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您当前的位置:首页 > 神经系统病例 > 脑脊膜

椎管神经鞘瘤(Spinal Schwannoma)MRI病例图片影像诊断分析

时间:2010-11-29  来源:ACR February 18, 2009  作者:freemanpyw译 【复制分享】【讨论-纠错】【举报

NtB影像园XCTMR.com

【讨论】:Nerve sheath tumors and meningiomas are the two most common intradural-extramedullary spinal tumors, representing 30 and 25% of presenting lesions, respectively. Both are typically benign, slow-growing tumors which may be present for years before there is functional impairment. MRI is the modality of choice in distinguishing these pathologies.NtB影像园XCTMR.com

    神经鞘瘤和脑膜瘤是两种最常见的髓内硬膜外肿瘤,分别占30%和25%。两者都是良性、缓慢生长的肿瘤,MRI是首选的检查方式。NtB影像园XCTMR.com

    nerve sheath tumors compromise schwannomas and neurofibromas, most often present in the fourth and fifth decades of life, and may be associated with neurofibromatosis. Schwannomas arise from dorsal sensory roots, more commonly in the lower thoracic and lumbar areas. Neurofibromas, unlike schwannomas, involve the parent nerve, and are unencapsulated.NtB影像园XCTMR.com

   神经鞘瘤又可以分为许旺氏细胞瘤和神经纤维瘤,大部分见于40-50岁,可能伴有神经纤维瘤病。许旺氏细胞瘤起源于背侧神经根,更常见于下段胸椎和腰椎区域,而神经纤维瘤常常累及神经根,且是无包膜的。NtB影像园XCTMR.com

   Meningiomas are the second most common intradural-extramedullary spinal tumor and are more common in women. Multiple meningiomas may also be associated with neurofibromatosis. Meningiomas are predominately located in the upper and mid- thoracic areas, different from schwannomas, but are in a similar distribution in the anterior-posterior plane. Both nerve sheath tumors and meningiomas can be found in a “dumbbell shape,” with both extra- and intradural components.NtB影像园XCTMR.com

    脊膜瘤是第二常见的髓外硬膜下肿瘤,更常见于女性。多发性的脊膜瘤可能也伴有神经纤维瘤病。不同于许旺氏细胞瘤,脊膜瘤主要位于上段和中段胸椎水平,但是在前后方向有相似的分布。神经鞘瘤和脊膜瘤都可以累及硬膜内外,而表现为哑铃状。NtB影像园XCTMR.com
NtB影像园XCTMR.com
    MRI  is the modality of choice in the evaluation of intradural-extramedullary spinal tumors. Nerve sheath tumors and meningiomas demonstrate characteristics of craniocaudal location divergence, hyperintensity and heterogeneity of T2W images, intensity and heterogeneity of enhancement, and the presence or absence of the “dural tail sign”. Schwannomas are typically hyperintense and heterogeneous compared to meningiomas on T2W images. The tumors show different contrast enhancement- meningiomas enhance moderately and homogenously, while schwannomas enhance strongly and irregularly. The “dural tail sign,” a reactive thickening of dura tapering away from the tumor, is associated with meningiomas, though this is not a specific sign. Additionally, neural foraminal extension and foraminal widening is suggestive of schwannoma, while bony sclerosis surrounding the mass is suggestive of meningioma.NtB影像园XCTMR.com

    对于髓外硬膜下肿瘤,MRI是首选的检查方式,神经鞘瘤和脊膜瘤显示的特征性表现可以帮助我们建立一个鉴别诊断体系,这居于病变的部位、T2序列上信号的强度和均匀性、强化程度和均匀性以及是否有脑膜尾征。许旺氏细胞瘤与脊膜瘤相比,通常信号更高更不均匀;两者的强化程度也不同,脊膜瘤中度均匀性强化,而许旺氏细胞瘤明显强化而不规则。脑膜尾征即反应性的硬脊膜增厚,常常见于脊膜瘤,虽然这不是一个特异性的征像。另外,神经孔的扩大和增宽也提示神经鞘瘤,而环绕肿瘤的骨质硬化提示脊膜瘤NtB影像园XCTMR.com

    The differential diagnosis for intradural-extramedullary spinal mass lesions includes nerve sheath tumor, meningioma, metastasis, paraganglioma, vascular malformations, inflammatory process, and developmental lesions. Vascular tumors may necessitate pre-operative angiography and embolizationNtB影像园XCTMR.com

    脊椎髓外硬膜下肿块的鉴别诊断包括神经鞘瘤、脊膜瘤、转移瘤、副神经节瘤、血管畸形、炎性病变以及发育性病变。血管性肿瘤可能需要采取术前的血管造影和栓塞。NtB影像园XCTMR.com

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