Intraneural perineuriomas: diagnostic value of magnetic resonance neurography

J Peripher Nerv Syst. 2018 Mar;23(1):23-28. doi: 10.1111/jns.12240. Epub 2017 Dec 7.


Intraneural perineurioma (IP) is an under-recognized hypertrophic peripheral nerve tumor. It affects young patients involving frequently the sciatic nerve and its branches and presents with a progressive, painless and predominantly motor deficit. Magnetic resonance neurography (MRN) is a useful tool to localize the lesion, evaluate its extension, and discriminate between different etiologies. We reviewed the clinical records of 11 patients with pathologically confirm IP. Eight patients were males with mean age 19 years. Initial complains were unilateral steppage (seven patients), bilateral steppage (one patient), unilateral gastrocnemius wasting (one patient), unilateral thigh atrophy (one patient), and unilateral hand weakness (one patient). Nine patients had mild painless sensory loss. Examinations revealed involvement of sciatic nerve extending into the peroneal nerve (eight patients), posterior tibial nerve (one patient), radial nerve (one patient), and femoral nerve (one patient). MRN revealed enlargement of the affected nerve isointense on T1-weighted, hyperintense on T2 fat-saturated images, and with avid enhancement on post-contrast imaging. In all patients, a nerve biopsy confirmed the diagnosis. MRN allows early and non-invasive identification of this tumor and is a key tool providing localization and differential diagnosis in patients with slowly progressive focal neuropathies.

Keywords: intraneural perineurioma; magnetic resonance neurography; peripheral nerve tumors; peroneal nerve; sciatic nerve; tibial nerve.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Nerve Sheath Neoplasms / diagnostic imaging*
  • Peripheral Nervous System Neoplasms / diagnostic imaging*
  • Retrospective Studies
  • Young Adult