神经鞘瘤的X线和MRI表现及诊断价值

目的 探讨神经鞘瘤的X线与MRI表现及二者在神经鞘瘤临床诊断中的应用价值。方法 选择2012年1月至2016年3月广州医科大学附属第四医院及广州医科大学附属第二医院收治的神经鞘瘤患者27例（27个病灶）作为研究对象进行回顾性分析，总结患者的X线与MRI表现及鉴别诊断要点。结果 神经鞘瘤的X线主要表现为软组织肿胀及肿块影，可伴有病理性钙化，骨内神经鞘瘤的X线表现主要为局限性单囊状类圆形改变，一般无钙化、骨化。恶性病例多边界不清，可见硬化缘，正常皮质髓质过度带大幅增宽，肿瘤穿破皮质累及周围软组织，脂肪间隙消失；良性病例边界清晰、皮质变薄，边缘硬化，周围软组织不受累及。神经鞘瘤的MRI增强可见病灶有完整包膜，可见靶征与神经出入征。恶性病例多表现为T₁WI等信号、T₂WI不均匀高信号；良性肿瘤亦可信号不均，T₁WI呈等信号，T₂WI呈高、低、等混杂信号。结论 MRI具有良好的软组织分辨力，多方位与多参数成像可精确显示肿瘤大小、形态、边缘及其与周围组织结构关系，对神经鞘瘤的诊断效果优于X线，诊断过程中需注意观察相关征象并予以鉴别。

Analysis of the findings and diagnostic value of X-ray and MRI in schwannoma

Objective To explore the findings of X-ray and MRI of schwannoma and their application value in clinical diagnosis of schwannoma. Methods Retrospective analysis was performed in 27 patients (27 lesions) with schwannomas who were admitted to the Fourth Affiliated Hospital of Guangzhou Medical University and the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and March 2016. The X-ray and MRI findings and key points of differential diagnosis were summarized. Results The main X-ray findings of schwannoma were soft tissue swelling and masses, may be accompanied by pethological calcification. The main X-ray finding of schwannoma of the bone were local single cystic and quasi-circular changes, generally without calcification or ossification. The main findings of malignant cases were fuzzy boundaries, with sclerotic margin, normal cortex/medulla transition zone obviously widened, tumor breaking into cortex, involvement of surrounding soft tissues and disappeared fat gap. The main findings of benign cases were clear boundaries, thinned cortex, sclerotic margin, without involvement of surrounding soft tissues. Enhanced MRI of schwannoma showed that lesions were with a complete capsule, target signs and nerve out-in signs. Malignant cases showed equal signal on T₁WI and high signal on T₂WI mixed signal; Benign tumors showed inhomogenous signal, with equal signal on T₁WI, high, low and mixed signal on T₂WI.Conclusion MRI has good definition to high soft tissues. Multidirectional and multi-parameter imaging can accurately display the size, shape and edge of tumor and the relationship with surrounding tissues, of which the diagnostic effect is superior to X-ray. The related signs need to be observed and identified during the diagnosis.