Nerve Tumors: What the MSK Radiologist Should Know

Area of Science:

• Radiology
• Oncology
• Neurology

Background:

• Nerve tumors are rare, heterogeneous soft tissue neoplasms originating from peripheral nerves or exhibiting nerve sheath differentiation.
• Accurate radiologic identification of neural origin, nerve association, and tumor versus pseudotumor (e.g., neuroma, fibrolipoma, ganglion) is essential.

Purpose of the Study:

• To review the role of imaging modalities in characterizing soft tissue lesions of neural origin.
• To highlight the diagnostic challenges in differentiating benign and malignant neurogenic tumors.

Main Methods:

• Review of current imaging techniques, primarily ultrasound (US) and magnetic resonance imaging (MRI).
• Discussion of US-guided biopsy for indeterminate or potentially malignant lesions.
• Analysis of imaging features for differential diagnosis.

Main Results:

• Ultrasound and MRI are the primary imaging modalities for characterizing neural soft tissue lesions.
• US can guide biopsies for indeterminate or suspicious lesions.
• Currently, no definitive imaging criteria reliably distinguish between neurofibroma and schwannoma or benign from malignant neurogenic tumors.

Conclusions:

• Accurate differentiation of nerve tumors using imaging alone is not consistently achievable.
• Multimodality imaging combined with expert consultation is recommended for optimal patient management.
• Referral to specialized nerve tumor/sarcoma units is advised for complex cases.