Neurofibroma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2] Shanshan Cen, M.D. [3]

Overview

MRI may be helpful in the diagnosis of neurofibroma. It appears as a hypointense, homogeneous low signal intensity lesion with center demonstrating a higher signal intensity than the periphery on T1. T2 weighted images show hyperintense, homogeneous lesion with positive target sign and fascicular sign. Moreover, neurofibromas have heterogeneous enhancement on T1 C+ (Gd) (with gadolinium contrast).

MRI

• MRI may be helpful in the diagnosis of neurofibroma
• MRI signal characteristics include:

MRI sequence	Characteristics
T1	Hypointense Homogeneous low signal intensity Center demonstrating a higher signal intensity than the periphery (reverse of target sign on T2)
T2	Hyperintense Homogeneous high signal intensity (higher than fat) Target sign (plexiform neurofibromas) Low signal intensity centrally with a ring of high signal intensity peripherally Due to a dense central area of collagenous stroma Highly suggestive of neurofibroma but occasionally also seen in schwannomas and malignant peripheral nerve sheath tumors Fascicular sign Plexiform neurofibromas may appear as a larger and more infiltrating mass with lobulated borders with inhomogeneous enhancement Myxoid stroma enhancement helps differentiating the high signal intensity at T2-weighted imaging from cystic change or necrosis
T1 C+ (Gd) (with gadolinium contrast)	Heterogenous enhancement

Plexiform neurofibroma of the submandibular gland in patient with von Recklinghausen's disease. The MRI T-2 weighted image with contrast (A. Axial & B. Coronal view) showed a mass with diffuse heterogeneous enhancement in the left submandibular gland. Source: Bisher HA. et al, General Surgery Department, King Fahd Hospital of the University, Al Khobar, Saudi Arabia

Plexiform Neurofibroma of the Bladder. Sagittal, T2-weighted MR image shows that the mass contains multiple areas of low signal intensity centrally and high signal intensity peripherally (arrow). This finding is referred to as the target sign and is suggestive of plexiform neurofibroma. Source: Wilkinson LM. et al, From the Department of Medical Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.

Plexiform Neurofibroma of the Bladder. Axial unenhanced MR image shows mild nonuniform enhancement of the large bladder mass.Source: Wilkinson LM. et al, From the Department of Medical Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.

Plexiform Neurofibroma of the Bladder.Axial gadolinium-enhanced MR image shows mild nonuniform enhancement of the large bladder mass. Source: Wilkinson LM. et al, From the Department of Medical Imaging, Hospital for Sick Children, Toronto, Ontario, Canada. ]

References

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