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Shen Y, Wang R, Zhao C, Liu L, Sun D, Chen X. Investigations on ultrasonography in the diagnosis of nodular localized cutaneous neurofibroma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:359-367. [PMID: 38264918 DOI: 10.1002/jcu.23639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To describe the ultrasound characteristics of nodular localized cutaneous neurofibroma (NLCN). MATERIALS AND METHODS Clinical features and ultrasound characteristics of 43 lesions of 40 patients pathologically proven as NLCNs at Peking University Shenzhen Hospital from October 2014 to May 2022 were analyzed retrospectively. The location, length-to-thickness (L/T) ratio, thickness-to-width (T/W) ratio, shape, margin, capsule, echogenicity, echotexture, posterior features, vascularity, and "rat tail sign" were evaluated. RESULTS All ultrasound findings showed almost perfect agreement. More than a half of NLCNs (n = 24, 55.8%, p < 0.001) were located in the subcutaneous fat layer wholly with well-demarcation from dermis and deep fascia. Most of the NLCNs were fusiform shape (n = 27, 62.8%, p < 0.001) in the long axis and oval shape (n = 35, 81.4%, p < 0.001) in the short axis. The other ultrasound findings of NLCNs included well-defined (n = 42, 97.7%, p < 0.001), encapsulated (n = 39, 90.7%, p < 0.001), predominately hypoechoic (n = 34, 79.1%, p < 0.001), homogeneous (n = 39, 90.7%, p < 0.001), posterior enhancement (n = 29, 67.4%, p = 0.033), and avascularity (n = 37, 86.0%, p < 0.001). Only a quarter (n = 11, 25.6%, p = 0.002) of lesions were recognized with the "rat tail sign." CONCLUSION NLCNs present as fusiform shape in long axis and round shape in short axis. The common ultrasound findings of NLCNs are well-defined, encapsulated, predominately hypoechoic, homogeneous lesion with posterior enhancement, and poor blood supply. The "rat tail sign" has low sensitivity in NLCNs.
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Affiliation(s)
- Yuzhou Shen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Run Wang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Chenyang Zhao
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiangmei Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Nakanishi Y, Shinkuma S, Mitsui Y, Ogawa K, Hirai T, Asada H, Shobatake C. Ultrasonographic findings in nevus lipomatosus cutaneous superficialis: What differentiates this tumor from other soft tissue tumors? J Dermatol 2024; 51:56-61. [PMID: 37804078 DOI: 10.1111/1346-8138.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
Nevus lipomatosus cutaneous superficialis is a rare, benign hamartoma characterized by mature adipocyte proliferation in the dermis. It is frequently difficult to distinguish clinically from soft tissue tumors, including lipoma, neurofibroma, venous malformation, and angiolipoma. Notably, the classical form, which shows multiple and sometimes enlarged nodules, is difficult to differentiate from liposarcoma based on clinical examination, computed tomography, and magnetic resonance imaging findings. Therefore, to ascertain the utility of ultrasonography in diagnosing nevus lipomatosus cutaneous superficialis, sonographic examinations were performed on eight patients with nevus lipomatosus cutaneous superficialis. All patients had ill-defined hyperechoic masses in the dermis or from the dermis to the subcutis, and the posterior echoes were attenuated in seven patients. Color Doppler sonography revealed no blood flow to the lesions. Ultrasound images were created using the reflections of ultrasound waves at interfaces with different acoustic impedances. Therefore, it is assumed that, in nevus lipomatosus cutaneous superficialis, the ultrasound beam is scattered by ectopic mature adipocytes intermingled with collagen bundles, which are shown as hyperechoic masses. Furthermore, the scattering of the ultrasound beam is thought to reduce tissue penetration, which may attenuate the posterior echo.
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Affiliation(s)
- Yukiko Nakanishi
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Satoru Shinkuma
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasuhiro Mitsui
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Dermatology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kohei Ogawa
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshiko Hirai
- Department of General Diagnostic Imaging Center, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Radiology, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Hideo Asada
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Chinatsu Shobatake
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
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Deka JB, Shah R, Jiménez M, Bhatnagar N, Bravo-Sánchez A, Piñas-Bonilla I, Abián-Vicén J, Jiménez F. A Retrospective Analysis of High Resolution Ultrasound Evaluation of the "Split Fat Sign" in Peripheral Nerve Sheath Tumors. Healthcare (Basel) 2023; 11:3147. [PMID: 38132037 PMCID: PMC10742399 DOI: 10.3390/healthcare11243147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Peripheral nerve sheath tumors (PNST) comprise schwannomas and neurofibromas. The finding of increased adipose tissue around benign PNSTs has been described as the "split fat sign" on magnetic resonance imaging exams, which is suggestive of an intramuscular or intermuscular location of the tumor. However, few studies have described this sign as a salient ultrasound feature of PNSTs. The main purpose of this study was to retrospectively evaluate the presence of increased fatty tissue deposition around benign PNSTs diagnosed by high-resolution ultrasound. In addition, we aimed to corroborate the presence of vascularization around the affected area. A retrospective analysis of ten cases of PNSTs and two cases of post-traumatic neuromas diagnosed by high-resolution ultrasound was performed with a Logiq® P8 ultrasound with a 2-11 MHz multifrequency linear probe L3-12-D (central frequency: 10 MHz). Localized types of neurofibromas and schwannomas in any location were seen as predominantly hypoechoic tumors with an oval or fusiform shape. Exiting and entering nerves (tail sign) were observed in six cases, showing localized lesions both in intermuscular and subcutaneous locations. The presence of increased hyperechoic tissue (the split fat sign) was noted in cases of solitary intermuscular and intramuscular peripheral nerve sheath tumors, mainly the schwannomas. Though small tumors did not demonstrate the tail sign, the increase in adipose tissue and vascularity on US was well demonstrated. In conclusion, the nerve in continuity forms the basis of the ultrasonographic diagnosis of PNSTs. However, high-resolution US can convincingly demonstrate the increased presence of fat in the upper and lower poles as well as circumferentially in intermuscular or intramuscular benign PNSTs.
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Affiliation(s)
- Jeena B. Deka
- Dispur Polyclinic and Hospitals Pvt. Ltd., Guwahati 781006, India;
- Faculty of Health Sciences, San Antonio Catholic University, 30107 Murcia, Spain; (N.B.); (F.J.)
| | - Ritu Shah
- Seth GS. Medical College and King Edward Memorial Hospital, Mumbai 400012, India;
| | | | - Nidhi Bhatnagar
- Faculty of Health Sciences, San Antonio Catholic University, 30107 Murcia, Spain; (N.B.); (F.J.)
- Radiology Department, Mata Devi Hospital Max Hospital, Panchsheel, New Delhi 110058, India
| | - Alfredo Bravo-Sánchez
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
| | | | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sport Sciences, University of Castilla-La Mancha, 13001 Toledo, Spain
| | - Fernando Jiménez
- Faculty of Health Sciences, San Antonio Catholic University, 30107 Murcia, Spain; (N.B.); (F.J.)
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sport Sciences, University of Castilla-La Mancha, 13001 Toledo, Spain
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García-Martínez FJ, Alfageme F, Duat-Rodríguez A, Andrés Esteban EM, Hernández-Martín A. Clinical and Sonographic Classification of Neurofibromas in Children with Neurofibromatosis Type 1 - A Cluster Analysis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e118-e125. [PMID: 34820795 DOI: 10.1055/a-1640-9621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE High-frequency ultrasound allows the accurate identification of neurofibromas in neurofibromatosis type 1 (NF1). This study aimed to analyze the ultrasound features of neurofibromas in children with NF1, to establish a classification based on the clinical and sonographic patterns of the different types of neurofibromas, and to evaluate the interobserver correlation coefficient (κ) of this classification. MATERIALS AND METHODS In this prospective, single referral center observational study, clinical and ultrasound findings of neurofibromas in children diagnosed with NF 1 were analyzed. To identify the ultrasound patterns, a cluster analysis allowing the inclusion of both clinical and ultrasound data was designed. The κ coefficient was calculated using 9 external evaluators. RESULTS 265 ultrasound scans were performed on a total of 242 neurofibromas from 108 children diagnosed with NF1. Cluster analysis allowed the identification of 9 patterns (Snedecor's F, P < 0.001) classified as "classic" cutaneous neurofibroma, blue-red neurofibroma, pseudoatrophic neurofibroma, nodular subcutaneous neurofibroma, diffuse subcutaneous neurofibroma, congenital cutaneous neurofibroma, congenital plexiform neurofibroma, congenital diffuse and plexiform neurofibroma, and subfascial neurofibroma. The κ coefficient of the interobserver ratings was 0.82. CONCLUSION Patterns identified in the cluster analysis allow neurofibromas to be classified with a very high interobserver correlation.
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Affiliation(s)
| | - Fernando Alfageme
- Dermatology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Anna Duat-Rodríguez
- Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Eva María Andrés Esteban
- Management of Bleeding Patient Unit, Hospital Universitario La Paz, Universidad Rey Juan Carlos, Madrid, Spain
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El Sayed L, H Masmejean E, Lavollé A, Biau D, Peyre M. Clinical results after surgical resection of benign solitary schwannomas: A review of 150 cases. Orthop Traumatol Surg Res 2022; 108:103281. [PMID: 35477039 DOI: 10.1016/j.otsr.2022.103281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 03/24/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Peripheral nerve schwannomas are the most common nerve tumors. While they are efficiently treated with surgery, the risk of neurological complications, especially sensory deficits, remains debated. HYPOTHESIS We postulate that rates of post-operative sensory deficits in peripheral schwannoma surgery are low and are not increased in schwannomas of the hand, in which preservation of discriminative tact is of prime functional importance. MATERIALS AND METHODS A retrospective multicenter study was carried out on 150 patients with an isolated peripheral schwannoma operated between 2002 and 2018, including 11 patients with schwannomas of the hand. All cases were reviewed preoperatively and postoperatively with a detailed exam of the neurological status. RESULTS Most schwannomas were located in the lower limbs (58%). The two main affected trunks were the posterior tibial nerve in the lower limb and the median nerve in the upper limb. The average preoperative tumor volume measured on MRI was 2.93 cm3 [0.11 cm3-25 cm3]. The most common preoperative symptoms were paresthesia (77.1%) and pseudo-Tinel sign (55.7%). Less frequently, pain (50.3%) and hypoesthesia (18.1%) were observed. On the other hand, preoperative neurological motor manifestations remained exceptional (3.3%). The rates of new post-operative motor deficits, paresthesias, and sensory deficits were 4.6%, 10.9% and 8% respectively and were not increased in schwannomas of the collateral nerves of the hand. CONCLUSION Surgical resection is a safe procedure for peripheral nerve schwannoma treatment with satisfying functional results and an acceptable risk of nerve injury, especially for sensory function. LEVEL OF PROOF D; Multicenter retrospective study.
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Affiliation(s)
- Laila El Sayed
- Hand and upper extremity surgery unit, Georges-Pompidou European Hospital (HEGP), Paris, France; University of Paris, Medical School, Paris, France.
| | - Emmanuel H Masmejean
- Hand and upper extremity surgery unit, Georges-Pompidou European Hospital (HEGP), Paris, France; University of Paris, Medical School, Paris, France; Clinique Blomet (Research Unit), Paris, France
| | | | - David Biau
- University of Paris, Medical School, Paris, France; Orthopedic Surgery, Hôpital Cochin, Paris, France
| | - Matthieu Peyre
- Genetics and Development of Brain Tumors - CRICM Inserm U1127 CNRS UMR 7225- Brain Institute - Hôpital Pitié-Salpêtrière, Paris, France
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Abdulwahab AD, Tawfeeq DN, Sultan OM. Intra-articular Synovial Hemangioma: A Rare Cause of Knee Pain and Swelling. J Clin Imaging Sci 2021; 11:26. [PMID: 33948341 PMCID: PMC8088478 DOI: 10.25259/jcis_129_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 04/05/2021] [Indexed: 11/08/2022] Open
Abstract
Synovial hemangioma is a rare intra articular lesion and it has several more common differentials. Therefore, our main objective is to consider the possibility of hemangioma in any intra-articular mass to prevent diagnostic delay of unnoticed or untreated hemangioma occurring within the knee joint. Ultrasound can be useful method in assessing the lesions. Surgical excision is the definitive treatment for such lesions.
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Affiliation(s)
| | - Dina N Tawfeeq
- Department of Radiology, College of Medicine, Tikrit University, Tikrit, Saladain, Iraq
| | - Omar Muayad Sultan
- Department of Radiology, College of Medicine, Tikrit University, Tikrit, Saladain, Iraq
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Boriani F, Raposio E, Errani C. Imaging Features of Primary Tumors of the Hand. Curr Med Imaging 2021; 17:179-196. [PMID: 32811403 DOI: 10.2174/1573405616999200817173154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues, ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences, data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis, prognosis and therapy. The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.
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Affiliation(s)
- Filippo Boriani
- Department of Plastic and Hand Surgery, Sanremo Hospital, Sanremo, Italy
| | - Edoardo Raposio
- Department of Surgical Sciences and Integrated Methodologies (DISC), University of Genova, Genova, Italy
| | - Costantino Errani
- Department of Musculo-Skeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Nguyen K, Siegelman ES, Tu W, Schieda N. Update on MR Imaging of cystic retroperitoneal masses. Abdom Radiol (NY) 2020; 45:3172-3183. [PMID: 31501965 DOI: 10.1007/s00261-019-02196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article reviews the MRI appearance of cystic retroperitoneal (RP) masses. CONCLUSION Lymphangiomas are the most common RP cystic masses and typically appear simple; microscopic fat is a specific but insensitive finding. Location, internal complexity, and enhancement pattern suggest alternative diagnoses which range from normal anatomic variants to congenital abnormalities and importantly include benign, neurogenic, and malignant neoplasms. An approach to the MR imaging of cystic RP masses is presented.
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Affiliation(s)
- Kathleen Nguyen
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Evan S Siegelman
- Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Wendy Tu
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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Diagnostic accuracy of an integrated approach using conventional ultrasonography, and Doppler and strain elastography in the evaluation of superficial soft tissue lesions. Pol J Radiol 2020; 85:e293-e300. [PMID: 32685064 PMCID: PMC7361366 DOI: 10.5114/pjr.2020.96961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/17/2020] [Indexed: 01/24/2023] Open
Abstract
Purpose To assess the diagnostic accuracy of an integrated approach using conventional ultrasonography, colour Doppler ultrasonography, and elastography strain ratios in tandem in the evaluation of superficial soft tissue lesions. Material and methods Sixty-five subjects were included in this prospective cross-sectional study. Greyscale features and Doppler parameters were recorded. Strain elastography of the non-vascular and non-cystic lesions was performed and strain ratios were calculated. Fine-needle aspiration or biopsy of all the lesions was performed depending on their site and condition. Inter-rater k agreement was used to determine the strength of agreement between imaging-based diagnosis and histopathological diagnosis. A diagnostic test was used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. A p value of < 0.05 was considered statistically significant. Results Multiple superficial soft tissue lesions were studied, the majority of which were lipomas, vascular anomalies, and epidermoid cysts. The diagnostic accuracy was very high and varied from 92.31% to 100% for various masses. The imaging-based diagnosis was in agreement with the histopathological diagnosis in 86.15% (n = 56) and disagreement in 13.85% (n = 9) of the cases (p < 0.007). There was very good inter-rater agreement between the imaging-based diagnosis and histopathological diagnosis (κ = 0.818). Conclusions The combined use of conventional ultrasonography, colour Doppler, and elastography strain ratios provides a very effective non-invasive tool for the diagnosis of superficial soft tissue lesions and may negate the need for unnecessary biopsies. The advantage of this integrated approach using various ultrasound techniques needs no further emphasis.
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Gersing AS, Cervantes B, Knebel C, Schwaiger BJ, Kirschke JS, Weidlich D, Claudi C, Peeters JM, Pfeiffer D, Rummeny EJ, Karampinos DC, Woertler K. Diffusion tensor imaging and tractography for preoperative assessment of benign peripheral nerve sheath tumors. Eur J Radiol 2020; 129:109110. [PMID: 32559592 DOI: 10.1016/j.ejrad.2020.109110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/14/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the diagnostic value of fiber tractography and diffusivity analysis generated from 3D diffusion-weighted (DW) sequences for preoperative assessment of benign peripheral nerve sheath tumors. METHOD MR imaging at 3 T was performed in 22 patients (mean age 41.9 ± 17.1y, 13 women) with histologically confirmed schwannomas (N = 18) and histologically confirmed neurofibromas (N = 11), including a 3D DW turbo spin echo sequence with fat suppression. Diffusion tensor parameters were computed and fiber tracks were determined. Evaluation was performed by two radiologists and one orthopedic surgeon blinded for final diagnosis. Mean diffusivity was computed to allow further assessment of tumor microstructure. Preoperative fascicle visualization was graded, fascicles were categorized regarding anatomical location and amount of fascicles surrounding the tumor. The agreement of imaging findings with intraoperative findings was assessed. RESULTS On 78.3 % of the DTI images, the fascicle visualization was rated as good or very good. Tractography differences were observed in schwannomas and neurofibromas, showing schwannomas to be significantly more often located eccentrically to the nerve (94.8 %) than neurofibromas (0 %, P < 0.01). Fascicles were significantly more often continuous (87.5 %) in schwannomas, while in neurofibromas, none of the tracks was graded to be continuous (0 %, P = 0.014). A substantial agreement between fiber tracking and surgical anatomy was found regarding the fascicle courses surrounding the tumor (κ = 0.78). Mean diffusivity of schwannomas (1.5 ± 0.2 × 10-3 mm2/s) was significantly lower than in neurofibromas (1.8 ± 0.2 × 10-3 mm2/s; P < 0.001). The Youden index showed an optimal cutoff at 1.7 × 10-3 mm2/s (sensitivity, 0.91; specificity, 0.78; J = 0.69). CONCLUSIONS Preoperative diffusion tensor imaging allowed to accurately differentiate between schwannomas and neurofibromas and to describe their location in relation to the nerve fascicles for preoperative planning.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Barbara Cervantes
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Weidlich
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Carolin Claudi
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Daniela Pfeiffer
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany; Chair for Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Rodríguez Bandera AI, Sebaratnam DF, Feito Rodríguez M, de Lucas Laguna R. Cutaneous ultrasound and its utility in pediatric dermatology. Part I: Lumps, bumps, and inflammatory conditions. Pediatr Dermatol 2020; 37:29-39. [PMID: 31743485 DOI: 10.1111/pde.14033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a non-invasive diagnostic technique that is particularly appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and can enhance our understanding of cutaneous diseases. Patient cooperation and limited training and experience are the main challenges for cutaneous ultrasonography in pediatric dermatology. This review describes cutaneous ultrasonography and the nuances of its use in the pediatric setting, followed by the ultrasonographic findings of cutaneous lumps, bumps, and inflammatory dermatoses commonly encountered in pediatric patients.
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Affiliation(s)
| | - Deshan Frank Sebaratnam
- Sydney Children's Hospitals' Network, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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Nepal P, Songmen S, Alam SI, Gandhi D, Ghimire N, Ojili V. Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation. J Clin Imaging Sci 2019; 9:15. [PMID: 31448166 PMCID: PMC6702939 DOI: 10.25259/jcis-6-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/16/2019] [Indexed: 01/14/2023] Open
Abstract
Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities. The imaging features are largely determined by the tumor histopathology; thus, the basic idea about the tumor histopathology will always be useful. This article intends to focus on a comprehensive approach including demographics, clinical presentation, and imaging findings required to diagnose the tumor definitely or narrow the differentials. This article discusses common soft tissue tumor mimics of the hand as well, however, excludes the bone tumors for the sake of brevity.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | | | | | - Darshan Gandhi
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Neeta Ghimire
- Department of Pediatric Dentistry, Kathmandu University, Nepal
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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13
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Sonographic evaluation of peripheral nerve pathology in the emergency setting. Emerg Radiol 2018; 25:521-531. [DOI: 10.1007/s10140-018-1611-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/01/2018] [Indexed: 12/31/2022]
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Abstract
CLINICAL/METHODICAL ISSUE For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. STANDARD RADIOLOGICAL METHODS Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. METHODICAL INNOVATIONS Using ultrasonography for peripheral nerve diagnostics. PERFORMANCE With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. ACHIEVEMENTS Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. PRACTICAL RECOMMENDATIONS Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves.
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Affiliation(s)
- T Bäumer
- Institut für Neurogenetik, Universität zu Lübeck (CBBM; Haus 66), Marie-Curie-Straße, 23562, Lübeck, Deutschland.
| | - A Grimm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Schelle
- Neurologische Klinik, Städtisches Klinikum Dessau, Dessau, Deutschland
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Morii T, Kishino T, Shimamori N, Motohashi M, Ohnishi H, Honya K, Aoyagi T, Tajima T, Ichimura S. Preoperative Ultrasonographic Evaluation for Malignancy of Soft-Tissue Sarcoma: A Retrospective Study. Open Orthop J 2018; 12:75-83. [PMID: 29619120 PMCID: PMC5859456 DOI: 10.2174/1874325001812010075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Ultrasonography is useful for distinguishing between benign and malignant soft-tissue tumors. However, no study has focused on its usefulness in the differential diagnosis between low-grade and high-grade soft-tissue sarcomas. We conducted a retrospective study to determine the usefulness of the parameters of ultrasonograph and to develop a practical scoring system for distinguishing between high-grade and low-grade sarcomas. Methods: Twenty-two cases of low-grade and 43 cases of high-grade malignant soft-tissue sarcoma were enrolled. Ultrasonography parameters including the longest diameter, depth of the tumor, echogenicity, tumor margin, and vascularity defined according to Giovagnorio’s criteria were analyzed as factors to distinguish between the two types of sarcoma. Significant factors were entered into a multivariate model to define the scores for distinction according to the odds ratio. The usefulness of the score was analyzed via receiver operating characteristic analyses. Results: In univariate analysis, tumor margin, echogenicity, and vascularity were significantly different between low- and high-grade sarcomas. In the multivariate regression model, the odds ratio for high-grade vs. low-grade sarcoma was 8.8 for tumor margin, 69 for echogenicity, and 8.3 for vascularity. Scores for the risk factors were defined as follows: 1, ill-defined margin; 2, hypoechoic echogenicity; and 1, type IV in Giovagnorio’s criteria. The sum of each score was confirmed by receiver operating characteristic analysis. The area under the curve was 0.95, with a cut-off score of 3, indicating that the scoring system was useful. Conclusion: The ultrasonography parameters of tumor margin, echogenicity, and vascularity are useful for distinguishing between low- and high-grade sarcomas.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Tomonori Kishino
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Naoko Shimamori
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Mitsue Motohashi
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Keita Honya
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan
| | - Takayuki Aoyagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Takashi Tajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
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Taljanovic MS, Gimber LH, Klauser AS, Porrino JA, Chadaz TS, Omar IM. Ultrasound in the Evaluation of Musculoskeletal Soft-Tissue Masses. Semin Roentgenol 2017; 52:241-254. [PMID: 28965544 DOI: 10.1053/j.ro.2017.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, Banner University Medical Center Tucson, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Lana H Gimber
- Department of Medical Imaging, Banner University Medical Center Tucson, The University of Arizona, College of Medicine, Tucson, AZ
| | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Section Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Jack A Porrino
- Department of Radiology, University of Washington, Seattle, WA
| | - Tyson S Chadaz
- Department of Medical Imaging, Banner University Medical Center Tucson, The University of Arizona, College of Medicine, Tucson, AZ
| | - Imran M Omar
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Telleman JA, Stellingwerff MD, Brekelmans GJ, Visser LH. Nerve ultrasound shows subclinical peripheral nerve involvement in neurofibromatosis type 2. Muscle Nerve 2017; 57:312-316. [DOI: 10.1002/mus.25734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Johan A. Telleman
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
| | - Menno D. Stellingwerff
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
| | - Geert J. Brekelmans
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
| | - Leo H. Visser
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
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18
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Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters. J Med Ultrason (2001) 2017. [DOI: 10.1007/s10396-017-0796-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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19
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Telleman JA, Stellingwerff MD, Brekelmans GJ, Visser LH. Nerve ultrasound. Neurology 2017; 88:1615-1622. [DOI: 10.1212/wnl.0000000000003870] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/30/2017] [Indexed: 01/17/2023] Open
Abstract
Objective:To determine ultrasonographic peripheral nerve involvement in patients with asymptomatic neurofibromatosis type 1 (NF1).Methods:Thirteen asymptomatic and 4 minimally symptomatic patients with NF1 were included in this cross-sectional pilot study to detect asymptomatic abnormalities of the brachial plexus and upper and lower extremity nerves. Patients underwent clinical examination, nerve conduction studies (NCS), and high-resolution ultrasonography (HRUS).Results:HRUS showed abnormalities in 16 patients (94.1%). Neurofibromas were identified in 10 patients (58.8%): localized neurofibromas were found in 3 patients (17.6%), plexiform neurofibromas in 3 (17.6%), and both in 4 (23.5%). In 6 patients (35.3%), only nerve enlargement without an abnormal fascicular pattern was observed. Severe involvement of the peripheral nervous system with multiple plexiform neurofibromas was observed in 7 patients (41.2%), while 4 patients (23.5%) had no or only minor involvement. Both NCS and HRUS were performed on 73 individual nerve segments. In 5.5%, abnormalities were found with both tests; in 50.7%, only with HRUS; and in 1.4%, only with NCS.Conclusions:HRUS frequently showed subclinical involvement of the peripheral nerves in NF1, also when NCS were normal. HRUS findings ranged from normal to widespread peripheral nerve involvement. Because the presence of plexiform neurofibromas and the benign tumor load are risk factors for the development of a malignant peripheral nerve sheath tumor, HRUS may be a useful tool to identify a subgroup of patients who could benefit from regular follow-up.
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Yang F, Chen XX, Wu HL, Zhu JF, Chen Y, Yu LF, Huang XJ. Sonographic Features and Diagnosis of Peripheral Schwannomas. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:127-133. [PMID: 28090635 DOI: 10.1002/jcu.22438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/01/2016] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND To determine the sonographic features of peripheral schwannomas. METHODS This retrospective study included 54 cases of schwannoma in 51 patients. Ultrasonography (US) and MRI were performed in all patients. The US features of each tumor were analyzed and compared with pathologic findings. The US target sign was compared with the MRI findings. RESULTS On US, 53 of the 54 schwannomas had a regular shape and clear margins, and one had an irregular shape. Thirty-seven of the 54 schwannomas were categorized as solid, 16 as cystic and solid, and one as entirely cystic; distal sound enhancement was associated with 47 schwannomas. The target sign was seen in 24, the rat tail sign in 28, the vessel accompanying sign in 22, and the split fat sign in 5. The entering and exiting nerves were situated centrally in 9 and eccentrically in 19 schwannomas. Vascularity on color Doppler imaging using a 0 to III scale was graded 0 in 4 schwannomas, I in 10, II in 26, and III in 14. Twenty-four target signs were detected in 54 schwannomas by US, and 28 were detected by MRI. There was good agreement between the target signs noted on US and those seen on MRI (κ = 0.631, p < 0.001). CONCLUSIONS The sonographic diagnosis of peripheral schwannomas is feasible and reliable. The target sign is a prominent US feature in peripheral schwannomas, comparable to that observed with MRI. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:127-133, 2017.
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Affiliation(s)
- Fan Yang
- Department of Ultrasound, The 92nd Hospital of Chinese PLA, NO. 99 Binjiangbei Road, Yanping District, Nanping, Fujian Province, 353000, China
| | - Xian-Xiang Chen
- Department of Pathology, The 92nd Hospital of Chinese PLA, NO. 99 Binjiangbei Road, Yanping District, Nanping, Fujian Province, 353000, China
| | - Huo-Lin Wu
- Department of Ultrasound, The 92nd Hospital of Chinese PLA, NO. 99 Binjiangbei Road, Yanping District, Nanping, Fujian Province, 353000, China
| | - Ji-Fa Zhu
- Department of Ultrasound, The 92nd Hospital of Chinese PLA, NO. 99 Binjiangbei Road, Yanping District, Nanping, Fujian Province, 353000, China
| | - Yuan Chen
- Department of Ultrasound, The 92nd Hospital of Chinese PLA, NO. 99 Binjiangbei Road, Yanping District, Nanping, Fujian Province, 353000, China
| | - Ling-Fang Yu
- Department of Ultrasound, The 92nd Hospital of Chinese PLA, NO. 99 Binjiangbei Road, Yanping District, Nanping, Fujian Province, 353000, China
| | - Xiao-Juan Huang
- Department of Ultrasound, The 92nd Hospital of Chinese PLA, NO. 99 Binjiangbei Road, Yanping District, Nanping, Fujian Province, 353000, China
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21
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Lee SJ, Yoon ST. Ultrasonographic and Clinical Characteristics of Schwannoma of the Hand. Clin Orthop Surg 2017; 9:91-95. [PMID: 28261433 PMCID: PMC5334033 DOI: 10.4055/cios.2017.9.1.91] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to report the ultrasonographic findings and clinical features of schwannoma of the hand. Methods We enrolled 8 patients who were initially diagnosed with ganglion by ultrasonography but finally with schwannoma by a tissue biopsy. We retrospectively analyzed the ultrasonographic findings of eight patients including echogenicity, internal homogeneity, posterior enhancement, internal vascularity, and clinical manifestations such as the occurrence site, tenderness, Tinel's sign, and paresthesia before the surgery. Results The occurrence sites were as follows: two cases on the thenar area, one case on the second web space, three cases on the third web space, one case on the radiovolar aspect of the proximal phalanx of the index finger, and one case on the radiovolar aspect of the proximal phalanx of the middle finger. Four patients suffered from tenderness and pain on presentation, and all patients had pain around the mass before presentation. Tinel's sign was present without paresthesia in one case. Ultrasonography revealed cystic lesions showing clear margins in all cases, and two of them had acoustic enhancement without internal flow. Conclusions It may not be easy to diagnosis schwannoma of the hand with ultrasonography alone when the lesion is small because of the similarity to the ultrasonographic findings of ganglion. Therefore, it is necessary to consider the possibility of schwannoma if a mass near the digital nerve or cutaneous nerve branch is accompanied by dull pain and tenderness.
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Affiliation(s)
- Seoung Joon Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Seok Tae Yoon
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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22
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Farschtschi S, Gelderblom M, Buschbaum S, Bostock H, Grafe P, Mautner VF. Muscle action potential scans and ultrasound imaging in neurofibromatosis type 2. Muscle Nerve 2016; 55:350-358. [PMID: 27422240 DOI: 10.1002/mus.25256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The neuropathy in patients with neurofibromatosis type 2 (NF2) is difficult to quantify and follow up. In this study we compared 3 methods that may help assess motor axon pathology in NF2 patients. METHODS Nerve conduction studies in median nerves were supplemented by deriving motor unit number estimates (MUNEs) from compound muscle action potential (CMAP) scans and by high-resolution ultrasound (US) peripheral nerve imaging. RESULTS CMAP amplitudes and nerve conduction velocity were normal in the vast majority of affected individuals, but CMAP scan MUNE revealed denervation and reinnervation in many peripheral nerves. In addition, nerve US imaging enabled monitoring of the size and number of schwannoma-like fascicular enlargements in median nerve trunks. CONCLUSION In contrast to conventional nerve conduction studies, CMAP scan MUNE in combination with US nerve imaging can quantify the NF2-associated neuropathy and may help to monitor disease progression and drug treatments. Muscle Nerve 55: 350-358, 2017.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Sabriena Buschbaum
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Hugh Bostock
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Peter Grafe
- Physiological Genomics, Institute of Physiology, Ludwig-Maximilians University Munich, Pettenkoferstrasse 12, 80336, Munich, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
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Zhang H, Li Y, Shao J, Chen W, Wang Y. High-Resolution Ultrasound of Schwannomas of the Limbs: Analysis of 72 Cases. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2538-2544. [PMID: 27554069 DOI: 10.1016/j.ultrasmedbio.2016.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
Schwannomas are common benign tumors that develop in peripheral nerves. High-resolution ultrasound (HRUS) is an effective imaging modality in clinics. The aim of this study was to define the value of HRUS in diagnosing schwannomas that originate from different nerves in limbs. We reviewed the ultrasound and surgical records of 72 pathologically confirmed schwannomas in the limbs of 60 patients. Results revealed that 44 (61.1%) of 72 cases, 44 (75.9%) of 58 cases and 0 (0%) of 14 cases received an overall correct pre-operative diagnosis, a correct pre-operative diagnosis in nerve trunks and a correct pre-operative diagnosis in small branches, respectively. Identification of the nerve of origin of schwannomas through HRUS likely increased confidence in diagnosing these benign tumors.
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Affiliation(s)
- Haixian Zhang
- Department of Ultrasound, Shanghai Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- Department of Ultrasound, Shanghai Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Shao
- Department of Ultrasound, Shanghai Huashan Hospital, Fudan University, Shanghai, China
| | - Weimin Chen
- Department of Ultrasound, Shanghai Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Ultrasound, Shanghai Huashan Hospital, Fudan University, Shanghai, China.
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Zheng X, Guo K, Wang H, Li D, Wu Y, Ji Q, Shen Q, Sun T, Xiang J, Zeng W, Chen Y, Wang Z. Extracranial schwannoma in the carotid space: A retrospective review of 91 cases. Head Neck 2016; 39:42-47. [PMID: 27442804 DOI: 10.1002/hed.24523] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/17/2016] [Accepted: 05/06/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Schwannomas of the vagus nerve and cervical sympathetic nerve are rare; hence, only limited information exists regarding their diagnosis and clinical management. METHODS We conducted a retrospective review of the clinical features, imaging studies, and treatment results of patients with schwannoma of the vagus nerve and schwannoma of the sympathetic nerve. RESULTS Of 91 patients, 91% (n = 83) were preoperatively diagnosed with schwannoma tumors. Using the hyoid bone as an anatomic landmark, the location of the schwannoma of the vagus nerve in the carotid space was significantly different to the location of schwannoma of the sympathetic nerve (p = .003). Although 52 of the 76 patients followed up (68%) had postoperative nerve weaknesses, 13 patients (50%) and 14 patients (53.8%), respectively, fully recovered from schwannoma of the vagus nerve and schwannoma of the sympathetic nerve. CONCLUSION In the carotid space, schwannomas of the vagus nerve are usually located below the hyoid bone, whereas schwannomas of the sympathetic nerve more commonly arise from the suprahyoid compartment. Accurate preoperative diagnosis and the intracapsular enucleation surgical approach decreased the incidence of postoperative morbidity. © 2016 Wiley Periodicals, Head Neck 39: 42-47, 2017.
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Affiliation(s)
- Xiaoke Zheng
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Kai Guo
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongshi Wang
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Duanshu Li
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Yi Wu
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qinghai Ji
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Qiang Shen
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Tuanqi Sun
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Xiang
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Wei Zeng
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Yaling Chen
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Zhuoying Wang
- Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
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Jacobson JA, Wilson TJ, Yang LJS. Sonography of Common Peripheral Nerve Disorders With Clinical Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:683-693. [PMID: 26931790 DOI: 10.7863/ultra.15.05061] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
Sonography is now considered an effective method to evaluate peripheral nerves. Low cost, high resolution, the ability to image an entire limb in a short time, and dynamic assessment are several of the positive attributes of sonography. This article will review the normal appearance of peripheral nerves as shown with sonography. In addition, the most common applications for sonography of the peripheral nerves will be reviewed, which include entrapment neuropathies, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Clinical information related to nerve disorders is also included, as it provides valuable information that can be obtained during sonographic examinations, increasing diagnostic accuracy.
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Affiliation(s)
- Jon A Jacobson
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan USA.
| | - Thomas J Wilson
- Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan USA
| | - Lynda J-S Yang
- Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan USA
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26
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Schwannoma of the Posterior Interosseous Nerve. Ultrasound Q 2016; 32:376-379. [PMID: 26808172 DOI: 10.1097/ruq.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ali ZS, Pisapia JM, Ma TS, Zager EL, Heuer GG, Khoury V. Ultrasonographic Evaluation of Peripheral Nerves. World Neurosurg 2016; 85:333-9. [DOI: 10.1016/j.wneu.2015.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 12/13/2022]
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Abstract
An ipsilateral axillary mass was detected on pre-operative ultrasound in a 79-year-old woman with newly diagnosed breast carcioma. The mass had sonographic features that were initially thought to represent a lymph node completely replaced by metastatic disease. Though ultrasound-guided axillary fine-needle aspiration was attempted, it could not be performed due to pain. At surgery, the mass was found to be a brachial plexus tumor.
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Ryu JA, Lee SH, Cha EY, Kim TY, Kim SM, Shin MJ. Sonographic Differentiation Between Schwannomas and Neurofibromas in the Musculoskeletal System. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2253-2260. [PMID: 26543170 DOI: 10.7863/ultra.15.01067] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/31/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to determine key features and define a strategy for differentiation between schwannomas and neurofibromas using sonography. METHODS This retrospective study was approved by the Institutional Review Board at our hospital, and informed consent was waived. We reviewed sonograms of pathologically proven schwannomas and neurofibromas of the extremities and body wall. On grayscale images, tumors were evaluated on the basis of their size, maximum-to-minimum diameter ratio, shape, contour, margin, location, encapsulation, echogenicity, echo texture, cystic changes, presence of intratumoral calcifications, presence of a target sign, and presence of an entering or exiting nerve. If an entering or exiting nerve was identified, the nerve-tumor position and nerve-tumor transition were characterized. On color Doppler images, the presence and amount of vascularity were evaluated. Student t tests were used for analysis of continuous variables (size, maximum-to-minimum diameter ratio, and age); χ(2) and Fisher exact tests were used for analysis of categorical variables. RESULTS A total of 146 pathologically proven tumors, including 115 schwannomas and 31 neurofibromas of the extremities and body wall, were included. The maximum diameter, maximum-to-minimum diameter ratio, contour, cystic portion, nerve-tumor position, nerve-tumor transition, and vascularity were significantly different in schwannomas versus neurofibromas (P < .05), and a lobulated contour, fusiform shape, and hypovascularity of neurofibromas could be helpful for differentiation when a prediction model is considered. The nerve-tumor position, nerve-tumor transition, and maximum-to-minimum diameter ratio were also significantly different between groups (P < .05) and thus could be useful for differentiation of neurogenic tumors. CONCLUSIONS Sonographic findings are helpful in differentiating between schwannomas and neurofibromas.
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Affiliation(s)
- Jeong Ah Ryu
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Sang Hoon Lee
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.).
| | - Eun-Young Cha
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Tae Yeob Kim
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Sung Moon Kim
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Myung Jin Shin
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
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Balzarotti R, Rondelli F, Barizzi J, Cartolari R. Symptomatic schwannoma of the abdominal wall: A case report and review of the literature. Oncol Lett 2015; 9:1095-1098. [PMID: 25663862 PMCID: PMC4315022 DOI: 10.3892/ol.2015.2866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 12/12/2014] [Indexed: 01/31/2023] Open
Abstract
Schwannoma is a rare, benign tumor that arises from the nerve sheath. This tumor usually involves the extremities, but can also be found in the head and neck, trunk, pelvis, retroperitoneum, mediastinum and gastrointestinal tract. In numerous cases, the tumors are asymptomatic and are identified incidentally on physical examination or imaging. Occasionally, schwannoma is symptomatic due to compression of surrounding large nerves. In the present study, a 57-year-old female presented to the surgical outpatient’s department due to a well-localized parietal pain in the left lower quadrant. The onset of the pain occurred three years prior to presentation, without apparent cause and in the absence of other symptoms. Ultrasound and a computed tomography scan revealed a small solid tumor in the anterior abdominal wall, which was dimensionally stable over time, but was not noted in a preliminary analysis by a radiologist. The lesion was surgically removed using an anterior surgical approach. Histopathology revealed the tumor to be benign schwannoma. The painful symptoms completely disappeared. To the best of our knowledge, this is the third case of an abdominal wall benign schwannoma in the medical literature, and the first symptomatic case.
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Affiliation(s)
- Ruben Balzarotti
- Surgical Unit, San Giovanni Hospital - Ente Ospedaliero Cantonale, Bellinzona, Ticino 6500, Switzerland
| | - Fabio Rondelli
- Surgical Unit, San Giovanni Hospital - Ente Ospedaliero Cantonale, Bellinzona, Ticino 6500, Switzerland
| | - Jessica Barizzi
- Surgical Pathology, Istituto Cantonale di Patologia, Locarno, Ticino 6601, Switzerland
| | - Roberto Cartolari
- Radiological Unit, San Giovanni Hospital - Ente Ospedaliero Cantonale, Bellinzona, Ticino 6500, Switzerland
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Sonography of Musculoskeletal Soft-Tissue Masses: Techniques, Pearls, and Pitfalls. AJR Am J Roentgenol 2014; 202:1281-90. [DOI: 10.2214/ajr.13.11564] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Toprak H, Kiliç E, Serter A, Kocakoç E, Ozgocmen S. Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions. J Clin Imaging Sci 2014. [PMID: 24744969 DOI: 10.4103/2156-7514.127965.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Improved developments in digital ultrasound technology and the use of high-frequency broadband transducers make ultrasound (US) imaging the first screening tool in investigating superficial tissue lesions. US is a safe (no ionizing radiation), portable, easily repeatable, and cheap form of imaging compared to other imaging modalities. US is an excellent imaging modality to determine the nature of a mass lesion (cystic or solid) and its anatomic relation to adjoining structures. Masses can be characterized in terms of their size, number, component, and vascularity with US and Doppler US especially with power Doppler US. US, however, is operator dependent and has a number of artifacts that can result in misinterpretation. In this review, we emphasize the role of ultrasound, particularly power Doppler, in superficial soft-tissue lesions.
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Affiliation(s)
- Huseyin Toprak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Kiliç
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
| | - Asli Serter
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ercan Kocakoç
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Salih Ozgocmen
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
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Simon NG, Cage T, Narvid J, Noss R, Chin C, Kliot M. High-resolution ultrasonography and diffusion tensor tractography map normal nerve fascicles in relation to schwannoma tissue prior to resection. J Neurosurg 2014; 120:1113-7. [PMID: 24628610 DOI: 10.3171/2014.2.jns131975] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The goals of the present study were to demonstrate the ability of high-resolution ultrasonography to delineate normal nerve fascicles within or around peripheral nerve sheath tumors (NSTs). A blinded examiner evaluated 2 patients with symptomatic upper limb NSTs with high-resolution ultrasonography performed in the perioperative suite using a portable ultrasonography system. Ultrasonographic examinations located the tumor mass and identified the normal nerve fascicles associated with the mass. The locations of normal nerve tissue were mapped and correlated with results of MR tractography, operative inspection, and intraoperative electrophysiological monitoring. The study demonstrated a close correlation between normal nerve fascicles identified by ultrasonography, MR tractography, and intraoperative electrophysiological mapping. In particular, ultrasonographic examinations accurately identified the surface regions of the tumor without overlying normal nerve tissue. These preliminary data suggest that preoperative ultrasonographic examinations may provide valuable information, supplementary to the information obtained from intraoperative electrophysiological monitoring. Identification of normal nerve tissue prior to surgery may provide additional information regarding the risk of iatrogenic nerve injury during percutaneous tumor biopsy or open resection of the tumor and may also aid in selecting the optimum surgical approach.
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Toprak H, Kiliç E, Serter A, Kocakoç E, Ozgocmen S. Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions. J Clin Imaging Sci 2014; 4:12. [PMID: 24744969 PMCID: PMC3988607 DOI: 10.4103/2156-7514.127965] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/06/2014] [Indexed: 12/01/2022] Open
Abstract
Improved developments in digital ultrasound technology and the use of high-frequency broadband transducers make ultrasound (US) imaging the first screening tool in investigating superficial tissue lesions. US is a safe (no ionizing radiation), portable, easily repeatable, and cheap form of imaging compared to other imaging modalities. US is an excellent imaging modality to determine the nature of a mass lesion (cystic or solid) and its anatomic relation to adjoining structures. Masses can be characterized in terms of their size, number, component, and vascularity with US and Doppler US especially with power Doppler US. US, however, is operator dependent and has a number of artifacts that can result in misinterpretation. In this review, we emphasize the role of ultrasound, particularly power Doppler, in superficial soft-tissue lesions.
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Affiliation(s)
- Huseyin Toprak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Kiliç
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
| | - Asli Serter
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ercan Kocakoç
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Salih Ozgocmen
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
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Song SE, Seo BK, Choi JW, Son GS, Cho KR, Kim BH. The sonographic "coffee bean" sign helps distinguish an axillary neurofibroma from a lymphadenopathy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:33-37. [PMID: 23606585 DOI: 10.1002/jcu.22051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/04/2012] [Accepted: 02/28/2013] [Indexed: 06/02/2023]
Abstract
Axillary masses may represent various soft tissue tumors or lymphadenopathy. Neurofibromas are benign peripheral nerve sheath tumors and, while they are very uncommon, it is important to remember that neurogenic tumors arising from brachial plexus can develop in the axilla. We describe an axillary neurofibroma arising from the brachial plexus that presented with a "coffee bean sign" on sonography that distinguished it from axillary lymphadenopathy.
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Affiliation(s)
- Sung Eun Song
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan-city, Kyunggi-do, Korea
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Ohana M, Moser T, Moussaouï A, Kremer S, Carlier R, Liverneaux P, Dietemann JL. Current and future imaging of the peripheral nervous system. Diagn Interv Imaging 2014; 95:17-26. [DOI: 10.1016/j.diii.2013.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Carvi y Nievas MN, Archavlis E, Unkel B. Delayed outcome from surgically treated patients with benign nerve associated tumors of the extremities larger than 5 cm. Neurol Res 2013; 32:563-71. [DOI: 10.1179/016164109x12581096870113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abreu E, Aubert S, Wavreille G, Gheno R, Canella C, Cotten A. Peripheral tumor and tumor-like neurogenic lesions. Eur J Radiol 2011; 82:38-50. [PMID: 21561733 DOI: 10.1016/j.ejrad.2011.04.036] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 01/30/2023]
Abstract
Neoplasms of neurogenic origin account for about 12% of all benign and 8% of all malignant soft tissue neoplasms. Traumatic neuroma, Morton neuroma, lipomatosis of a nerve, nerve sheath ganglion, perineurioma, benign and malignant peripheral nerve sheath tumors (PNST) are included in this group of pathologies. Clinical and radiologic evaluation of patients with neurogenic tumors and pseudotumors often reveals distinctive features. In this context, advanced imaging techniques, especially ultrasound (US) and magnetic resonance (MR) play an important role in the characterization of these lesions. Imaging findings such as location of a soft tissue mass in the region of a major nerve, nerve entering or exiting the mass, fusiform shape, abnormalities of the muscle supplied by the nerve, split-fat sign, target sign and fascicular appearance should always evoke a peripheric nerve sheath neoplasm. Although no single imaging finding or combination of findings allows definitive differentiation between benign from malign peripheric neurogenic tumors, both US and MR imaging may show useful features that can lead us to a correct diagnosis and improve patient treatment. Traumatic neuromas and Morton neuromas are commonly associated to an amputation stump or are located in the intermetatarsal space. Lipomatosis of a nerve usually appears as a nerve enlargement, with thickened nerve fascicles, embedded in evenly distributed fat. Nerve sheath ganglion has a cystic appearance and commonly occurs at the level of the knee. Intraneural perineuroma usually affects young people and manifests as a focal and fusiform nerve enlargement. In this article, we review clinical characteristics and radiologic appearances of these neurogenic lesions, observing pathologic correlation, when possible.
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Affiliation(s)
- Evandro Abreu
- Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et Imagerie de l'Appareil Locomoteur, CHRU de Lille, 59037 Lille, France
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Park JY, Park H, Park NJ, Park JS, Sung HJ, Lee SS. Use of Calretinin, CD56, and CD34 for Differential Diagnosis of Schwannoma and Neurofibroma. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.1.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ji Young Park
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Hoon Park
- Department of Otolaryngology, Korea Cancer Center Hospital, Seoul, Korea
| | - Nam Jo Park
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - June Sik Park
- Department of Otolaryngology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun-Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang Sook Lee
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
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Loh ZHK, Allan GS, Nicoll RG, Hunt GB. Ultrasonographic characteristics of soft tissue tumours in dogs. Aust Vet J 2009; 87:323-9. [DOI: 10.1111/j.1751-0813.2009.00460.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chiou HJ, Chou YH, Chiu SY, Wang HK, Chen WM, Chen TH, Chang CY. Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color doppler ultrasonography. J Chin Med Assoc 2009; 72:307-15. [PMID: 19541566 DOI: 10.1016/s1726-4901(09)70377-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study was performed to evaluate the usefulness of high-resolution grayscale and color Doppler ultrasound to distinguish benign from malignant soft-tissue masses on the basis of ultrasonographic patterns. METHODS We enrolled 398 female and 420 male patients aged 1-104 years (mean, 49.8 years). All presented with a palpable nodule or mass located superficially in the body. Each lesion was examined by grayscale and color Doppler ultrasonography to assess its echogenicity, margin, shape, composition, acoustic transmission, size and other patterns. Spectral Doppler was applied in lesions with positive color flow signals. The nature of all masses was confirmed by aspiration cytology, biopsy, surgical pathology or long-term clinical follow-up. RESULTS There were a total of 693 benign and 125 malignant masses. Five malignant and 14 benign histologies (including 6 types with inflammation-related, hematoma or pseudoaneurysm) occurred that had more than 10 subjects with each histology. Eight benign histopathologies included cysts, neoplasms, vascular and miscellaneous. Five malignant histologies included metastases, osteogenic sarcomas, lymphomas, malignant fibrous histiocytomas and liposarcomas. There were significant differences (p < 0.05) between the benign and malignant soft-tissue tumors in terms of parameters including tumor margin, shape and size. Benign lesions did not have infiltrated margins or a scalloped shape and malignant tumors tended to be large. However, there was no significant difference (p > 0.05) between the benign and malignant soft-tissue tumors in terms of echogenicity, composition and color Doppler features. CONCLUSION Ultrasonography with color Doppler imaging is a good modality for characterizing most soft-tissue masses, and tumor size > 5 cm and having infiltrated margin highly suggests malignancy.
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Affiliation(s)
- Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
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