Imaging characteristics of schwannoma of the cervical sympathetic chain: a review of 12 cases

AJNR Am J Neuroradiol. 2010 Sep;31(8):1408-12. doi: 10.3174/ajnr.A2212. Epub 2010 Jul 8.

Abstract

Background and purpose: SCSCs are rare. This study reviews our experience with CT and MR imaging of SCSCs.

Materials and methods: We retrospectively reviewed the CT and MR imaging studies as well as clinical data of 12 patients (6 men, 6 women; mean age, 41 years; range, 27-55 years) with surgicopathologic evidence of SCSC, referred to our institution between January 1999 to October 2008. Images were evaluated with respect to the location, number, morphology, attenuation/signal intensity, enhancement characteristics, and patterns of mass effect of the schwannomas.

Results: The schwannomas were solitary, well-circumscribed, and medial to the carotid sheath. Seven were hypoattenuated to skeletal muscle on CT with poor postcontrast enhancement, 4 were isoattenuated, and a single lesion showed intense heterogeneous enhancement. At MR imaging, they were heterogeneously bright on T2WI with intense inhomogeneous postgadolinium enhancement. The ICA was displaced anteriorly in 9 patients with a component of lateral displacement in 8 of these patients. The ICA was in a neutral position in 2 patients and posterolaterally displaced in 1 patient. A single patient demonstrated separation of the ICA and IJV. There was splaying of the carotid bifurcation in 4 patients.

Conclusions: We present the patterns of mass effect and the spectrum of CT and MR imaging characteristics of SCSC, including certain observations that are infrequently described in the published literature.

MeSH terms

  • Adult
  • Carotid Arteries / diagnostic imaging
  • Carotid Arteries / pathology
  • Diagnosis, Differential
  • Female
  • Gadolinium
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / pathology*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurilemmoma / diagnostic imaging*
  • Neurilemmoma / pathology*
  • Peripheral Nervous System Neoplasms / diagnostic imaging
  • Peripheral Nervous System Neoplasms / pathology
  • Retrospective Studies
  • Superior Cervical Ganglion / diagnostic imaging*
  • Superior Cervical Ganglion / pathology*
  • Tomography, X-Ray Computed
  • Vagus Nerve / diagnostic imaging
  • Vagus Nerve / pathology

Substances

  • Gadolinium