盆腔良性神经鞘肿瘤的影像学诊断  

Cross-sectional Imaging of Benign Peripheral Nerve Sheath Tumors in the Pelvis

作　　者：蒋朝霞[1] 彭卫军[1] 李小秋[2] 许玲辉[1] 杨天锡[1] 叶定伟[3] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科,上海市200032 [2]复旦大学附属肿瘤医院病理科,上海市200032 [3]复旦大学附属肿瘤医院泌尿外科,上海市200032

出　　处：《中国医学计算机成像杂志》2008年第2期130-134,共5页Chinese Computed Medical Imaging

摘　　要：目的:探讨盆腔良性神经鞘肿瘤的MRI、CT特点,提高术前诊断准确性。材料和方法:回顾性分析经手术病理证实的16例盆腔神经鞘肿瘤(神经鞘瘤11例,神经纤维瘤5例)的MRI、CT表现,并与术中及病理所见对照。结果:①所有16例盆腔良性神经鞘肿瘤均为圆形或类圆形,边缘光整;肿瘤平均直径8.2cm。12例位于骶前,其中2例伸入骶孔导致其扩大及周围骨质硬化(神经鞘瘤和神经纤维瘤各1例)。病变对周围脏器以推移改变为主,无明显外侵。大部分肿瘤密度或信号不均匀(11/16),但中央大片囊变更多见于神经鞘瘤(8/11vs.0/5)。增强扫描神经鞘瘤多呈环状强化(7/11),而神经纤维瘤多为不规则强化(4/5)。②术中发现大部分病灶包膜光整,易分离(9例),所有病灶均完整切除。③肿瘤剖面见不同程度的囊变,神经鞘瘤囊变范围相对较大。结论:典型的盆腔神经鞘瘤与神经纤维瘤表现为位于骶前较大的、圆形、边界光整的不均质肿块;可引起骶骨的吸收硬化,但不会侵犯邻近脏器;中央大片囊变或环状强化提示神经鞘瘤可能。Purpose： To characterize the CT and MR imaging findings of pelvic benign peripheral nerve sheath tumors（BPNSTs） .Materials and Methods： CT and MR images of 16 patients with a pathologically proven pelvic BPNST（including 11 neurilemmas and 5 neurofibromas） were retrospectively reviewed. The following morphologic characteristics were evaluated according to tumor shape, size, position, margin, density or signal intensity, the pattern of enhancement, invasion into adjacent structures. Results： All 16 pelvic BPNSTs were round in shape, with well - defined margins; the mean diameter was 8.2cm; they were usually located in the presacral region（11/16）, in 2 cases there was smooth expansion of a sacral foramen with marginal sclerosis. Tumors were typically heterogeneous with cystic change（11/ 16）, but centrally massive cystic attenuation was more common in neurilemmas than in neurofibromas （8/11 vs 0/5）. On CT or MRI contrast - enhanced images, peripheral enhancement was apparent in 7of 11 neurilemmas, whereas irregular enhancement was evident in 4 of 5 neurofibromas. （2） Most of the lesions （9 cases） were well - circumscribed and could be resected easily. （3） The section of specimen exhibited cystic necrosis, and the extent of necrosis in neurilemmas was relatively larger. Conclusion： Both pelvic neurilemmas and neurofibromas are typically round, large, well- circumscribed, heterogeneous tumors that located in the presacral space. They can occasionally cause bony changes in the sacrmn, but do not invade adjacent structures. Central massive necrosis or peripheral enhancement favors the diagnosis of a neurilexnma.

关 键 词：神经鞘瘤 神经纤维瘤 磁共振成像 X线计算机 体层摄影术 

分 类 号：R739.9[医药卫生—肿瘤]