食管神经鞘瘤影像表现与病理分析  

Esophageal Schwannomas: Radiological Features and Pathological Correlation

作　　者：孙琳琳 陈婧[1] 丁博闻 朱蕾[2] 于红 陈群慧[1] 施珏倩 陈怡楠 李克 朱莉[1] SUN Linlin;CHEN Jing;DING Bowen;ZHU Lei;YU Hong;CHEN Qunhui;SHI Jueqian;CHEN Yinan;LI Ke;ZHU Li(Department of Radiology,Shanghai Chest Hospital,Shanghai Jiao Tong University;Department of Pathology,Shanghai Chest Hospital,Shanghai Jiao Tong University;Department of Radiology,Huashan Hospital,Fudan University)

机构地区：[1]上海市胸科医院/上海交通大学附属胸科医院放射科 [2]上海市胸科医院/上海交通大学附属胸科医院病理科 [3]复旦大学附属华山医院放射科

出　　处：《中国医学计算机成像杂志》2021年第6期510-515,共6页Chinese Computed Medical Imaging

基　　金：国家自然科学基金(81871353,82071873);上海市卫生健康委员会科研项目(201940221);上海市胸科医院科技发展基金资助项目(YJXT20190210Z);徐汇区人工智能医疗院地合作项目(2020-010);上海交通大学交大之星计划医工交叉研究基金(YG2021QN123)。

摘　　要：目的:探讨食管神经鞘瘤的影像学特征并与病理进行对照,以提高对该病的诊断水平。方法:回顾性分析经手术病理证实的21例食管神经鞘瘤的临床、影像学与病理学资料。结果:21例患者中,肿瘤均为单发,17例位于食管胸部上段,3例位于胸部下段,1例位于胸部中段。21例患者均行术前上消化道钡餐,均表现为食管管腔充盈缺损,管壁光整,黏膜未见明显破坏。18例患者行术前CT检查:长径平均值为(60±19)mm,CT平扫病灶均显示边界清晰的低密度灶,增强后15例轻中度均匀强化,3例不均匀强化,其中2例出现明显囊变区;5例患者行MRI检查,平扫T1WI等低、T2WI高信号为主,增强后实性部分动态增强曲线呈平台型;2例患者行PET检查,均见病灶FDG浓聚,代谢增高。21例病理结果中,18例呈富细胞型、Antoni A区为主,3例Antoni A区、B区混杂分布。结论:食管神经鞘瘤具有一定的影像特征,CT及MRI增强上多为均匀强化,囊变少见,与富细胞型、Antoni A区为主的病理学表现吻合。Purpose: To describe the radiological and pathological findings of esophageal schwannomas in 21 patients, so as to improve the diagnostic accuracy of the disease.Methods: The clinical, radiological and pathological findings of 21 cases of pathologically proven esophageal schwannomas were retrospectively reviewed. Results: All the tumors in this study(n=21) are solitary,of which 17 originated from the upper part of esophagus, 3 from the lower part and 1 from the middle part. On the images of barium examination in 21 cases, esophageal filling defects without mucosal damages were revealed. On the CT images of 18 cases, the average longest diameter was(60±19) mm.Tumors were homogeneously hypodense, whose densities were lower than muscles’ at the same levels. After contrast,15 cases tended to be homogeneously enhanced, and 3 cases heterogeneously enhanced, of which 2 cases had obviously cystic changes. On the MR images of 5 cases, tumors were mostly hypointense on T1WI and hyperintense on T2WI, and the dynamic enhancement curves of the solid parts were platform-type. Through PET, 2 cases of tumors were hypermetabolic. In 21 cases, 18 cases showed predominant Antoni A patterns with compact areas of palisaded spindle cells, and 3 cases showed mixed distribution of Antoni A and B patterns. Conclusion: Most esophageal schwannomas appear to be homogeneously enhanced with infrequent cystic changes on CT and MR images, in accordance with the features of predominant Antoni A patterns on pathological exam.

关 键 词：食管 神经鞘瘤 上消化道钡餐 计算机体层摄影 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R445.3[医药卫生—诊断学]