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Extraaxial Neurofibromas Versus Neurilemmomas: Discrimination with MRI

¹ Department of Diagnostic Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea, 505 Banpodong, Seocho-gu, Seoul 137-701, South Korea.
² Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT.
³ Department of Radiology, Kyung-Hee University, Seoul, South Korea.
⁴ Department of Radiology, Yonsei University, Seoul, South Korea.
⁵ Department of Radiology, Korea Cancer Center Hospital, Seoul, South Korea.
⁶ Department of Pathology, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul 137-701, South Korea.
⁷ Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, South Korea.

Abstract

OBJECTIVE. The purpose of our study was to evaluate whether MRI can discriminate between extraaxial neurofibromas and neurilemmomas.

MATERIALS AND METHODS. MR images of 52 patients with a pathologically proven extraaxial neurofibroma or neurilemmoma were retrospectively reviewed by observers who were unaware of the surgical results, regarding the presence or absence of individual imaging criteria. MRI findings in 12 patients with a localized neurofibroma and 40 patients with a neurilemmoma were compared using the chi-square test or Fisher's exact test.

RESULTS. MRI findings suggestive of neurofibroma (p < 0.05) were a target sign on T2-weighted images (58% in neurofibromas vs 15% in neurilemmomas), central enhancement (75% vs 8%), and a combination of both findings (63% vs 3%). MRI findings suggestive of a neurilemmoma (p < 0.05) were a fascicular appearance on T2-weighted images (25% vs 63%), a thin hyperintense rim on T2-weighted images (8% vs 58%), a combination of both findings (8% vs 48%), and diffuse enhancement (13% vs 67%). No significant difference was seen between neurofibromas and neurilemmomas for a centrally entering and exiting nerve (42% in neurofibromas vs 23% in neurilemmomas), a peripherally entering and exiting nerve (58% vs 77%), a cystic area (38% vs 64%), a low-signal margin (100% vs 100%), peripheral enhancement (13% vs 26%), or a target sign on contrast-enhanced images (11% vs 31%).

CONCLUSION. MRI shows features helpful for differentiating extraaxial neurofibromas from neurilemmomas; however, no single finding or combination of findings allows definitive differentiation.

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