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MRI features of peripheral traumatic neuromas

  • Musculoskeletal
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Abstract

Objectives

To describe the MRI appearance of traumatic neuromas on non-contrast and contrast-enhanced MRI sequences.

Methods

This IRB-approved, HIPAA-compliant study retrospectively reviewed 13 subjects with 20 neuromas. Two observers reviewed pre-operative MRIs for imaging features of neuroma (size, margin, capsule, signal intensity, heterogeneity, enhancement, neurogenic features and denervation) and the nerve segment distal to the traumatic neuroma. Descriptive statistics were reported. Pearson’s correlation was used to examine the relationship between size of neuroma and parent nerve.

Results

Of 20 neuromas, 13 were neuromas-in-continuity and seven were end-bulb neuromas. Neuromas had a mean size of 1.5 cm (range 0.6–4.8 cm), 100 % (20/20) had indistinct margins and 0 % (0/20) had a capsule. Eighty-eight percent (7/8) showed enhancement. All 100 % (20/20) had tail sign; 35 % (7/20) demonstrated discontinuity from the parent nerve. None showed a target sign. There was moderate positive correlation (r = 0.68, p = 0.001) with larger neuromas arising from larger parent nerves. MRI evaluation of the nerve segment distal to the neuroma showed increased size (mean size 0.5 cm ± 0.4 cm) compared to the parent nerve (mean size 0.3 cm ± 0.2 cm).

Conclusion

Since MRI features of neuromas include enhancement, intravenous contrast medium cannot be used to distinguish neuromas from peripheral nerve sheath tumours. The clinical history of trauma with the lack of a target sign are likely the most useful clues.

Key Points

• MRI features of neuromas include enhancement and lack of a target sign.

• Contrast material cannot be used to distinguish traumatic neuromas from PNSTs.

• Traumatic neuromas can simulate peripheral nerve neoplasms on imaging.

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Acknowledgments

The scientific guarantor of this publication is Shivani Ahlawat. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. LMF - AUR-General Electric Radiology Research Fellowship (GERRAF) 2008-2010, Siemens Medical Systems, 2011-2012, Sarcoma Grant Program, Johns Hopkins, current.

No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. The publication did not include animals. No subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Musculoskeletal Radiology Section, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD, 21287, USA

    Shivani Ahlawat

  2. Department of Neurosurgery, The Johns Hopkins Hospital, Meyer Bldg, Room 5-181, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Allan J. Belzberg

  3. Pathology, Oncology and Orthopedic Surgery, The Johns Hopkins Hospital, Weinberg Room 2242, 600 N. Wolfe Street, Sheikh Zayed Tower, Baltimore, MD, 21287, USA

    Elizabeth A. Montgomery

  4. Department of Radiology and Radiological Science, Musculoskeletal Imaging Section Chief, Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD, 21287, USA

    Laura M. Fayad

  5. Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA

    Laura M. Fayad

Authors
  1. Shivani Ahlawat
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  2. Allan J. Belzberg
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  3. Elizabeth A. Montgomery
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  4. Laura M. Fayad
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Correspondence to Shivani Ahlawat.

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Ahlawat, S., Belzberg, A.J., A. Montgomery, E. et al. MRI features of peripheral traumatic neuromas. Eur Radiol 26, 1204–1212 (2016). https://doi.org/10.1007/s00330-015-3907-9

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  • DOI: https://doi.org/10.1007/s00330-015-3907-9

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