E3374. What a Zinger! A Guide to Ultrasound of Peripheral Nerve Sheath Tumors with MRI Correlation
  1. Eric Royston; University of Michigan
  2. Heidi Ehrich; University of Michigan
  3. Mary Creedon; University of Michigan
  4. Kara Gaetke-Udager; University of Michigan
  5. Gunjan Malhotra; University of Michigan
  6. Corrie Yablon; University of Michigan
  7. Steven Soliman; University of Michigan
Ultrasound imaging is crucial for thoroughly assessing peripheral nerve sheath tumors (PNSTs), providing insights into their appearance, and aiding in accurate classification. This educational exhibit explores ultrasound's role in diagnosing PNSTs, revealing how different features distinguish benign from malignant tumors. By examining a variety of ultrasound images and subtle differences among PNST subtypes, attendees will enhance their ability to differentiate between these tumors, facilitating precise diagnosis and effective clinical management.

Educational Goals / Teaching Points
This educational exhibit aims to achieve the following objectives: Deliver a comprehensive overview of PNSTs, encompassing their pathology, clinical contexts, and associated conditions. Conduct a thorough review of the distinct sonographic characteristics exhibited by PNSTs, supported by MRI correlations. Explore potential differential diagnoses, such as malignant soft tissue masses, intraneural ganglia, and traumatic neuromas, while highlighting methods to differentiate based on distinct sonographic features. Discuss the role of ultrasound-guided biopsy, including technique, the significance of precise localization, and the inherent advantages in acquiring targeted tissue samples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomically, PNSTs frequently arise adjacent to peripheral nerves, often demonstrating distinct encapsulation and well-defined borders within surrounding soft tissue. Ultrasound plays a crucial role in discerning PNSTs and distinguishing among their subtypes. These tumors typically manifest as hypoechoic masses on ultrasound imaging, often demonstrating internal vascularity through Doppler analysis. However, differentiation among PNST subtypes can be achieved by scrutinizing specific sonographic features. Schwannomas, for instance, may present as well-defined, encapsulated masses with the "target sign," where a central hypoechoic area is surrounded by a hyperechoic rim. Neurofibromas, on the other hand, tend to display a more heterogeneous internal echotexture. In cases of malignant PNSTs, the presence of irregular borders, heterogeneous echogenicity, and increased vascularity may suggest malignancy. By meticulously analyzing these nuanced sonographic attributes, clinicians can enhance their ability to differentiate and classify various peripheral nerve sheath tumor subtypes, guiding accurate diagnosis and informed management decisions.

In summary, ultrasound emerges as a vital diagnostic tool for peripheral nerve sheath tumors, revealing intricate anatomical and sonographic details. With real-time imaging, dynamic assessment, and noninvasive methods, ultrasound offers key insights of this range of neoplasms. This exhibit underscores ultrasound's pivotal role in peripheral nerve pathology, empowering clinicians to diagnose and guide management effectively. By blending advanced imaging with clinical expertise, practitioners will be able to enhance patient care and excel in the diagnostic precision of PNSTs.