Sonographic Differentiation Between Schwannomas and Neurofibromas in the Musculoskeletal System

• Published in: Journal of ultrasound in medicine 2015-12, Vol.34 (12), p.2253-2260
• Main Authors: Ryu, Jeong Ah, Lee, Sang Hoon, Cha, Eun-Young, Kim, Tae Yeob, Kim, Sung Moon, Shin, Myung Jin
• Format: Article
• Language: English
• Subjects: Diagnosis, Differential; Female; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Male; Middle Aged; Musculoskeletal Diseases - diagnostic imaging; musculoskeletal ultrasound; Neurilemmoma - diagnostic imaging; neurofibroma; Neurofibroma - diagnostic imaging; Peripheral Nervous System Neoplasms - diagnostic imaging; Reproducibility of Results; schwannoma; Sensitivity and Specificity; soft tissue tumor; Ultrasonography - methods
• ISSN: 0278-4297; 1550-9613
• DOI: 10.7863/ultra.15.01067

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); χ2 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.