脑实质神经鞘瘤影像学表现及相关病理分析

目的：通过对脑实质神经鞘瘤的影像学表现及相关病理分析，提高该病的诊断准确率，有利于手术方案的制定及患者的预后。方法：回顾性分析4例经手术病理及免疫组织化学证实的脑实质神经鞘瘤。其中1例行CT平扫及增强检查，1例行MR平扫，2例行CT及MR平扫＋增强扫描，并结合文献进行分析。结果：4例中，3例年龄小于30岁，均位于幕上；均出现囊变征象，3例出现壁结节，3例增强者中壁结节呈明显强化2例，中度强化1例；1例壁结节内见钙化征象，1例周边水肿明显；病理上均见AntoniA区、B区；免疫组织化学检查，酸性钙结合蛋白（S100）、波形蛋白（Vim）阳性，胶质纤维酸性蛋白（GFAP）、上皮膜抗原（EMA）阴性。结论：脑实质神经鞘瘤好发于青少年，囊变及周围水肿为其特征性表现，结合病理及免疫组织化学检查有利于最终确诊。

Imaging characteristics of intraparenchymal schwannoma and the related pathology

Objective To Analyze the imaging characteristics of intraparenchymal schwannoma and the related pathology, in order to improve the accuracy of diagnosis and be in favor of the clinics and the prognosis. Methods Four cases were confirmed to be intraparenchymal schwannoma by pathological and immunohistochemistry examination. One case was examined with precontrast and enhanced CT scanning, one with unenhanced MRI scanning, two with unenhanced and enhanced CT and MRI scanning. Their images were retrospectively analyzed. Results Of the four cases, three patients were less than 30 years old, with tumors located supratentorially. Cysts were found in all cases, with nodules on the wall in 3 cases. The nodules were enhanced markedly in two cases and moderately in one case. In addition, calcification was detected in one case and prominent peritumoral edema existed in 1 case. The picture of the pathology demonstrated Antoni type A and Antoni type B. Immunostaining showed intense immunoreactivity for S-100 protein and Vim and negative immunoreactivity for GFAP and EMA. Conclusions Intraparenchymal schwannoma mostly occurred in juvenile, which located supratentorially in most cases. The presence of a cyst and peritumoral edema together with the tumor appears to be characteristic of intraparenchymal schwannoma. Calcification or the enhanced nodule is the helpful sign for the diagnosis. Combining the imaging findings with the pathology and immunohistochemistry results can gain the accurate diagnosis. [