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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] [What about the content of this article? (0)] [Affiliation(s)] [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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