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Peripheral nerve sheath tumor: differentiation of malignant from benign tumors with conventional and diffusion-weighted MRI

  • Musculoskeletal
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Abstract

Objectives

To evaluate potential of conventional MRI and diffusion-weighted imaging (DWI) for differentiating malignant from benign peripheral nerve sheath tumors (PNSTs).

Methods

Eighty-seven cases of malignant or benign PNSTs in the trunk or extremities that underwent conventional MRI with contrast enhancement, DWI, and pathologic confirmation between Sep. 2014 and Dec. 2017 were identified. Of these, 55 tumors of uncertain nature on MRI were included. Tumor size, signal, and morphology were reviewed on conventional MRI, and apparent diffusion coefficient (ADC) values of solid enhancing portions were measured from DWI. Patient demographics, MRI features, and ADC values were compared between benign and malignant tumors, and robust imaging findings for malignant peripheral nerve sheath tumors (MPNSTs) were identified using multivariable models.

Results

A total of 55 uncertain tumors consisted of 18 malignant and 37 benign PNSTs. On MRI, tumor size, margin, perilesional edema, and presence of split fat, fascicular, and target signs were significantly different between groups (p < 0.05), as were mean and minimum ADC values (p = 0.002, p < 0.0001). Most inter-reader agreement was moderate to excellent (κ value, 0.45–1.0). The mean ADC value and absence of a split fat sign were identified as being associated with MPNSTs (odds ratios = 13.19 and 25.67 for reader 1; 49.05 and 117.91 for reader 2, respectively). The C-indices obtained by combining these two findings were 0.90 and 0.95, respectively.

Conclusions

Benign and malignant PNSTs showed different features on MRI and DWI. A combination of mean ADC value and absence of split fat was excellent for discriminating malignant from benign PNSTs.

Key Points

• It is important to distinguish between malignant peripheral nerve sheath tumors (MPNSTs) and benign peripheral nerve sheath tumors (BPNSTs) to ensure an appropriate treatment plan.

• On conventional MRI and diffusion-weighted imaging (DWI), MPNSTs and BPNSTs showed significant differences in tumor size, margin, presence of perilesional edema, and absence of split fat, fascicular, and target signs.

• Absence of a split fat sign and mean apparent diffusion coefficient (ADC) values were robust imaging findings distinguishing MPNSTs from BPNSTs, with a C-index of > 0.9.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

BPNSTs:

Benign peripheral nerve sheath tumors

CEFST1WI:

Contrast-enhanced fat-suppressed T1-weighted imaging

DWI:

Diffusion-weighted imaging

MPNSTs:

Malignant peripheral nerve sheath tumors

MRI:

Magnetic resonance imaging

NF-1:

Neurofibromatosis type 1

OR:

Odds ratio

ROC:

Receiver operating characteristic

ROIs:

Regions of interest

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jae Sung Yun, Min Hee Lee, Seung Min Lee, Hye Won Chung, Sang Hoon Lee & Myung Jin Shin

  2. Department of Radiology, Ajou University School of Medicine, Suwon, South Korea

    Jae Sung Yun

  3. Department of Radiology, Leaders Hospital, Seoul, South Korea

    Seung Min Lee

  4. Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Jong Seok Lee

  5. Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, South Korea

    Hwa Jung Kim

  6. Department of Clinical Epidemiology and Biostatics, Asan Medical Center, Seoul, South Korea

    Hwa Jung Kim

  7. Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea

    Sun Joo Lee

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  1. Jae Sung Yun
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Correspondence to Min Hee Lee.

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The scientific guarantor of this publication is Min Hee Lee.

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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.

Statistics and biometry

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Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Yun, J.S., Lee, M.H., Lee, S.M. et al. Peripheral nerve sheath tumor: differentiation of malignant from benign tumors with conventional and diffusion-weighted MRI. Eur Radiol 31, 1548–1557 (2021). https://doi.org/10.1007/s00330-020-07234-5

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  • DOI: https://doi.org/10.1007/s00330-020-07234-5

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