颈部神经源性肿瘤的MRI表现及其相关病理改变的研究
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摘要
目的：探讨颈部神经源性肿瘤的MR影像表现及其相关的病理基础，旨在揭示颈部不同组织类型神经源性肿瘤特有的MR影像表现，尤其是副神经节瘤与神经鞘肿瘤的MR影像表现的鉴别诊断，提高术前诊断准确率，为临床治疗方案的制定提供可靠依据。
方法：回顾性分析51例经手术、病理证实的颈部神经源性肿瘤的MR影像表现，并与相应的病理大体标本及组织切片进行对照分析。对其临床资料进行统计分析。
结果：
1、颈部副神经节瘤病程长于神经鞘瘤与神经纤维瘤，两者差异有显著性意义(P〈0.01)。它们在年龄及性别分布上无明显差别(P〉0.05)。
2、不同组织类型的神经源肿瘤的肿块大小及形状无明显差别。神经鞘瘤及神经纤维瘤肿块边缘光滑，而副节瘤肿块边缘多数不光滑，它们之间的差异有显著性意义(P〈0.01)。
3、T2WI上副节瘤绝大多数呈中等信号，神经鞘肿瘤绝大多数呈高信号，二者差异有显著性意义(P〈0.01)。T1WI上它们基本上都呈低信号。
4、副节瘤信号相对均匀，神经鞘肿瘤信号不均匀，尤以T2WI
上为突出，它们之间的差异有显著性意义瞩＜0刀1、增强扫
描，副节瘤多呈均匀强化，而神经鞘肿瘤 100％显示不均
匀强化，二者差异有显著性意义o＜0刀 1卜
5、大多数副节瘤肿块内及其周围可见斑点状及迂曲条状血管
流空影，而神经鞘肿瘤几乎见不到这种征象，二者差异有
显著性意义O功刀1）
6、靶征仅见于神经纤维瘤，神经鞘瘤及副节瘤无此征象。
7、虽然舌骨水平的神经鞘肿瘤也可引起颈动脉分叉角度扩
大，但副节瘤几乎 100％见到此征象，它们的差异有显著
性意义严＜0刀1）。
8、不同组织类型神经源肿瘤的MRI表现与其病理组织学所见
有好的对应关系：副节瘤的血管流空征与病理组织切片见
到的肿块内丰富的血窦相一致；TZWI上神经鞘瘤信号不均
匀与病理组织切片上集细胞区与乏细胞区交错分布、肿块
内囊变及出血有关；神经纤维瘤的靶征反映了组织切片上
中央区及周围区成分的差异。
结论：
1．颈部不同组织类型的神经源性肿瘤MM表现各具特点。肿块内
及周围血管流空征，TZWI上病灶信号强度及其肿块内信号结构，
强化均匀程度及肿块边缘光滑度是鉴别副节瘤与神经鞘瘤及神经
纤维瘤的最主要征象。MRA成像有助于副节瘤与神经鞘肿瘤的
鉴别。靶征是神经纤维瘤特有的MRJ表现。
2
2．颈部不同组织类型神经源性肿瘤的MR影像表现具有其相应病理
组织学基础。二者有很好的对应关系。
3．鉴别颈部神经源性肿瘤不同组织类型具有重要的临床价值。可指
导制定治疗方案，术前准备及术中处理，并预测术后可能并发症
的发生。
Objective: To find the characteristics of various histologic types of neurogenic tumors on the MR imaging appearances and the corresponding pathologic fundaments, and to provide reliable evidences for preoperative accurate diagnosis and clinical treatment of paraganglioma and nerve-sheath tumor.
Method: MR imaging of 51 cervical neurogenic tumors treated with operation were analyzed retrospectively, and then compared with corresponding histopathological samples. The clinical information was analyzed statistically. Result:
1. Disease duration of paraganglioma was longer than that of nerve sheath tumor(P<0.01).No significant differences were seen about their age and sex distribution.. 2.No significant differences were observed in size and shape of mass between paraganglioma and nerve-sheath tomur. But the edge of nerve-sheath tumor was often smooth, while most edge of paraganglioma was unsmooth(P<0.01).
3.Most paragangliomas showed intermediate signal intensity on T2-weighted images, and nearly all nerve-sheath tumor presented as high signal intensity on T2-weighted imaging(P<0.01).
4. Compared with that of nerve-sheath tumor signal of paraganglioma was relative homogenous, especially on T2-weighted images(p<0.01). Most paraganglioma was detected to exhibit homogeneous enhancement after iv administration of MR contrast media. While all of the nerve-sheath tumors exhibited inhomogeneous enhancement ( P<0.01 ).
5.Most paragangliomas demonstrated multiple punctate and serpentine areas of signal void in and around tumor, but no similar features were found in nerve-sheath tumors(P<0.01).
6.Target appearances was seen only in neurofibromas.
T.The enlargement of the carotid bifurcation might be seen in some of cervical neurogenic tumors, but such sign was found in all paragangliomas (up to 100%).
8.A well corresponding relation between MR imaging appearances of various neurogenic tumor and pathologic findings were shown. The vascular flow void of the
paraganglioma was closely related to numerous vessel channel seen on pathologic specimen. The target appearance of neurofibromas at MR imaging represented the geographic difference between the histologic zones of the neurofibroma. The inhomogeneous signal intensity of schwannomas at T2-weighted imaging was well related to alternating distribution of dense and scanty cellular areas, cystic degeneration ,and hemorrhage within the tumors.
Conclusion:
l.Each of cervical neurogenic rumors has characteristics of MR imaging . Vascular flow void in and around tumor, signal intensity of masses and signal structure in masses on T2-weighted imaging, homogeneous enhancement and smooth edge of masses were important feature to distinguish paraganglioms with nerve-sheath tumors. The target appearances was the particular manifestations of neurofibroma on MR images.
2.MR imaging appearances of cervical neurogenic tumor were well corresponding related to pathologic fundament.
3.MR imageing appearances of cervical neurogenic tumors may be important value to the distinguishment various histologic types of cervical neruogenic tumors ,and also of
great help to the selection of proper clinical treatment, preoperative preparation, intraoperative manipulation, and prediction of postoperative complication which may occur in some case.
方法：回顾性分析51例经手术、病理证实的颈部神经源性肿瘤的MR影像表现，并与相应的病理大体标本及组织切片进行对照分析。对其临床资料进行统计分析。
结果：
1、颈部副神经节瘤病程长于神经鞘瘤与神经纤维瘤，两者差异有显著性意义(P〈0.01)。它们在年龄及性别分布上无明显差别(P〉0.05)。
2、不同组织类型的神经源肿瘤的肿块大小及形状无明显差别。神经鞘瘤及神经纤维瘤肿块边缘光滑，而副节瘤肿块边缘多数不光滑，它们之间的差异有显著性意义(P〈0.01)。
3、T2WI上副节瘤绝大多数呈中等信号，神经鞘肿瘤绝大多数呈高信号，二者差异有显著性意义(P〈0.01)。T1WI上它们基本上都呈低信号。
4、副节瘤信号相对均匀，神经鞘肿瘤信号不均匀，尤以T2WI
上为突出，它们之间的差异有显著性意义瞩＜0刀1、增强扫
描，副节瘤多呈均匀强化，而神经鞘肿瘤 100％显示不均
匀强化，二者差异有显著性意义o＜0刀 1卜
5、大多数副节瘤肿块内及其周围可见斑点状及迂曲条状血管
流空影，而神经鞘肿瘤几乎见不到这种征象，二者差异有
显著性意义O功刀1）
6、靶征仅见于神经纤维瘤，神经鞘瘤及副节瘤无此征象。
7、虽然舌骨水平的神经鞘肿瘤也可引起颈动脉分叉角度扩
大，但副节瘤几乎 100％见到此征象，它们的差异有显著
性意义严＜0刀1）。
8、不同组织类型神经源肿瘤的MRI表现与其病理组织学所见
有好的对应关系：副节瘤的血管流空征与病理组织切片见
到的肿块内丰富的血窦相一致；TZWI上神经鞘瘤信号不均
匀与病理组织切片上集细胞区与乏细胞区交错分布、肿块
内囊变及出血有关；神经纤维瘤的靶征反映了组织切片上
中央区及周围区成分的差异。
结论：
1．颈部不同组织类型的神经源性肿瘤MM表现各具特点。肿块内
及周围血管流空征，TZWI上病灶信号强度及其肿块内信号结构，
强化均匀程度及肿块边缘光滑度是鉴别副节瘤与神经鞘瘤及神经
纤维瘤的最主要征象。MRA成像有助于副节瘤与神经鞘肿瘤的
鉴别。靶征是神经纤维瘤特有的MRJ表现。
2
2．颈部不同组织类型神经源性肿瘤的MR影像表现具有其相应病理
组织学基础。二者有很好的对应关系。
3．鉴别颈部神经源性肿瘤不同组织类型具有重要的临床价值。可指
导制定治疗方案，术前准备及术中处理，并预测术后可能并发症
的发生。
Objective: To find the characteristics of various histologic types of neurogenic tumors on the MR imaging appearances and the corresponding pathologic fundaments, and to provide reliable evidences for preoperative accurate diagnosis and clinical treatment of paraganglioma and nerve-sheath tumor.
Method: MR imaging of 51 cervical neurogenic tumors treated with operation were analyzed retrospectively, and then compared with corresponding histopathological samples. The clinical information was analyzed statistically. Result:
1. Disease duration of paraganglioma was longer than that of nerve sheath tumor(P<0.01).No significant differences were seen about their age and sex distribution.. 2.No significant differences were observed in size and shape of mass between paraganglioma and nerve-sheath tomur. But the edge of nerve-sheath tumor was often smooth, while most edge of paraganglioma was unsmooth(P<0.01).
3.Most paragangliomas showed intermediate signal intensity on T2-weighted images, and nearly all nerve-sheath tumor presented as high signal intensity on T2-weighted imaging(P<0.01).
4. Compared with that of nerve-sheath tumor signal of paraganglioma was relative homogenous, especially on T2-weighted images(p<0.01). Most paraganglioma was detected to exhibit homogeneous enhancement after iv administration of MR contrast media. While all of the nerve-sheath tumors exhibited inhomogeneous enhancement ( P<0.01 ).
5.Most paragangliomas demonstrated multiple punctate and serpentine areas of signal void in and around tumor, but no similar features were found in nerve-sheath tumors(P<0.01).
6.Target appearances was seen only in neurofibromas.
T.The enlargement of the carotid bifurcation might be seen in some of cervical neurogenic tumors, but such sign was found in all paragangliomas (up to 100%).
8.A well corresponding relation between MR imaging appearances of various neurogenic tumor and pathologic findings were shown. The vascular flow void of the
paraganglioma was closely related to numerous vessel channel seen on pathologic specimen. The target appearance of neurofibromas at MR imaging represented the geographic difference between the histologic zones of the neurofibroma. The inhomogeneous signal intensity of schwannomas at T2-weighted imaging was well related to alternating distribution of dense and scanty cellular areas, cystic degeneration ,and hemorrhage within the tumors.
Conclusion:
l.Each of cervical neurogenic rumors has characteristics of MR imaging . Vascular flow void in and around tumor, signal intensity of masses and signal structure in masses on T2-weighted imaging, homogeneous enhancement and smooth edge of masses were important feature to distinguish paraganglioms with nerve-sheath tumors. The target appearances was the particular manifestations of neurofibroma on MR images.
2.MR imaging appearances of cervical neurogenic tumor were well corresponding related to pathologic fundament.
3.MR imageing appearances of cervical neurogenic tumors may be important value to the distinguishment various histologic types of cervical neruogenic tumors ,and also of
great help to the selection of proper clinical treatment, preoperative preparation, intraoperative manipulation, and prediction of postoperative complication which may occur in some case.
引文
1．王玖华，杨天锡，刘邦令。颈部周围神经源性肿瘤的CT诊断。中华放射学杂志，1992；26：458—461。
2．王弘士，杨天锡，顾雅佳。颈动脉间隙肿瘤的CT诊断。中华放射学杂志。1994；28：677—681。
3．曹代荣，倪希和，王彪，等。3例颈动脉体瘤的CT诊断。福建医学院学报，1994：28；58—60。
4．罗德仁，石木兰。颈部神经源肿瘤的CT诊断。临床放射学杂志，1999；18：333—336。
5. Furukawa M, Furukawa MK, Katoh K, et al. Differentiation between schwannoma of the vagus nerve and schwannoma of the cervical sympathetic chain by imaging diagnosis. Laryngoscope, 1996,106:554.
6．顾雅佳，王玖华，陈彤箴。颈部神经鞘瘤的CT表现及其病理基础。中华放射学杂志，2000；34：551—554。
7. Cohen LM, Schwartz AM, Rockoff SD. Benign schwannomas :pathologic basis for CT inhomogeneities. AJR,1986,147:141-143.
8. Olsen WL,Dillon WP, Kelly WM,et al. MR imaging of paragwngliomas. AJR; 1987,142:201.
9．杨军，周康荣，陈祖望，等。颈动脉体瘤的MRI和MRA表现。临床放射学杂志，2000；19(5)：275。
10. Colletti-PM; Terk-MR; Zee-CS. Magnetic resonance angiography in
neck mass. Comput-Med-Imaging-Graph. 1996 Sep-Oct;20(5) :379-88．
11． Stein-AM; Lewin-JS; Maniglia-AJ. Value of magnetic resonance angiography in the evaluation of head and neck neoplasms. Otolaryngol-Head-Neck-Surg. 1996Jan: 114(1) : 125-
12． Aisen AM, Martel W, Braunstein EM, et al. MRI and CT evaluation of primary bone and soft tissue tumors. AJR 1986; 146:749-756．
13． Sun JS, Abenoza P, Galloway HR, et al . Peripheral(extracranial) nerve tumors: correlation of MR imaging and histologic findings. Radiology, 1992, 183:341-346．
14． Rao OB, Koeller KK, Adair CF. Paragangliomas of head and neck : Radiologic-pathologic correlation Radiographics, 1999,19:1605．
15． Reyt E, Guidicelli H, Mouret P, et al. Cervical branchiomeric paraganglioma: report of 21 cases. Ann Otolaryngol Chir Cervicofac 1992; 109:2240-244．
16． Liapis C, Kougoulakis A, Karydakis V, et al .Changing trends in management of carotid body tumors. Am Surg 1995;61:989-993．
17． Westerband-A; Hunter-GC; Cintora-I; et al . Current trend in the detection and management of carotid body tumors. J-Vasc-Surg. 1998 Jul; 28910:84-92; discussion 92-3．
18． Urquhart AC, Joimson JT, Myers EN, et al .Glomus vagal:
Paraganglioms of the vagus nerve. Laryngoscope. 1994,104:440-445．
19． Kohn-JS; Raftery-KB; Jewell-ER. Familial carotid body tumors: a closer look. J-Vasc-Surg. 1999 Apr; 29(4) :649-53．
20． Phillip Gardner, MD; Michael Dalsing ,MD; Edward weisberger, MD; et al. Carotid body tumors, inheritance, and high incidence of associated cervical paragangliomas. Am-J-Surg. 1996; 172: 196-199
21． Borowy-ZJ; Probst-L; Deitel-M; et al .A family exhibiting carotid body tumor . Can-J-Surg. 1992 Oct;35(5) :546-51．
22． Protst-LE;Shankar-L;Borowy-Z. Bilateral carotid body tumors.J-Otolargngol. 1992 Apr;21(2) : 160-2．
23． Som PM, Sacher M, Stollman AL, et al . Common tumors of the parapharyngeal space : refined imaging diagnosis. Radiology 1988,169:81-85．
24． Adrian P.G. van Gils, Rene van den Berg,Theo H.M.Falke, et al. MR Diagnosis of Paraganglioma of the Head and Neck: value of Contrast Enhancement. AJR,1994;162:147-153．
25． Sakai F, Sone S, Kiyono K, et al .Intrathoracic Neurogenis Tumors:MR-Pathologic Correlation. AJR, 1992; 159:279-283．
26． 刘庆余, 梁碧玲, 陈健宇. 软组织神经源性肿瘤的MRI诊断. 临床放射学杂志, 1999; 358-360
27． Enzinger FM, Weiss SW. Soft tissue tumors. St Louis:
Mosby, 1994.719-735.
28．邹绿清，粟占兰。17例颈动脉体瘤的临床和病理特征。中国医师杂志 1999；1：36。
29. Matticari-S;Credi-G;Pratesi-C et al .Diagnosis and surgical treatment of the carotid body tumors. J-Cardiovas-Surg-Torino.1995 Jun;36(3):233-9.
2．王弘士，杨天锡，顾雅佳。颈动脉间隙肿瘤的CT诊断。中华放射学杂志。1994；28：677—681。
3．曹代荣，倪希和，王彪，等。3例颈动脉体瘤的CT诊断。福建医学院学报，1994：28；58—60。
4．罗德仁，石木兰。颈部神经源肿瘤的CT诊断。临床放射学杂志，1999；18：333—336。
5. Furukawa M, Furukawa MK, Katoh K, et al. Differentiation between schwannoma of the vagus nerve and schwannoma of the cervical sympathetic chain by imaging diagnosis. Laryngoscope, 1996,106:554.
6．顾雅佳，王玖华，陈彤箴。颈部神经鞘瘤的CT表现及其病理基础。中华放射学杂志，2000；34：551—554。
7. Cohen LM, Schwartz AM, Rockoff SD. Benign schwannomas :pathologic basis for CT inhomogeneities. AJR,1986,147:141-143.
8. Olsen WL,Dillon WP, Kelly WM,et al. MR imaging of paragwngliomas. AJR; 1987,142:201.
9．杨军，周康荣，陈祖望，等。颈动脉体瘤的MRI和MRA表现。临床放射学杂志，2000；19(5)：275。
10. Colletti-PM; Terk-MR; Zee-CS. Magnetic resonance angiography in
neck mass. Comput-Med-Imaging-Graph. 1996 Sep-Oct;20(5) :379-88．
11． Stein-AM; Lewin-JS; Maniglia-AJ. Value of magnetic resonance angiography in the evaluation of head and neck neoplasms. Otolaryngol-Head-Neck-Surg. 1996Jan: 114(1) : 125-
12． Aisen AM, Martel W, Braunstein EM, et al. MRI and CT evaluation of primary bone and soft tissue tumors. AJR 1986; 146:749-756．
13． Sun JS, Abenoza P, Galloway HR, et al . Peripheral(extracranial) nerve tumors: correlation of MR imaging and histologic findings. Radiology, 1992, 183:341-346．
14． Rao OB, Koeller KK, Adair CF. Paragangliomas of head and neck : Radiologic-pathologic correlation Radiographics, 1999,19:1605．
15． Reyt E, Guidicelli H, Mouret P, et al. Cervical branchiomeric paraganglioma: report of 21 cases. Ann Otolaryngol Chir Cervicofac 1992; 109:2240-244．
16． Liapis C, Kougoulakis A, Karydakis V, et al .Changing trends in management of carotid body tumors. Am Surg 1995;61:989-993．
17． Westerband-A; Hunter-GC; Cintora-I; et al . Current trend in the detection and management of carotid body tumors. J-Vasc-Surg. 1998 Jul; 28910:84-92; discussion 92-3．
18． Urquhart AC, Joimson JT, Myers EN, et al .Glomus vagal:
Paraganglioms of the vagus nerve. Laryngoscope. 1994,104:440-445．
19． Kohn-JS; Raftery-KB; Jewell-ER. Familial carotid body tumors: a closer look. J-Vasc-Surg. 1999 Apr; 29(4) :649-53．
20． Phillip Gardner, MD; Michael Dalsing ,MD; Edward weisberger, MD; et al. Carotid body tumors, inheritance, and high incidence of associated cervical paragangliomas. Am-J-Surg. 1996; 172: 196-199
21． Borowy-ZJ; Probst-L; Deitel-M; et al .A family exhibiting carotid body tumor . Can-J-Surg. 1992 Oct;35(5) :546-51．
22． Protst-LE;Shankar-L;Borowy-Z. Bilateral carotid body tumors.J-Otolargngol. 1992 Apr;21(2) : 160-2．
23． Som PM, Sacher M, Stollman AL, et al . Common tumors of the parapharyngeal space : refined imaging diagnosis. Radiology 1988,169:81-85．
24． Adrian P.G. van Gils, Rene van den Berg,Theo H.M.Falke, et al. MR Diagnosis of Paraganglioma of the Head and Neck: value of Contrast Enhancement. AJR,1994;162:147-153．
25． Sakai F, Sone S, Kiyono K, et al .Intrathoracic Neurogenis Tumors:MR-Pathologic Correlation. AJR, 1992; 159:279-283．
26． 刘庆余, 梁碧玲, 陈健宇. 软组织神经源性肿瘤的MRI诊断. 临床放射学杂志, 1999; 358-360
27． Enzinger FM, Weiss SW. Soft tissue tumors. St Louis:
Mosby, 1994.719-735.
28．邹绿清，粟占兰。17例颈动脉体瘤的临床和病理特征。中国医师杂志 1999；1：36。
29. Matticari-S;Credi-G;Pratesi-C et al .Diagnosis and surgical treatment of the carotid body tumors. J-Cardiovas-Surg-Torino.1995 Jun;36(3):233-9.