Extraneural perineurioma: CT and MRI imaging characteristics

Stephen Broski, Laurel A. Littrell, Benjamin M. Howe, Andrew L. Folpe, Doris E. Wenger

Research output: Contribution to journalArticle

Abstract

Objective: To examine the CT and MRI characteristics of extraneural perineuriomas. Materials and methods: With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. Results: We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16–70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with “reticular” features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9–10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. Conclusions: Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.

Original languageEnglish (US)
JournalSkeletal Radiology
DOIs
StatePublished - Jan 1 2019

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Nerve Sheath Neoplasms
Denervation
Skeletal Muscle
Electronic Health Records
Research Ethics Committees
Schwann Cells
Neurilemmoma
Sarcoma
Databases
Biopsy

Keywords

  • CT
  • Extraneural perineurioma
  • MRI
  • Peripheral nerve
  • Tumor

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Extraneural perineurioma : CT and MRI imaging characteristics. / Broski, Stephen; Littrell, Laurel A.; Howe, Benjamin M.; Folpe, Andrew L.; Wenger, Doris E.

In: Skeletal Radiology, 01.01.2019.

Research output: Contribution to journalArticle

Broski, Stephen ; Littrell, Laurel A. ; Howe, Benjamin M. ; Folpe, Andrew L. ; Wenger, Doris E. / Extraneural perineurioma : CT and MRI imaging characteristics. In: Skeletal Radiology. 2019.
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abstract = "Objective: To examine the CT and MRI characteristics of extraneural perineuriomas. Materials and methods: With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. Results: We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16–70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with “reticular” features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9–10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. Conclusions: Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.",
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AB - Objective: To examine the CT and MRI characteristics of extraneural perineuriomas. Materials and methods: With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. Results: We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16–70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with “reticular” features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9–10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. Conclusions: Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.

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