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MR neurography of tibial nerve schwannoma

Case Study
Wang, Guangbin, M.D., Ph.D. Shandong Medical Imaging Reseach Institute • China, People's Republic of

Patient history

A 31-year-old man with a painless mass in the right leg underwent MR neurography on a Release 5.1.7 Achieva 3.0T TX at Shandong Medical Imaging Research Institute, China.

MR examination

The patiënt was examined on a Release 5.1.7 Achieva 3.0T TX with 8-channel SENSE Knee coil.

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Images

Click on an image to enlarge.
MIP oblique lateral MIP anteroposterior
MIP oblique lateral
MIP anteroposterior
MIP in oblique lateral and anteroposterior projection shows extrinsic appearance of the mass (arrow) relative to a compressed and anteriorly displaced right tibial nerve (arrowheads). The common peroneal nerve (CP) is normal.
Intraoperative
Intraoperative
The intraoperative photograph shows the proximal tibial nerve entering the mass and the distal tibial nerve exiting the mass and fascicles (arrowheads) running over surface of mass.
MIP oblique lateral MIP anteroposterior
MIP oblique lateral
MIP anteroposterior
Two months after surgery, follow-up MR neurography in oblique lateral and anteroposterior projection show that it is difficult to differentiate the tibial nerve (arrowheads) from surrounding hypertense tissues in the surgical area.

Diagnosis

The mass was removed surgically. The intraoperative photograph shows the proximal tibial nerve entering the mass and the distal tibial nerve exiting the mass. Histology demonstrated tibial nerve schwannoma.

Clinical impact of MR neurography

Because ultrasound is convenient and less costly, it is a natural first choice for nerve imaging. However, sometimes ultrasound cannot demonstrate nerve lesions well, and field of view isn’t large.

MR neurography has high spatial resolution and a large field of view, so it can help to confirm ultrasound findings when they are inconclusive. And even when ultrasound or electromyography results in a conclusive diagnosis, MR can be useful to add information by its capabilities to help demonstrate the lesion’s position and shape.

Related reading

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary.



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Feb 12, 2015

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Case Study
Achieva 3.0T TX
Release 5
8-channel SENSE knee coil, DWIBS, knee, MR neurography, Neuro, Oncology, Schwannoma, tibial nerve
 

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