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Extraaxial Neurofibromas Versus Neurilemmomas: Discrimination with MRI

Won-Hee Jee1, Soon-Nam Oh1, Thomas McCauley2, Kyung-Nam Ryu3, Jin-Suck Suh4, Jeong-Hoon Lee5, Jung-Mi Park1, Kyung-Ah Chun1, Mi-Sook Sung1, Kijun Kim1, Yeon-Soo Lee6, Yong-Koo Kang7, In-Young Ok7 and Jung-Man Kim7

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.



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  		Fig. 1A. —25-year-old man with neurofibroma. Axial T1-weighted image (TR/TE, 450/12) shows hypointense- to intermediate-signal mass (arrows).

 


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  		Fig. 1B. —25-year-old man with neurofibroma. On axial T2-weighted fast spin-echo image (3,600/96; echo-train length, 7), mass has peripheral high signal intensity and central low signal intensity, representing target sign (arrows), which was seen in more than half of neurofibromas.

 


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  		Fig. 1C. —25-year-old man with neurofibroma. On axial fat-suppressed contrast-enhanced T1-weighted image (600/12), mass shows central enhancement (arrows), which was seen in three quarters of neurofibromas.

 


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  		Fig. 2. —64-year-old woman with neurilemmoma. On axial T2-weighted image (TR/TE, 1,800/90), mass has peripheral high signal intensity and internal low signal intensity, representing target sign (arrows), which is more typical of neurofibromas but is occasionally seen in neurilemmomas.

 


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  		Fig. 3A. —34-year-old woman with neurilemmoma. Axial T1-weighted image (TR/TE, 440/15) shows hypointense mass (arrows).

 


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  		Fig. 3B. —34-year-old woman with neurilemmoma. On axial T2-weighted turbo spin-echo image (3,600/96; echo-train length, 7), mass has peripheral high signal intensity and central low signal intensity, representing target sign (arrows).

 


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  		Fig. 3C. —34-year-old woman with neurilemmoma. On axial fat-suppressed contrast-enhanced T1-weighted image (760/17), mass shows diffuse heterogeneous enhancement (arrows).

 


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  		Fig. 4. —42-year-old man with neurilemmoma. On axial turbo spin-echo T2-weighted image (TR/TE, 3,500/96; echo-train length, 7), mass shows multiple small, circular low-signal-intensity areas surrounded by background of mild hyperintensity representing fascicular appearance (arrows), which is more commonly seen in neurilemmomas than in neurofibromas.

 


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  		Fig. 5. —57-year-old man with neurilemmoma. Sagittal T2-weighted fast spin-echo image (TR/TE, 3,000/85; echo-train length, 8) reveals mass with thin hyperintense rim (arrows), which was seen in most neurilemmomas.

 


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  		Fig. 6A. —57-year-old woman with neurilemmoma. Oblique sagittal T1-weighted image (TR/TE, 500/15) shows fusiform hypointense mass and surrounding fat, representing "split-fat" sign (arrows).

 


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  		Fig. 6B. —57-year-old woman with neurilemmoma. Oblique sagittal T2-weighted image (3,700/90; echo-train length, 7) reveals heterogeneously hyperintense mass with centrally entering and exiting nerve (arrows).

 


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  		Fig. 6C. —57-year-old woman with neurilemmoma. On sagittal fat-suppressed contrast-enhanced T1-weighted image (560/15), mass shows homogeneous diffuse enhancement (arrows), which is seen in most neurilemmomas.

 

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