周围神经鞘瘤影像学表现及误诊分析

目的 探讨周围神经鞘瘤的影像学表现及诊断要点,以提高临床确诊率.方法 回顾性分析经病理学检查证实的周围神经鞘瘤6例的CT及磁共振成像（MRI）表现.结果 本组6例行CT平扫及增强扫描2例,行MRI平扫及增强扫描4例,其中病变位于舌根、胸壁、腹膜后各1例,病变位于下肢3例.经病理结果证实首次诊断正确者2例（小腿神经鞘瘤）,误诊4例,误诊为血管瘤、转移瘤、横纹肌肉瘤和卵巢肿瘤各1例.6例确诊后均予手术切除,其中左侧大腿神经鞘瘤1例因肿块未完全切除,术后3个月复发；余5例均完整切除,预后良好,未见复发.结论 CT、MRI检查对周围神经鞘瘤术前的定位、定性及鉴别诊断具有一定价值；对于发生于少见部位且影像学特征不典型的良性周围神经鞘瘤易误诊.

Imaging Findings and Misdiagnosis Causes of Peripheral Nerve Sheath Tumors

Objective To explore imaging findings and diagnostic criteria of peripheral nerve sheath tumors in order to improve the accuracy rate of clinical diagnosis.Methods The CT and MRI imaging findings of six patients with peripheral nerve sheath tumors confirmed by pathology were retrospectively analyzed.Results Two of the six patients underwent the plain and contrast enhancement CT scans,and 4 patients underwent the plain and contrast enhancement MRI scans.Tumors were found in the rear of the radix linguae,chest wall and peritoneum in one patient respectively,and found in the lower limbs in three patients.Pathological results showed that the primal diagnosis was correct in two patients （surae neurilemmoma）,and the other four patients were misdiagnosed as having hemangioma,metastatic tumors,rhabdomyosarcoma and ovarian neoplasms respectively.Six patients underwent the surgical ablation after final diagnosis.One with left thigh neurilemmoma recurred postoperative 3 months due to incomplete tumor resection ; the other five patients underwent complete resection with good prognosis and no recurrence.Conclusion CT and MRI examinations are valuable in confirming the preoperative location,qualitation and differential diagnosis of the peripheral nerve sheath tumors; the benign peripheral nerve sheath tumors with atypical imaging characteristics in rare positions are often misdiagnosed.