不典型椎管内神经鞘瘤MRI影像学表现  

MR imaging characteristic of atypical spinal Schwannoma

作　　者：邹悄悄 王铭梁 李文彬[1] ZOU Qiao-qiao;WANG Ming-liang;LI Wen-bin(Department of Radiology,Shanghai Jiao Tong University Affiliated Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院放射科,上海200233

出　　处：《生物医学工程与临床》2023年第3期316-321,共6页Biomedical Engineering and Clinical Medicine

基　　金：国家自然科学基金青年科学基金项目(81901727)。

摘　　要：目的探讨不典型椎管内神经鞘瘤的MRI影像学表现,提高对该疾病的诊断率。方法选择34例经手术病理诊断证实的不典型椎管内神经鞘瘤患者,其中男性19例,女性15例;年龄18~83岁,平均年龄50.9岁(标准差16.7岁);肿瘤单发28例,多发6例;平均直径2.5 cm(标准差1.3 cm)。分析患者临床、病理诊断及MRI诊断资料,观察肿瘤的数目、发病部位、大小、形态、生长方式、信号特点、囊性变、出血及强化方式。结果椎管内神经鞘瘤单发者被误诊为脊膜瘤者10例,室管膜瘤9例,血管瘤7例,神经源性肿瘤1例,骶管囊肿1例;多发者被误诊为神经纤维瘤病5例,1例被误诊为室管膜瘤。不典型神经鞘瘤位于髓内者3例,髓外硬膜下者14例,椎管内者14例,硬膜外者1例,椎管内及皮下者1例,髓外硬膜下及椎管内者1例;单发者有28例,多发者有6例;MRI快速自旋回波T_(1)加权成像(T_(1)WI)、快速自选回波T_(2)加权成像(T_(2)WI)信号多样,以T_(1)低信号、T_(2)高信号为主,增强扫描以不均匀明显强化为主,肿瘤可伴有囊变、出血。结论不典型椎管内神经鞘瘤MRI影像学表现定性诊断困难,需全面综合分析并借助CT、脊髓血管造影等影像学手段,可帮助明确诊断。Objective To study the MR imaging features of atypical spinal Schwannoma,and improve diagnosis accuracy of the diseases.Methods A total of 34 patients with surgically pathologically confirmed atypical intradural Schwannoma were enrolled,which included 19 males and 15 females,ages 18-83 years old with mean age of 50.9 years old(standard deviation 16.7 years old).Tumors were solitary in 28 cases and multiple in 6 cases;mean tumor diameter was 2.5 cm(standard deviation 1.3 cm).Clinical,pathological and MRI diagnostic data of patients were analyzed,and number,site,size,morphology,growth pattern,signal characteristics,cystic changes,hemorrhage and enhancement pattern of tumors were observed.Results The single spinal Schwannoma was misdiagnosed as meningioma in 10 cases,ependymoma in 9,hemangioma in 7,neurogenic tumor in 1 and sacral cyst in 1.The multiple spinal Schwannoma were misdiagnosed as neurofibromatosis in 5 cases,and ependymoma in 1 case.Atypical Schwannoma of 3 cases were located at intramedullary,14 located at intradural and extramedullary space,14 located at intraspinal space,1 located at extradural space,1 located at intraspinal and subcutaneous space,1 located at extramedullary and intradural space and intraspinal space.There were 28 cases of single lesion and 6 of multiple lesions.The MRI T_(1)-weighted imaging(T_(1)WI)and T_(2)-weighted imaging(T_(1)WI)signals were diverse,mainly showed low-signal on T_(1)and high-signal on T_(2),heterogeneous and obvious enhancement on contrast images,and tumor was accompanied by cystic changes and hemorrhage.Conclusion It is demonstrated that the qualitative diagnosis of atypical spinal Schwannoma is difficult,comprehensive analysis of MRI signs and combined CT_(1)spinal angiography and other imaging means can improve correct diagnosis.

关 键 词：不典型椎管内神经鞘瘤 MRI 诊断与鉴别诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.42[医药卫生—诊断学]