Skip to main content

Advertisement

SpringerLink
Log in

Morphology of the entering and exiting nerve as a differentiating feature of benign from malignant peripheral nerve sheath tumours of the brachial plexus

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To identify if morphology of the entering and exiting nerve involved by a nerve sheath tumour in the brachial plexus can help differentiate between benign (B) and malignant (M) peripheral nerve sheath tumours (PNSTs).

Materials and methods

Retrospective review of 85 patients with histologically confirmed primary PNSTs of the brachial plexus over a 12.5-year period. Clinical data and all available MRI studies were independently evaluated by 2 consultant musculoskeletal radiologists blinded to the final histopathological diagnosis assessing for maximal lesion dimension, visibility and morphology of the entering and exiting nerve, and other well-documented features of PNSTs.

Results

The study included 47 males and 38 females with mean age 46.7 years (range, 8–81 years). There were 73 BPNSTs and 12 MPNSTs. The entering nerve was not identified in 5 (7%), was normal in 17 (23%), was tapered in 38 (52%) and showed lobular enlargement in 13 (18%) BPNSTs compared with 0 (0%), 0 (0%), 2 (17%) and 10 (83%) MPNSTs respectively. The exiting nerve was not identified in 5 (7%), was normal in 20 (27%), was tapered in 42 (58%) and showed lobular enlargement in 6 (8%) BPNSTs compared with 4 (33%), 0 (0%), 2 (17%) and 6 (50%) MPNSTs respectively. Increasing tumour size, entering and exiting nerve morphology and suspected MRI diagnosis were statistically significant differentiators between BPNST and MPNST (p < 0.001). IOC for nerve status was poor to fair but improved to good if normal/tapered appearance were considered together with improved specificity of 81–91% for BPNST and sensitivity of 75–83%.

Conclusions

Morphology of the adjacent nerve is a useful additional MRI feature for distinguishing BPNST from MPNST of the brachial plexus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Saifuddin A. Imaging tumours of the brachial plexus. Skelet Radiol. 2003;32:375–87.

    Article  Google Scholar 

  2. Ogose A, Hotta T, Morita T, Yamamura S, Hosaka N, Kobayashi H, et al. Tumors of peripheral nerves: correlation of symptoms, clinical signs, imaging features, and histologic diagnosis. Skelet Radiol. 1999;28:183–8.

    Article  CAS  Google Scholar 

  3. Li CS, Huang GS, Wu HD, Chen WT, Shih LS, Lii JM, et al. Differentiation of soft tissue benign and malignant peripheral nerve sheath tumors with magnetic resonance imaging. Clin Imaging. 2008;32:121–7.

    Article  Google Scholar 

  4. Matsumine A, Kusuzaki K, Nakamura T, Nakazora S, Niimi R, Matsubara T, et al. Differentiation between neurofibromas and malignant peripheral nerve sheath tumors in neurofibromatosis 1 evaluated by MRI. J Cancer Res Clin Oncol. 2009;135:891–900.

    Article  Google Scholar 

  5. Wasa J, et al. MRI features in the differentiation of malignant peripheral nerve sheath tumors and neurofibromas. AJR. 2010;194:1568–74.

    Article  Google Scholar 

  6. Demehri S, Belzberg A, Blakeley J, Fayad LM. Conventional and functional MR imaging of peripheral nerve sheath tumors: initial experience. AJNR Am J Neuroradiol. 2014;35(8):1615–20.

    Article  CAS  Google Scholar 

  7. Karsy M, Guan J, Ravindra VM, Stilwill S, Mahan MA. Diagnostic quality of magnetic resonance imaging interpretation for peripheral nerve sheath tumors: can malignancy be determined? J Neurol Surg A Cent Eur Neurosurg. 2016;77(6):495–504.

    Article  Google Scholar 

  8. Soldatos T, Fisher S, Karri S, Ramzi A, Sharma R, Chhabra A. Advanced MRI imaging of peripheral nerve sheath tumors including diffusion imaging. Semin Musculoskelet Radiol. 2015;19:179–90.

    Article  Google Scholar 

  9. Well L, Salamon J, Kaul MG, et al. Differentiation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1 using diffusion-weighted magnetic resonance imaging. Neuro-Oncology. 2019;21(4):508–16.

    Article  CAS  Google Scholar 

  10. Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009;253:297–316.

    Article  Google Scholar 

  11. Salunke AA, Chen Y, Tan JH, et al. Intramuscular schwannoma: clinical and magnetic resonance imaging features. Singap Med J. 2015;56(10):555–7.

    Article  Google Scholar 

  12. Bhargava R, Parham DM, Lasater OE, et al. MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol. 1997;27:124–9.

    Article  CAS  Google Scholar 

  13. Varma DG, Moulopoulos A, Sara AS, et al. MR imaging of extracranial nerve sheath tumors. J Comput Assist Tomogr. 1992;16(3):448–53.

    Article  CAS  Google Scholar 

  14. Shimose S, Sugita T, Kubo T, et al. Major-nerve schwannomas versus intramuscular schwannomas. Acta Radiol. 2007;48:672–7.

    Article  CAS  Google Scholar 

  15. Ahlawat S, Fayad LM. Imaging cellularity in benign and malignant peripheral nerve sheath tumors: utility of the “target sign” by diffusion weighted imaging. Eur J Radiol. 2018;102:195–201.

    Article  Google Scholar 

  16. Koga H, Matsumoto S, Manabe J, Tanizawa T, Kawaguchi N. Definition of the target sign and its use for the diagnosis of schwannomas. Clin Orthop Relat Res. 2007;464:224–9.

    Article  Google Scholar 

  17. Zhang Z, Deng L, Ding L, Meng Q. MR imaging differentiation of malignant soft tissue tumors from peripheral schwannomas with large size and heterogeneous signal intensity. Eur J Radiol. 2015;84(5):940–6.

    Article  Google Scholar 

  18. Mazal AT, Ashikyan O, Cheng J, Le LQ, Chhabra A. Diffusion-weighted imaging and diffusion tensor imaging as adjuncts to conventional MRI for the diagnosis and management of peripheral nerve sheath tumors: current perspectives and future directions. Eur Radiol. 2019;29(8):4123–32.

    Article  Google Scholar 

  19. Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG. A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg. 2005;102(2):246–55.

    Article  Google Scholar 

  20. Ahlawat S, Blakeley JO, Rodriguez FJ, Fayad LM. Imaging biomarkers for malignant peripheral nerve sheath tumors in neurofibromatosis type 1 [published correction appears in Neurology. 2020 Mar 17;94(11):504]. Neurology. 2019;93(11):e1076–84.

    Article  CAS  Google Scholar 

  21. Schmidt M, Kasprian G, Amann G, Duscher D, Aszmann OC. Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors. Neurosurg Focus. 2015;39(3):E17.

    Article  Google Scholar 

  22. Chhabra A, Thakkar RS, Andreisek G, et al. Anatomic MR imaging and functional diffusion tensor imaging of peripheral nerve tumors and tumorlike conditions. AJNR Am J Neuroradiol. 2013;34(4):8.

    Article  Google Scholar 

  23. Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation 1. Radiographics. 1999;19:1253–80.

    Article  CAS  Google Scholar 

  24. Mauermann ML, Amrami KK, Kuntz NL, et al. Longitudinal study of intraneural perineurioma- a benign, focal hypertrophic neuropathy of youth. Brain. 2009;132:2265–76.

    Article  Google Scholar 

  25. Lusk MD, Kline DG, Garcia CA. Tumors of the brachial plexus. Neurosurgery. 1987;21(4):439–53.

    Article  CAS  Google Scholar 

  26. Jia X, Yang J, Chen L, Yu C, Kondo T. Primary brachial plexus tumors: clinical experiences of 143 cases. Clin Neurol Neurosurg. 2016;148:91–5.

    Article  Google Scholar 

  27. Brahmi M, Thiesse P, Ranchere D, et al. Diagnostic accuracy of PET/CT-guided percutaneous biopsies for malignant peripheral nerve sheath tumors in neurofibromatosis type 1 patients. PLoS One. 2015;10(10):e0138386 Published 2015 Oct 7.

    Article  Google Scholar 

  28. Pianta M, Chock E, Schlicht S, McCombe D. Accuracy and complications of CT-guided core needle biopsy of peripheral nerve sheath tumours. Skelet Radiol. 2015;44(9):1341–9.

    Article  Google Scholar 

  29. Tøttrup M, Eriksen JD, Hellfritzsch MB, Sørensen FB, Baad-Hansen T. Diagnostic accuracy of ultrasound-guided core biopsy of peripheral nerve sheath tumors. J Clin Ultrasound. 2020;48(3):134–8.

    Article  Google Scholar 

  30. Chee DW, Peh WC, Shek TW. Pictorial essay: imaging of peripheral nerve sheath tumours. Can Assoc Radiol J. 2011;62(3):176–82.

    Article  Google Scholar 

  31. Kakkar C, Shetty CM, Koteshwara P, Bajpai S. Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging. Indian J Radiol Imaging. 2015;25(4):453–8.

    Article  Google Scholar 

  32. WHO Classification of Tumours Editorial Board. WHO Classification of Tumours of Soft Tissue and Bone. 5th ed. Lyon, France: IARC Press; 2020.

    Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Paul Bassett for statistical support.

Author information

Authors and Affiliations

  1. Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    I. Pressney, M. Khoo, R. Hargunani & A. Saifuddin

  2. Department of Radiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates

    R. Khan

  3. Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK

    P. Abernethy

Authors
  1. I. Pressney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Khoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Abernethy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Hargunani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Saifuddin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Pressney.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pressney, I., Khoo, M., Khan, R. et al. Morphology of the entering and exiting nerve as a differentiating feature of benign from malignant peripheral nerve sheath tumours of the brachial plexus. Skeletal Radiol 50, 1557–1565 (2021). https://doi.org/10.1007/s00256-020-03689-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03689-1

Keywords

Search

Navigation