Seul Ki Lee1, Jee-Young Kim2, Yeon-Soo Lee3, Hyang Sook Jeong4. 1. Department of Radiology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. 2. Department of Radiology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. jeeykim@catholic.ac.kr. 3. Department of Radiology, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. 4. Department of Hospital Pathology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon-si, 16247, Gyeonggi-do, Republic of Korea.
Abstract
PURPOSE: To analyze the prevalence of classic magnetic resonance imaging (MRI) findings of intramuscular peripheral nerve sheath tumors (PNSTs), including schwannoma, ancient schwannoma, and neurofibroma. METHOD: Thirty pathologically confirmed benign intramuscular PNSTs (24 schwannomas, 3 ancient schwannomas, and 3 neurofibromas) were retrospectively reviewed. Classic MRI findings of PNSTs including split fat sign, fascicular sign, target sign, entering and exiting nerve, and thin hyperintense rim were assessed for each intramuscular PNST. Denervation change of the affected muscle was also assessed. In ancient schwannoma and neurofibroma, the signal intensity (SI) and enhancement pattern were analyzed. RESULTS: All intramuscular schwannomas revealed two more classic MRI findings. Eight of the 24 intramuscular schwannomas revealed affected muscle denervation change. All intramuscular ancient schwannomas showed only split fat sign. All intramuscular ancient schwannomas showed denervation change of the associated muscle. All intramuscular neurofibroma showed split fat sign and one case with target sign was detected. Ancient schwannomas were isointense SI on T1-weighted image (T1WI) and one case had hyperintense foci. They showed heterogeneously hyperintense SI on T2-weighted image (T2WI) with heterogeneous enhancement. Neurofibromas were isointense SI (2/3) and slight hyperintense SI (1/3) on T1WI and heterogeneously hyperintense SI on T2WI with heterogeneous enhancement. One ancient schwannoma showed conglomerated calcifications. CONCLUSIONS: Intramuscular schwannomas were easily diagnosed based on MRI. In the case of intramuscular ancient schwannoma and neurofibroma with only split fat sign among the classic MRI findings, they might be distinguished from other intramuscular soft tissue tumors based on muscle denervation change or typical crescent split fat sign.
PURPOSE: To analyze the prevalence of classic magnetic resonance imaging (MRI) findings of intramuscular peripheral nerve sheath tumors (PNSTs), including schwannoma, ancient schwannoma, and neurofibroma. METHOD: Thirty pathologically confirmed benign intramuscular PNSTs (24 schwannomas, 3 ancient schwannomas, and 3 neurofibromas) were retrospectively reviewed. Classic MRI findings of PNSTs including split fat sign, fascicular sign, target sign, entering and exiting nerve, and thin hyperintense rim were assessed for each intramuscular PNST. Denervation change of the affected muscle was also assessed. In ancient schwannoma and neurofibroma, the signal intensity (SI) and enhancement pattern were analyzed. RESULTS: All intramuscular schwannomas revealed two more classic MRI findings. Eight of the 24 intramuscular schwannomas revealed affected muscle denervation change. All intramuscular ancient schwannomas showed only split fat sign. All intramuscular ancient schwannomas showed denervation change of the associated muscle. All intramuscular neurofibroma showed split fat sign and one case with target sign was detected. Ancient schwannomas were isointense SI on T1-weighted image (T1WI) and one case had hyperintense foci. They showed heterogeneously hyperintense SI on T2-weighted image (T2WI) with heterogeneous enhancement. Neurofibromas were isointense SI (2/3) and slight hyperintense SI (1/3) on T1WI and heterogeneously hyperintense SI on T2WI with heterogeneous enhancement. One ancient schwannoma showed conglomerated calcifications. CONCLUSIONS: Intramuscular schwannomas were easily diagnosed based on MRI. In the case of intramuscular ancient schwannoma and neurofibroma with only split fat sign among the classic MRI findings, they might be distinguished from other intramuscular soft tissue tumors based on muscle denervation change or typical crescent split fat sign.
Entities:
Keywords:
Entering and exiting nerves; Fascicular pattern; Intramuscular peripheral nerve sheath tumor; Split fat sign; Target sign; Thin hyperintense rim