MRI Findings and Diagnostic Significance of Soft Tissue Schwannomas in the Extremities
Download PDF
$currentUrl="http://$_SERVER[HTTP_HOST]$_SERVER[REQUEST_URI]"

Keywords

Schwannomas
Extremities
Magnetic resonance imaging

DOI

10.26689/jcnr.v8i8.8187

Submitted : 2024-08-06
Accepted : 2024-08-21
Published : 2024-09-05

Abstract

Objective: To analyze the MRI features and rare manifestations of schwannomas of the extremities to improve diagnosis. Methods: Retrospective analysis of 23 cases of schwannomas in the extremities confirmed by surgical pathology, summarizing its signs, signal characteristics and MRI enhancement. Results: Among the 23 cases, 20 were single lesions, and 3 were multiple lesions, resulting in a total of 28 lesions. The distribution of these lesions included 7 in the thigh, 9 in the calves, 4 in the armpits, 3 in the hips, and 4 each in the upper arms and forearms. Additionally, there was one lesion located in the groin. On T1-weighted imaging (T1WI), the lesions showed iso-intensity or hypo-intensity. On T2-weighted imaging (T2WI), they appeared slightly hyperintense or hyper-intense. Some lesions exhibited multiple small vesicle-like higher signals, cystic changes, and fiber spacing on T2WI. Furthermore, one lesion showed a liquid-liquid plane. The “target sign” was observed in 18 lesions (64.3%) and “neuropathic signs” were present in six lesions (21.4%). Finally, it was noted that on MRI enhancement, the lesions demonstrated uniform or uneven enhancement. The lesions were uniformly or unevenly enhanced on MRI enhancement. Conclusions: The MRI findings of schwannoma in the extremities exhibit specific characteristics. The cystic changes on T2WI also display distinct features. Recognition of rare MRI findings, such as cystic changes, liquid-liquid plane and septum, should be emphasized to enhance the accuracy of pre-diagnosing schwannomas.

References

Zhou H, Yao C, Dong Y, et al., 2022, Clinical Characteristics and Management Experience of Schwannoma in Extremities: Lessons Learned from a 10-Year Retrospective Study. Frontier of Neurology, 13: 1083896.

Suzuki A, Kanda T, Yoshimizu T, et al., 2021, Investigation of Schwannomas in the Forearms, Hands, and Digits: A Retrospective Study. The Journal of Hand Surgery (Asian-Pacific Volume), 26(1): 17–23.

Pertea M, Filip A, Huzum B, et al., 2022, Schwannoma of the Upper Limb: Retrospective Study of a Rare Tumor with Uncommon Locations. Diagnostics (Baseline), 12(6): 1319.

Istefan E, Belstock J, Dahlin LB, et al., 2023, Surgery of Schwannoma in the Upper Limb-Sensitivity and Specificity of Preoperative Magnetic Resonance Imaging and Relation Between Tumour Size and Symptoms. BMC Musculoskeletal Disorders, 24(1): 713.

El Sayed L, Masmejean E, Lavollé A, et al., 2022, Clinical Results After Surgical Resection of Benign Solitary Schwannomas: A Review of 150 Cases. Orthopaedics & Traumatology: Surgery & Research, 108(4): 103281.

Majumder A, Ahuja A, Chauhan DS, et al., 2021, A Clinicopathological Study of Peripheral Schwannomas. Medicine and Pharmacy Reports94(2): 191–196.

Albert P, Patel J, Badawy K, et al., 2017, Peripheral Nerve Schwannoma: A Review of Varying Clinical Presentations and Imaging Findings. The Journal of Foot and Ankle Surgery, 56(3): 632–637.

Salunke AA, Chen Y, Tan JH, et al., 2015, Intramuscular Schwannoma: Clinical and Magnetic Resonance Imaging Features. Singapore Medical Journal, 56(10): 555–557.

Chang WC, Huang GS, Lee HS, et al., 2009, Fluid-Fluid Level in Peripheral Nerve Schwannoma: Report of a Case with Histological Correlation. Clinical Imaging, 33(3): 248–251.

Ishizawa M, Okabe H, Matsumoto K, et al., 2021, Histopathological Explanation of the MRI Target Sign in Extra-Axial Schwannomas. Journal of Orthopaedic Science, 26(4): 660–665.

Stull MA, Moser RP Jr, Kransdorf MJ, et al., 1991, Magnetic Resonance Appearance of Peripheral Nerve Sheath Tumors. Skeletal Radiology, 20(1): 9–14.

Petscavage-Thomas JM, Walker EA, Logie CI, et al., 2014, Soft-Tissue Myxomatous Lesions: Review of Salient Imaging Features with Pathologic Comparison. Radiographics, 34(4): 964–980.