Abstract
Purpose
The aim of this study was to evaluate whether there exists a characteristic distribution pattern of vessels within neurinomas that may be used to characterise this type of lesion by employing a contrast-specific ultrasound technique.
Materials and methods
Between January 2003 and May 2010, 66 suspected neurinomas were evaluated according to their sonographic features (solid fusiform mass with well-defined margins located in direct continuity with the nerve that was not always discernible and heterogeneous as a result of the presence of small cystic areas or calcifications). The lesions were examined using a sonographic contrast medium consisting of sulphur hexafluoride microbubbles and equipment with dedicated contrast-specific software [contrast tuned imaging (CnTI)]. Of these lesions, five were excluded from the analysis because the definitive diagnosis was not available (in two cases, the follow-up was still in progress, whereas in the remaining three, there was no follow-up). Our study, therefore, is based on 61 surgically excised lesions that were confirmed to be neurinomas by histology, which is regarded as the gold standard.
Results
In 41/61 cases (67.2%), we identified an enhancement pattern that we termed reticular owing to the interweaving of blood vessels, of which two subtypes were identified depending on whether the interwoven vessels were densely or sparsely packed: loose-knit reticular in 18/41, and tight-knit reticular in 23/41. In 20/61 (32.8%) cases, we observed a vascular pattern of diffuse heterogeneous enhancement, which was divided into two subtypes based on the presence of one (7/20) or more (13/20) avascular areas.
Conclusions
Results showed that all neurinomas studied could be divided into two groups according to the type of enhancement pattern observed: reticular or diffuse heterogeneous.
Riassunto
Obiettivo
Scopo dello studio è valutare, mediante l’impiego di una tecnica ecografica contrasto-specifica, se esiste una distribuzione caratteristica dei vasi all’interno dei neurinomi che possa essere usata per una caratterizzazione del tipo di lesione.
Materiali e metodi
Nel periodo compreso tra gennaio 2003 e maggio 2010 sono state valutate nel nostro dipartimento 66 lesioni sospette per neurinoma in base alle loro caratteristiche ecografiche (formazioni solide, fusiformi, a margini netti, in diretta continuità con la fibra nervosa, non sempre riconoscibile, disomogenee per l’eventuale presenza di piccole aree similcistiche o calcificazioni), ed esaminate con mezzo di contrasto (MdC) ecografico, costituito da microbolle a base di esafluoruro di zolfo e apparecchiatura dotata di software dedicato Contrast Tuned Imaging (CnTI) contrasto specifico. Di queste lesioni, 5 sono state escluse dall’analisi in quanto non era disponibile una diagnosi definitiva (n=2 follow-up in corso; n=3 assenza di follow-up). Pertanto il nostro studio si basa unicamente sulle 61 lesioni asportate chirurgicamente e confermate come neurinomi all’esame istologico, considerato come gold standard.
Risultati
In 41/61 (67,2%) casi abbiamo identificato una distribuzione del mezzo di contrasto definita “a reticolo” in base all’intreccio formato dalle strutture vascolari, in cui si riconoscono due sottotipi: “reticolo a maglie larghe” in 18/41 e “reticolo a maglie strette” in 23/41, distinti in base all’aspetto dell’incrocio dei vasi, se più rado o più fitto. In 20/61 (32,8%) casi abbiamo osservato un diverso pattern di vascolarizzazione, denominato “impregnazione diffusa disomogenea”, a sua volta suddiviso in due sottotipi in base alla presenza di una (7/20) o più aree avascolari (13/20).
Conclusioni
I risultati ottenuti in questo studio hanno dimostrato che tutti i neurinomi analizzati possono essere distinti in due gruppi, in base al tipo di pattern vascolare riscontrato: di tipo reticolare o ad impregnazione diffusa disomogenea.
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De Marchi, A., Pozza, S., Sutera, R. et al. Study of neurinomas with ultrasound contrast media: review of a case series to identify characteristic imaging patterns. Radiol med 116, 634–643 (2011). https://doi.org/10.1007/s11547-011-0653-1
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DOI: https://doi.org/10.1007/s11547-011-0653-1