外周神经鞘膜肿瘤的高频超声检查

目的 探讨神经鞘瘤与神经纤维瘤的声像图特征及两者间的鉴别要点,以及恶性神经鞘瘤与良性神经鞘瘤的鉴别方法.方法 高频超声检查27例经病理证实的外周神经鞘瘤患者,观察其病变大小、形态、边界、内部回声,并注意观察病变与周围组织关系,观察病变内彩色多普勒血流情况.结果 ①21例神经鞘瘤均边界清晰,7例圆形,14例椭圆性;15例有包膜,6例无包膜;所有肿瘤均为低回声,后方回声均增强;肿瘤内均有血流信号,1例为血流信号丰富;有6例可见瘤体与神经相连,具体表现为神经干在接近瘤体时内部结构紊乱或消失、回声减低并逐渐增粗连于肿瘤的两端.②5例孤立性神经纤维瘤均是单发结节,边界清晰,4例椭圆形,1例圆形,肿瘤均为低回声;3例有包膜,2例无包膜,后方回声增强,肿瘤内均有血流信号;2例与神经相连.③恶性神经鞘瘤仅发现1例,肿瘤较大,约7.0 cm,位于颈部,形状不规则,边界不清,未见明显包膜,未见与神经相连,其内可见丰富血流信号.结论 ①高频超声可发现肿瘤与神经相连,可作出病变为神经鞘瘤的正确诊断.②高频超声可明确病变范围与周围组织的关系.③部分肿瘤可根据声像图表现明确诊断;部分肿瘤缺乏特征性声像图表现,须在超声引导下穿刺活检,以便明确诊断.     

乳腺乳头腺瘤的超声表现

目的:探讨乳腺乳头腺瘤的高频超声图像特征.材料和方法:回顾性分析7例经术后病理证实的乳腺乳头腺瘤的超声图像资料.在灰阶声像图上观察病灶形状、大小、边界、内部回声及后方回声.应用彩色多普勒血流成像(CDFI)观察病灶内部及周围血流分布和供应情况.结果:6例乳腺乳头腺瘤声像图表现为乳头内圆形或椭圆形低回声结节,境界清楚,后方回声增强,彩色多普勒显示结节内少量血流或边缘血流.1例位于左乳乳头后方低回声结节,边界清晰,周边见薄的包膜回声,彩色多普勒显示其内中等量的血流信号.结论:乳腺乳头腺瘤是一种少见的乳腺良性肿瘤,超声检查有助于乳腺乳头腺瘤的诊断及鉴别诊断.     

周围神经源性良性肿瘤的超声特性

目的通过分析周围神经源性良性肿瘤的超声特性,评价超声在周围神经源性良性肿瘤中的诊断作用。方法采用回顾性调查方法收集2000—2011年我院收治的有完整临床资料的良性周围神经肿瘤65例患者的术前超声检查、手术图片及病理检查结果,其中58例肿瘤患者同时包含彩色多普勒超声检查结果,由2位有丰富临床经验的超声影像医师对患者的术前超声图像进行回顾分析,评估肿瘤超声特性包括肿瘤的形状、大小、边界、包膜、内部回声特性、后方回声情况与周围神经的关系以及血流情况。结果本组65例良性周围神经源性肿瘤70处病变的超声检查结果显示42处病变(60%)为内部回声均匀的实质性低回声结构;28处病变(40%)为回声不均的低回声结构,其中18处(26%)病变为低回声结构内部可见高回声区,10处(14%)病变为低回声结构内部可见液性暗区;36处病变与知名周围神经相连。58例肿瘤彩色多普勒超声检查显示24例肿瘤(41%)有丰富血流信号,22例肿瘤(38%)有少量血流信号,12例(21%)肿瘤无血流信号。65例患者70处病变均行手术切除,术中见54处病变来源于知名的周围神经,16处病变位于肌肉内,无知名神经纤维连结。超声检查显示病变与神经相连的阳性率为67%(36/54)。65例肿瘤手术切除后病理检查结果显示,62例肿瘤为神经鞘膜瘤,2例为神经纤维瘤,1例为神经纤维瘤病。结论超声检查能提供良性神经源性肿瘤较详细的形态、内部结构、边界、包膜以及肿瘤与周围组织的关系的信息,还能显示肿瘤与周围神经的联系以及血流情况等,检查方便易行,检查费用低廉,患者易于接受。     

胸壁神经鞘瘤的CT、超声表现和病理对照研究

目的 探讨胸壁神经鞘瘤的CT、超声表现及其与病理组织学间的关系,提高对胸壁神经鞘瘤影像表现的认识.资料与方法 搜集经手术病理证实的胸壁神经鞘瘤11例,回顾性分析其CT、超声表现和病理表现之间的对照关系.结果 10例良性神经鞘瘤,1例恶性神经鞘瘤,均为单发.CT和超声显示病灶位于胸神经走行分布区.良性病变表现为边界清晰的实性或囊实性肿块,呈中低密度或回声区.恶性病变边缘不规整,累及周围组织.肿瘤密度或回声是否均匀取决于瘤内Antoni B型组织的分布以及囊变、骨化或出血和血栓形成等变化.肿瘤强化表现多样,强化幅度一般为20～35 HU,主要由肿瘤内Antoni A型和Antoni B型组织比例决定;无强化或低强化取决于肿瘤囊变出血、胶原沉积、纤维化或钙化和Antoni B型组织分布.彩色多普勒血流显像(CDFI)显示肿瘤多无显著血流信号.结论 了解胸壁神经鞘瘤的病理学特征与CT和超声影像表现的相关性有助于诊断和鉴别诊断.     

瘤样钙盐沉着症的超声表现

目的 探讨瘤样钙盐沉着症的临床及超声表现。资料与方法 回顾性分析2016年1月—2022年5月四川省人民医院经手术病理证实的44例瘤样钙盐沉着症患者的临床及超声资料,总结临床表现（年龄、性别、压痛、质地、皮肤改变、血磷、碱性磷酸酶、血钙）及超声表现（病变部位、大小、内部回声、边界、后方声影、与周围结构的关系、血流信号）。结果 44例瘤样钙盐沉着症患者共47个病灶,17个病灶位于臀部,9个病灶位于肢体,33个病灶呈无痛性包块。44例患者血钙及碱性磷酸酶均正常,5例血磷升高。瘤样钙盐沉着症主要位于皮肤层、脂肪层或肌层内,不累及骨质。瘤样钙盐沉着症的超声表现分为3型,(1)结节状钙化灶堆积型：41个（87.23%）病灶表现为沙粒样或颗粒状钙化灶堆积呈结节状,所有结节后方均伴有声影,其中8个病灶边界较清楚,周边可见细窄的低回声带,内未见明显血流信号,10个病灶周边见较宽的低回声带,边界可辨,血流信号较丰富;(2)囊性团块伴钙化灶沉积型：4个（8.51%）病灶表现为囊性团块,内可见分隔,囊壁及分隔多发细沙样或颗粒样钙化灶沉积伴声影,囊性团块边界不清晰,囊壁可见稀疏血流信号;(3)孤立粗大钙化灶型...     

超声检查对甲状腺微小乳头状癌的诊断价值

目的通过对28例甲状腺微小乳头状癌患者的术前超声表现进行回顾性分析,探讨甲状腺微小乳头状癌的二维声像图和彩色多普勒特征。方法观察结节的超声表现,包括内部回声、有无钙化及钙化的特点、边界、形状、血流信号、有无侵犯被膜及颈部淋巴结转移等。结果 9例单发结节具有典型的甲状腺癌超声图像特征;4例单发结节仅表现为边界清,形态尚规则,低回声,内部回声均匀,血流稀少;15例多发结节中5例仅表现为边界清,形态规则,中等或偏低回声,8例内部可见微小钙化灶,血流较丰富,2例内部可见粗大或弧形的钙化灶。结论高频超声具有准确、实时、方便、价格低廉,尤其适用于随访观察,超声检查对甲状腺微小乳头状癌具有重要的诊断价值。     

男性乳腺疾病的超声诊断

目的探讨男性乳腺常见疾病的声像图表现,以提高其诊断水平。方法 82例经超声检查并经临床证实的男性乳腺疾病,包括乳腺发育症65例,乳腺炎7例,乳腺癌5例,乳腺纤维腺瘤2例,乳腺脂肪瘤3例,对所有患者的声像图表现进行了回顾性分析。结果声像图显示男性乳腺疾病随病种而有不同表现,乳腺发育症呈弥漫型与结节型低回声区;乳腺癌呈边界不清和内部回声不均匀的病灶,常伴灶内微小钙化;急性乳腺炎表现为乳头周围局限性低回声区,边界清楚,回声均匀,而慢性乳腺炎表现为乳房内不均质低回声区;乳腺纤维腺瘤表现为椭圆形实质低回声光团,边缘光整;乳腺脂肪瘤表现为边界清楚的扁椭圆形稍高或低回声光团。本组2例慢性乳腺炎误诊为乳腺癌。诊断敏感性、特异性、准确性、阳性预测值及阴性预测值分别为100%,97.4%,96.3%,71.4%,97.4%。结论超声检测能直观显示男性乳腺病变的部位、大小、形态、内部回声及血流显像特征,有助于鉴别良性与恶性病变。     

小儿神经母细胞瘤特殊Ⅳ期的超声诊断价值及特征

目的:探讨小儿神经母细胞瘤特殊Ⅳ期(4sNB)的超声诊断价值及图象特征,以提高超声诊断水平。方法:回顾分析12例经手术病理证实的4sNB的超声表现特点。结果:原发瘤呈圆形或类圆形,边界清晰。肿瘤回声不均或欠均匀,中等回声为主7例,低回声为主4例,高回声为主1例。内部可见强回声光团或光点4例,1例可见小囊区。肝脏改变:肝巨大11例,1例肝不大。肝内呈弥漫密集大小不等中低回声结节11例,呈高回声结节1例。肝不大者以右睾丸转移为主要表现。腹膜后未探及肿大淋巴结。6例行CT检查,5例检出原发瘤,4例检出肝内转移灶。结论:4sNB原发瘤较小位于肾上腺,呈圆形或类圆形,超声很容易发现。绝大多数肝脏明显增大,肝内转移灶呈不规则形或球形弥漫低回声结节,亦可呈细小点状,少数为高回声结节。除肝转移外亦可睾丸转移。本病超声诊断简便准确,不需鉴别,并优于CT。     

彩色多普勒超声诊断甲状腺癌临床价值研究

目的：探讨彩色多普勒超声（彩超）诊断甲状腺癌的临床价值。方法：选择超声诊断甲状腺癌50例,分析其二维及彩超图像特征,并与术后病理学检查结果进行比较。结果：甲状腺癌二维及彩超主要表现多为单发结节,低回声,边界不清晰,部分边界呈毛刺样改变,结节内大多有特征性砂粒样钙化灶或粗钙化,或周边型钙化;同时也有无任何钙化灶病例。甲状腺癌血流速度与结节大小有关,与甲状腺癌所处位置无关。淋巴结转移彩超主要表现为淋巴结呈圆形或椭圆形,淋巴门和髓质消失,多为低回声合并钙化灶。经术后病理学证实,50例甲状腺癌中,彩超明确诊断恶性38例,可疑恶性10例,误诊2例,彩超诊断敏感度为96.0%。结论：彩超诊断甲状腺癌的敏感度较高,结合病理学检查可做出明确诊断。     

超声在乳腺实性神经内分泌癌诊断中的应用

目的 :探讨超声对乳腺实性神经内分泌癌的诊断价值。方法 :回顾性分析4例经病理证实为乳腺神经内分泌癌的超声表现。结果:4例均能触及包块,超声表现均为不均匀实性低回声包块,形态欠规则,均无钙化;3例边界欠清晰,1例边界清晰;4例肿块后方回声均略增强;CDFI示1例可见较粗大血流信号,2例可见少许点条样血流信号,1例未见明显血流信号。4例均未见腋窝淋巴结转移。结论:超声对乳腺实性神经内分泌癌的诊断有重要价值。     

Integrated imaging in peripheral nerve lesions in type 1 neurofibromatosis

PURPOSE: Our aim was to evaluate the role of Ultrasonography (US) and Magnetic Resonance (MR) in the staging and follow-up of peripheral nerve lesions in type 1 Neurofibromatosis (NF1). MATERIAL AND METHODS: We evaluated forty-six NF1 patients (16 males and 30 females, age range 12-65 years, mean age 34 years) affected by 51 soft tissue lesions, clinically diagnosed as subcutaneous (18 cases) and plexiform (33 cases) neurofibromas. The lesions were studied to identify site, size, extension, relationship with surrounding structures, and any features indicating malignant transformation. All patients underwent at least one US examination performed with a 7.5 - 10 MHz linear multi-frequency probe. All subcutaneous neurofibromas larger than 2 cm, all superficial or deep plexiform neurofibromas not clearly defined at US, and all large plexiform neurofibromas with massive involvement of surrounding tissues were studied by MR using 0.2 T magnet (Artoscan) or 1.5 T magnet (Magnetom Vision Plus Siemens). Fifteen patients underwent surgery; the remaining cases (31) were followed up according to the National Institutes of Health (NIH) protocol. RESULTS: The subcutaneous neurofibromas smaller than 2 cm showed homogeneous hypoechoic echotexture (10 cases), whereas lesions equal to or larger than 2 cm showed a characteristic target pattern (peripheral hypoechoic rim with hyperechoic core). All lesions larger than 2 cm studied by MRI displayed the target pattern in T2-weighted sequences, with peripheral signal hyperintensity and central signal hypointensity. At US, the 33 plexiform neurofibromas had an irregular shape with undefined borders; the patterns were classified as follows: 1) superficial plate-like lesions (14 cases); 2) superficial lesions with deep digitations (8 cases); 3) deep multi-lobulated lesions (5 cases); 4) extensive lesions massively involving soft tissues (6 cases). MRI was performed in 11 cases, showing an isointense or moderately hyperintense signal on T1-weighted sequences, high signal intensity on T2-weighted sequences, and, after intravenous gadolinium administration, variable enhancement on T1-weighted sequences. CONCLUSIONS: The results obtained in subcutaneous neurofibromas indicate a clear relationship between lesion size and US-MR imaging, with similar local staging. Since MRI failed to provide additional information, US may be considered the first-choice, and sometimes decisive, examination in these cases. As regards plexiform neurofibromas, US only proved useful in staging superficial lesions and partly deep multi-lobulated lesions as it accurately depicted lesion size, but not local extension; MRI is therefore useful in the preoperative staging of lesions. In extensive lesions, US proved unable to provide accurate and complete local staging of the lesions, so that MRI should be systematically used in these cases.     

Tumors and tumor-like lesions of peripheral nerves

The diagnosis of a peripheral nerve tumor can often be suggested on imaging. Direct continuity with a neural structure or location along a typical nerve distribution, shape, and intrinsic magnetic resonance (MR) signal characteristics represent the most important signs in this regard. Although several nonneoplastic nerve lesions can be specifically diagnosed by MR imaging, benign and malignant neoplasms of peripheral nerves can usually not be distinguished with confidence. This article reviews the MR imaging appearance, clinical and pathological features of schwannoma, localized neurofibroma, plexiform neurofibroma, intraneural perineurioma, fibrolipomatous hamartoma, nerve sheath ganglion, traumatic neuroma, malignant peripheral nerve sheath tumor, and secondary malignant neoplasms of peripheral nerves. Typical findings are illustrated on the basis of histologically confirmed cases.     

Neurofibromatosis type 1: a diagnostic mimicker at CT.

Neurofibromatosis type 1 (NF1) is the most common of the phakomatoses and has a variety of localized or, more frequently, systemic manifestations throughout the thorax, abdomen, pelvis, and extremities. Classic computed tomographic (CT) findings in NF1 with thoracic involvement include small, well-defined subcutaneous neurofibromas, focal thoracic scoliosis, posterior vertebral scalloping, enlarged neural foramina, and characteristic rib abnormalities due to bone dysplasia or erosion from adjacent neurofibromas. However, more atypical manifestations are occasionally seen, and magnetic resonance (MR) imaging can be useful in equivocal cases. NF1 with abdominopelvic involvement tends to arise in the retroperitoneal, mesenteric, and paraspinal regions; it may be quite extensive and therefore difficult to distinguish from adenopathy at CT. The multiplanar capabilities of MR imaging, particularly with T2 weighting, make this modality helpful in evaluating affected patients and making the diagnosis. The classic peripheral manifestations of NF1 include limb hemihypertrophy, pseudarthrosis, peripheral nerve neurofibromas, and subcutaneous common and plexiform neurofibromas. In some cases of NF1, imaging findings are inconclusive, and biopsy and subsequent pathologic analysis are required. Familiarity with the various manifestations of NF1 in different anatomic locations is important in making the diagnosis and optimizing postdiagnostic treatment.     

Extracerebral neoplastic manifestations in neurofibromatosis 1: integrated diagnostic imaging

PURPOSE: To analyze the extracerebral manifestations of type 1 neurofibromatosis (NF-1), with special reference to peripheral nerve tumors. MATERIAL AND METHODS: The findings of 376 NF-1 patients (194 men and 182 women; age range: 0.1-48 years, mean: 8.1) were retrospectively reviewed. The patients had been submitted to abdominopelvic and superficial US and, in case of abnormal US findings or in the presence of symptoms, to CT and/or MRI. In addition, we considered 5 more patients (2 men and 3 women; age range: 50-72 years, mean: 64.4) with incomplete forms of NF-1 diagnosed after the finding of nerve sheath tumors. Biopsy (12 cases), surgery (10 cases), or clinical-instrumental follow-up were the study criteria. RESULTS: In the first group of patients we identified 91 cutaneous, 222 subcutaneous, 11 pendulous and 25 internal neurofibromas. Plexiform neurofibromas were found in the neck (1 case), chest (6 cases), abdomen (16), pelvis (8). We also found 1 benign and 1 malignant Schwannomas, 2 nerve sheath fibrosarcomas, 1 dopamine-producing sympatoma and 1 spermacytoma. As for the second group of patients, we had 2 Schwannomas, 1 pulmonary neurofibroma, and 2 multiple plexiform neurofibromas. The neurofibromas exhibited homogeneous US hypoechogenicity or slight echogenicity, with little contrast enhancement at CT. MR showed peripheral hyperintensity and central hypointensity on T2-weighted sequences and marked contrast enhancement after gadolinium, sometimes with mostly central uptake. The plexiform neurofibromas, which are typical of NF-1, had poorly-defined or infiltrating margins, with similar findings to the previous ones but sometimes with less homogeneous patterns at both US and CT. The Schwannomas, which are a less common finding in NF-1, exhibited different features at MRI and CT, namely pseudo-liquid or solid-inhomogeneous patterns with irregular and inhomogeneous contrast enhancement relative to the Antoni A/B tumor component. In the malignant lesions we observed infiltrating patterns, with irregular and inhomogeneous contrast enhancement, arranged asymmetrically relative to the contralateral lesion. CONCLUSIONS: Extra-axial neoplasms are a frequent finding in NF-1. Despite the extremely variable appearances of some lesions (particularly Schwannomas), the typical plexiform neurofibroma exhibits characteristic patterns. The diagnosis of malignancy often requires bioptic confirmation.     

Granulomatous prostatitis: A hypoechoic lesion of the prostate

Numerous benign and malignant entities can disrupt the normal prostatic parenchymal architecture producing hypoechoic lesions in the peripheral zone. We report two cases of granulomatous prostatitis mimicking carcinoma. The differential diagnosis of hypoechoic lesions and the etiologies of granulomatous prostatitis are discussed. All hypoechoic lesions in the peripheral zones of the prostate require biopsy for histologic diagnosis.     

Granulomatous prostatitis: a hypoechoic lesion of the prostate

Numerous benign and malignant entities can disrupt the normal prostatic parenchymal architecture producing hypoechoic lesions in the peripheral zone. We report two cases of granulomatous prostatitis mimicking carcinoma. The differential diagnosis of hypoechoic lesions and the etiologies of granulomatous prostatitis are discussed. All hypoechoic lesions in the peripheral zones of the prostate require biopsy for histologic diagnosis.     

Abdominal manifestations of neurofibromatosis

The purpose of this review is to illustrate, with examples, the abdominal manifestations of neurofibromatosis type 1 (NF) on imaging, with emphasis on computed tomography. Mutations of the NF gene lead to abnormal tumor suppression. Consequently, NF is a complex disease, with patients having an increased prevalence of benign and malignant neoplasms throughout the body. We present cases of the most common abdominal presentations: neurofibroma, malignant peripheral nerve sheath tumor, pheochromocytoma, carcinoid, gastrointestinal stromal tumor, and seminoma.     

Magnetic resonance appearance of peripheral nerve sheath tumors

Magnetic resonance imaging (MRI) was used to evaluate 22 histologically proven peripheral nerve sheath tumors, approximately two-thirds of which arose in the lower extremity. The histologic distribution was as follows: 12 schwannomas, 7 neurofibromas, and 3 malignant peripheral nerve sheath tumors (2 of which occurred in patients with neurofibromatosis). Most lesions demonstrated an intermediate to moderately bright signal on T₁-weighted images and were minimally inhomogeneous. All lesions were moderately bright on proton-density-weighted images and bright on T₂-weighted images, again with variable inhomogeneity. The extent of the tumor was best assessed on proton-density- and T₂-weighted images. Smooth margins were noted in 19 lesions. Of the 3 remaining lesions, 2 were malignant (but had been subjected to biopsy prior to MRI), and the other lesion was a plexiform neurofibroma. MRI accurately determined the relationship between the lesion and the adjacent neurovascular structures and muscles, thereby assisting surgical management. On MRI, 5 lesions demonstrated coexistent subtle muscle atrophy along the longitudinal axis of surrounding or distally innervated musculature. This latter finding, together with the presence of a tumor in the vicinity of a large nerve trunk, suggests a peripheral nerve sheath neoplasm.The opinions and assertions contained herein are the private views of the authors and do not reflect the views of the Uniformed Services University of the Health Sciences, the Department of the Army, or of the Department of Defense     

Diffusion-weighted imaging of retroperitoneal malignant peripheral nerve sheath tumor in a patient with neurofibromatosis type 1.

We present the diffusion-weighted imaging (DWI) findings for a malignant peripheral nerve sheath tumor arising in a retroperitoneal plexiform neurofibroma in a patient with neurofibromatosis type 1. Signal intensity of the malignant area was high on DWI and low on the apparent diffusion coefficient map and differed from findings for the benign area. DWI enabled clear differentiation between malignant and benign areas of the tumor.