醫(yī)學(xué)影像學(xué)實驗中樞神經(jīng)系統(tǒng)常見疾病的影像學(xué)診斷

中樞神經(jīng)系統(tǒng)常見疾病的影像學(xué)診斷

ImageologicalDiagnosisofCentreNerousSystemCommonDiseases(I)腦腫瘤腦外傷腦血管性疾病顱內(nèi)感染脫髓鞘疾病先天發(fā)育異常腦腫瘤(Braintumor)膠質(zhì)細胞瘤（astrocystictumors）腦膜瘤(meningioma)垂體瘤(pituitrytumor)顱咽管瘤(craniopharyngioma)聽神經(jīng)瘤(acousticneurinoma)轉(zhuǎn)移瘤(metastatictumors)三叉神經(jīng)瘤血管網(wǎng)織細胞瘤脈絡(luò)叢乳頭狀瘤脊索瘤皮樣囊腫表皮樣囊腫生殖細胞瘤嗅母細胞瘤膠質(zhì)細胞瘤星形膠質(zhì)細胞瘤Ⅰ級～Ⅳ級（最常見）少突膠質(zhì)細胞瘤（鈣化常見）室管膜瘤（室管膜細胞）髓母細胞瘤（小腦蚓部）膠質(zhì)母細胞瘤星形細胞瘤

I級POST-CEPRE-CE星形細胞瘤II-III級POST-CEPRE-CE星形細胞瘤II-Ⅲ級PRE-CEPOST-CE星形細胞瘤II級CORT1WI平掃＋增強AXT2WI+T1WICE星形細胞瘤Ⅲ-Ⅳ級CORT1WI平掃＋增強AXT2WI+T1WICE星形細胞瘤AXT2WI+T1WICEAX+CORT1WICORT1WICE+MRA星形細胞瘤AXT1WI+T2WIT1WICEAX+COR星形細胞瘤SAGT1WI+AXT2WIT1WICEAX+COR少突膠質(zhì)細胞瘤PRE-CEPOST-CE少突膠質(zhì)細胞瘤T1WI+T2WIT1WICE四腦室

室管膜瘤AXT2WI+SAGT1WIAX+SAGCE側(cè)腦室

室管膜瘤AXT2WI+T1WIT1WICEAX+SAG室管膜瘤(腦實質(zhì)型)PRE-CEPOST-CE髓母細胞瘤PRE-CEPOST-CE左小腦髓母細胞瘤PRE-CEPOST-CE髓母

細胞瘤腦膜瘤PRE-CEPOST-CE腦膜瘤AXT1WI+T2WIT1WICEAX+CORT1WIAXT2WIAXT1WICESAG腦膜瘤T2WIT1WICET1WIT2WIT1WICEMRV

多發(fā)腦膜瘤聽神經(jīng)瘤PRECEPOSTCE骨窗T2WIT1WICET1WICECOR聽神經(jīng)瘤AXT1WI+T2WIT1WICEAX+COR三叉神經(jīng)鞘瘤AXT2WI+T1WIT1WICEAX+SAG三叉神經(jīng)鞘瘤AXT2WI+T1WIT1WICEAX+COR顱咽管瘤顱咽管瘤顱咽管瘤T1WISAGT2WICOR顱咽管瘤T1WICORT2WIAXT1WISAG正常垂體MRIT1WISAG+CORT1WICESAG+COR垂體微腺瘤T1WICORPRE-CEPOST-CE垂體大腺瘤T2WIAXT1WISAGT1WICOR轉(zhuǎn)移瘤PRE-CEPOST-CE(fromlung)轉(zhuǎn)移瘤(fromliver)轉(zhuǎn)移瘤(fromlung)轉(zhuǎn)移瘤

(frombreast)腦膜、板障松果體區(qū)

生殖細胞瘤脊索瘤血管網(wǎng)織細胞瘤皮樣囊腫表皮樣囊腫表皮樣囊腫腦腫瘤腦外傷腦血管性疾病顱內(nèi)感染脫髓鞘疾病先天發(fā)育異常皮膚顱骨蛛網(wǎng)膜軟腦膜硬膜外間隙硬腦膜蛛網(wǎng)膜下腔腦實質(zhì)硬膜下間隙DifferentialdianosisEpiduralematomaFusiformNotspanningsuturesRangelimitedSub-duralhematomaluniformSpanningsuturesRangeextensive

硬膜外血腫硬膜外血腫慢性硬膜下血腫硬膜下血腫硬膜下血腫

Sub-durahematoma額葉挫裂傷并硬膜下出血、蛛網(wǎng)膜下腔出血腦挫裂傷腦挫裂傷

并SAH、腦疝胼胝體壓部挫裂傷Brain

contusionbrainswellinghemorrhageinjuryofthebrainparenchyma腦腫瘤腦外傷腦血管性疾病顱內(nèi)感染脫髓鞘疾病先天發(fā)育異常腦出血腦梗死動脈瘤血管畸形CTfindingsAcutestageclearmarginround-likehighdensitysurroudingbyedemamasseffectResorptionstagebluredmarginHigh,iso,lowdensitylessedemaLessmasseffect

Cyststagelargeonesresiduecapsularspacering-likeenhancement腦出血腦出血并破入腦室MRIfindings

Super-acutestage(<6h)：T1WI：iso-，T2WI：hyper-

Acutestage（7h～3d）:T1WI：iso-;T2WI:verylow(IntegratedRBC,deoxyhemoglobin)Sub-acutestage:（3d-4w）Earlierperiod:T1WI&T2WI:hypo-Laterstage:T1WI&T2WI:hyper-Chronicphase（≥4w）:longT1longT2Cystformstage:T1WI:hypo-;T2WI:hyper-(margin:hypo-depositionofhemosiderin)亞急性腦出血橋腦出血右側(cè)小腦出血SAH（Subarachnoidhemorrhage）Clinicalmenifestation-triad:severeheadache、meningealirritationsign、hemorrhagicCSF頭痛、腦膜刺激征及血性腦脊液SAH右額顳枕葉梗死腦出血腦梗死動脈瘤血管畸形Acutecerebralischemia-infarctionT1WI:corticalswelling,lossofgray-whitematterbordersT2WI:hyperintensityinaffectedregion,maynormalizeafter2-3weeksFLAIR:maybepositivewhenothersequencesisnormal(asearlyas6hourspost-ictus)T2GRE:sensitivefordetectionofacutebloodproducts右顳葉梗死胼胝體及雙側(cè)基底節(jié)區(qū)腔梗橋腦梗死Case1AcuteinfractionMedialpartoftherightoccipitallobe：corticalswelling，lossborders

Case2DWIissensitivefordetectingtheacuteinfractionlesion,andhighsignalcanpersistupto5-7dayspost-ictusDWIcandistinguishcytoxicfromvasogenicedema

EnhancedT1WICase3動脈瘤動脈瘤動脈瘤DSA-

左頸內(nèi)動脈虹吸段動脈瘤AV-MfeedingarterydrainingveindeformitybloodvesselOnCT，AVMusuallyshowedslightlyhighdensityonCT,especiallycombinedwithhemorrhage.OnMRIitshowedmixedSI,thesignalofarteryislowbecauseofflowingvoideffect,andthevenousshowedhighSI(thebloodfloodisslow)AV-MAV-MAV-MAV-M海綿狀血管瘤腦腫瘤腦外傷腦血管性疾病顱內(nèi)感染脫髓鞘疾病先天發(fā)育異常腦膿腫多發(fā)腦膿腫腦膿腫結(jié)核性腦膜炎病毒性腦炎隱球菌性腦膜炎腦囊蟲腦囊蟲Braincysticercosisscolex腦腫瘤腦外傷腦血管性疾病顱內(nèi)感染脫髓鞘疾病先天發(fā)育異常

多發(fā)性硬化（MS）MS腎上腺腦白質(zhì)營養(yǎng)不良腦腫瘤腦外傷腦血管性疾病顱內(nèi)感染脫髓鞘疾病先天發(fā)育異常胼胝體發(fā)育不全胼胝體發(fā)育不全并脂肪瘤巨腦回畸形Chiari畸形Chiari畸形腦灰質(zhì)移位脊髓(CORD)脊髓影像檢查方法X-RAY（脊椎平片、脊髓造影）CT（平掃、增強、CTM）MRI（平掃、增強、MRA、MRM）脊柱平片脊髓造影正常腰椎MRI中樞神經(jīng)系統(tǒng)常見疾病的影像學(xué)診斷

ImageologicalDiagnosisofCentreNerousSystemCommonDiseases(II)椎管內(nèi)腫瘤脊髓空洞癥椎管內(nèi)腫瘤髓內(nèi)：室管膜瘤、星形細胞瘤髓外硬膜下：脊膜瘤、神經(jīng)源性腫瘤硬膜外：轉(zhuǎn)移瘤、骨腫瘤髓內(nèi)腫瘤室管膜瘤起源：脊髓中央管的室管膜細胞或終絲等部位的室管膜殘留物部位：馬尾、終絲最常見，其次為頸髓區(qū)表現(xiàn)：沿中央管呈縱向?qū)ΨQ性膨脹性生長，部分為外生性生長；內(nèi)可見囊變、壞死，兩側(cè)可見空洞MRI表現(xiàn)：T1WI：低/等信號，T2WI高信號，內(nèi)可見囊變壞死室管膜瘤T1WI（A）示下部脊髓明顯增粗，呈等信號T2WI（B）呈不均勻高信號T2軸位（C）呈不均勻高信號，增強掃描矢狀位（D）和軸位（E）示腫瘤呈顯著強化T1WI示腰骶段椎管內(nèi)腫瘤呈等信號，形態(tài)不規(guī)則，壓迫椎體后緣呈不規(guī)則壓跡和缺損T2WI腫瘤呈不均質(zhì)高信號T2加權(quán)橫切位腫瘤呈不均質(zhì)高信號T1WI示（A）腰骶段椎管內(nèi)腫瘤呈等信號，形態(tài)不規(guī)則，壓迫椎體后緣呈不規(guī)則壓跡和缺損，T2WI（B）示腫瘤呈不均質(zhì)高信號ABT2加權(quán)圖橫切位（C）示腫瘤呈不均質(zhì)高信號，增強掃描矢狀位（D）和軸位（E）示腫瘤實質(zhì)部分顯著強化CDE頸7~胸2平面脊髓室管膜瘤星形膠質(zhì)細胞瘤好發(fā)于頸、胸段，常累及多個節(jié)段，甚至全長脊髓明顯增粗，與正常脊髓分界不清，常位于脊髓后部，偏心非對稱性生長星形細胞瘤頸髓星形膠質(zhì)細胞瘤長Ｔ１長Ｔ２顯著強化T1WI（A）示頸胸段脊髓彌漫性增粗，呈不均質(zhì)低信號，T2WI（B）和橫切位（C）示腫瘤呈不均質(zhì)高信號T1WI（A）示頸和上胸段脊髓彌漫性增粗T2WI（B）和軸位（C）示腫瘤呈不均質(zhì)高信號髓外硬膜下腫瘤神經(jīng)源性腫瘤神經(jīng)鞘瘤與神經(jīng)纖維瘤脊膜瘤一、神經(jīng)源性腫瘤最常見的髓外硬膜下腫瘤可發(fā)生于椎管各個階段，多數(shù)腫瘤位于椎管后外側(cè)圓形或卵圓形腫