探讨高频超声在体表部位神经鞘瘤诊断及鉴别诊断中的价值。

回顾性分析常州第二人民医院普外科2011年1月至2017年1月收治的97例体表部位神经鞘瘤患者的超声诊断结果。超声检查记录肿块部位、数量、大小、形态、内部及周边回声、边界、包膜、后方回声、病灶与周围组织的关系；彩色多普勒血流显像检测肿块内部及周边血流情况。

97例神经鞘瘤(四肢53例，颈部19例，体表其他部位25例)具体如下：(1)病灶数量：97.9%(95/97)的病例为单发病灶；(2)肿块包膜：边界清晰，所有肿块均见较完整或完整的包膜回声；(3)肿块内部回声：71例肿块(73.2%，71/97)内部为均匀或不均实质性低回声；26例(26.8%，26/97)肿块内部可见大小不等的暗区，其中有12例"呈蜂窝"样改变，另有3例为囊性；(4)"鼠尾征"：71例肿块一端或两端见"鼠尾征"；(5)彩色多普勒血流显像观察肿块内部及周边血流情况：71例(73.2%，71/97)肿块内部及周边可见血流信号。97例中71例术前超声提示神经鞘瘤，超声总体诊断符合率为73.2%(71/97)。误诊及未明确诊断的情况：颈部4例误诊为肿大淋巴结；颈部2例误诊为颈动脉体瘤；四肢3例误诊为神经纤维瘤；腘窝处有3例误诊为腘窝区囊肿；下肢2例误诊为纤维瘤；12例仅限于超声物理诊断，未能提示神经鞘瘤。颈部与四肢两组共72例，其中颈部19例中12例超声提示符合病理，四肢53例中45例超声提示符合病理。四肢组神经鞘瘤的超声提示符合率(84.9%，45/53)高于颈部组(63.2%，12/19)，两组差异具有统计学意义(χ²＝4.01，P<0.05)。

多数体表部位神经鞘瘤声像图具有一定特征，高频超声具有一定的诊断准确率；四肢部位较颈部诊断准确率更高；当声像图缺乏特征性表现时，应结合病史、临床表现及其他影像学检查，以免误诊。

To investigate the diagnosis and differential diagnosis value of the high-frequency ultrasound superficial schwannoma.

Sonograms of superficial schwannoma in 97 cases from January 2011 to January 2017 in Changzhou 2nd People′s Hospital were analyzed. The ultrasonic manifestations of 97 cases are collected, such as position, quantity, size, shape, internal and periphery echo, boundary, envelope, rear echo. The surveyed mass blood flow information in 97 cases is surveyed by color doppler flow imaging.

The ultrasonic manifestations of 97 cases(53 cases located in limbs, 19 cases located in cervical part, 25 cases located in other positions of body surface) specifically as follows. 1. Lump quantity: 97.9% cases were olitary(95/97). 2. Lump envelope: completed or relative completed envelope echo and sharpness of border were found in all cases(100%, 97/97). 3. Lump internal echo: Well-distributed or dis-well-distributed low level echo was found in 71 cases (73.2%, 71/97), anechoic areas of variable size were found in 26 cases (26.8%, 26/97), honeycombing structure were found in 12 cases, cyst were found in 3 cases. 4. "Mouse-tail-sign" : "Mouse-tail-sign" in uni-tip or/and amphi-tip in 71 cases. 5. To observe the mass internal and periphery blood flow with color dopper flow imaging(CDFI): Mass internal and periphery were found blood flow signal in 71 cases(73.2%, 71/97). Disdiagnosis and indefinite diagnosis information: four cases located in cervical part were misdiagnosed as swelling lymph nodes, two cases located in cervical part were misdiagnosed as tumor of carotid body, three cases located in four limbs were misdiagnosed as neurofibroma, three cases were misdiagnosed as popliteal fossa region cyst in popliteal fossa region, two cases located in lower limbs were misdiagnosed as fibroma. Ultrasonic physical diagnosis were issued in 12 cases only, failed to cue schwannoma. Among 72 cases in cervix and limbs, the ultrasonic diagnosis were according with pathological diagnosis of 12/19 (84.9%) cases in cervix and 45/53 (63.2%) cases in limbs. The difference between cervix and limb groups are statistically significant (χ²=4.01, P<0.05).

Most of body superficial schwannoma ultrasonogram have some characteristics, high-frequency ultrasound has high diagnostic accurate rate. The four limbs part has higher accurate rate than cervical part. When the ultrasonogram lacking marking manifest, medical history, clinical situation and other iconography check should be combined in avoiding of misdiagnosis.