concert, often allows for a limited differential or single best diagnosis. The ability to provide a prospective, pre-intervention diagnosis based solely on imaging and clinical presentation is crucial as several of these entities are "do not touch" lesions, for which even a biopsy may have deleterious consequences. To our knowledge, the majority of these benign entities associated with nerves have only been described in scattered case reports or small case series. Therefore, the aim of this article is to provide a radiopathologic comprehensive review of these benign entities that arise in association with nerves with a focus on characteristic MRI features, unique histopathologic findings, and entity specific clinical exam findings/presentation.
周围神经鞘肿瘤包括相当大比例的良性和恶性软组织肿瘤。这些病变绝大多数是神经鞘瘤和神经纤维瘤,大多数放射科医生都很熟悉,包括描述明确的多种成像特征。然而,还存在许多其他经常被低估的与神经相关的良性实体。随着横断面成像的普及,特别是磁共振成像(MRI)的普及,这些更罕见的实体越来越常见。对于放射科医生来说,了解这些实体是很重要的,因为许多实体都有近特征性的磁共振成像特征,以及特定的临床表现,这些特征结合起来,通常可以进行有限的鉴别诊断或单一最佳诊断。能够仅根据影像学和临床表现提供前瞻性的干预前诊断是至关重要的,因为这些实体中有几个是“不要触碰”的病变,即使是活检也可能产生有害的后果。据我们所知,与神经相关的这些良性实体大多数仅在零散的病例报告或小病例系列中描述过。因此,本文的目的是对与神经相关的这些良性实体进行放射病理学的全面回顾,重点介绍其特征性的 MRI 特征、独特的组织病理学发现以及特定实体的临床检查结果/表现。