中樞神經(jīng)系統(tǒng)影像學診斷培訓課件

1、中樞神經(jīng)系統(tǒng)腦脊髓中樞神經(jīng)系統(tǒng)影像學診斷10/2/20221中樞神經(jīng)系統(tǒng)腦中樞神經(jīng)系統(tǒng)影像學診斷10/2/20221檢查方法Modalities頭顱MRI頭顱CTECT，emission computed tomographySPECT, single photon emission computed tomographyPET, positron emission tomography腦血管造影, cerebral angiography經(jīng)顱Doppler, transcranial doppler，TCD 頭顱平片, plain film最好的檢查方法，為首選First choice中樞神

2、經(jīng)系統(tǒng)影像學診斷10/2/20222檢查方法Modalities頭顱MRI最好的檢查方法，為首檢查方法 Modalities顯示腦實質(zhì) parenchymaMRI，Magnetic Resonance ImagingCT, Computed Tomography中樞神經(jīng)系統(tǒng)影像學診斷10/2/20223檢查方法 Modalities顯示腦實質(zhì) parenchym檢查方法 Modalities顯示腦實質(zhì) ParenchymaMRI是顱腦最好的檢查方法 first choice優(yōu)點：advantage軟組織分辨率最高任意面成像，有利于觀察解剖關系檢查序列多T1WI, T2WI, PDWI等缺點：d

3、isadvantage鈣化、骨化、早期出血灶顯示不如CT價格貴中樞神經(jīng)系統(tǒng)影像學診斷10/2/20224檢查方法 Modalities顯示腦實質(zhì) Parenchym檢查方法Modalities顯示腦實質(zhì) parenchymaCT是最常用的檢查方法優(yōu)點顯示骨和鈣化一般比MRI好顯示早期出血比MRI好缺點對腦組織的分辨率不如MRI中樞神經(jīng)系統(tǒng)影像學診斷10/2/20225檢查方法Modalities顯示腦實質(zhì) parenchym檢查方法 Modalities顯示腦血管 blood vessel腦血管造影 cerebral angiographyDSA，digital substractive an

4、giographyMRA, magnetic resonance angiographyCTA, computed tomography angiographyTCD, transcranial Doppler中樞神經(jīng)系統(tǒng)影像學診斷10/2/20226檢查方法 Modalities顯示腦血管 blood vesDSA MRA中樞神經(jīng)系統(tǒng)影像學診斷10/2/20227DSA MRA中樞神Transcranial Doppler，TCD中樞神經(jīng)系統(tǒng)影像學診斷10/2/20228Transcranial Doppler，TCD中樞神經(jīng)系統(tǒng)CT angiography中樞神經(jīng)系統(tǒng)影像學診斷10/2/2

5、0229CT angiography中樞神經(jīng)系統(tǒng)影像學診斷10/2/檢查方法顯示腦功能 brain functionDWI, diffusion weighted imagingPWI, perfusion weighted imagingBOLD, blood oxygenation level dependentECT, emission computed tomography中樞神經(jīng)系統(tǒng)影像學診斷10/2/202210檢查方法顯示腦功能 brain function中樞神經(jīng)系統(tǒng)DWI in cerebral infarct中樞神經(jīng)系統(tǒng)影像學診斷10/2/202211DWI in cere

6、bral infarct中樞神經(jīng)系統(tǒng)影Absolute CBF (A) D= time for the lower edge of the bolus to reach the tissue (B)A patient with right carotid occlusion and small right side infarction (arrow)Perfusion Imaging中樞神經(jīng)系統(tǒng)影像學診斷10/2/202212Absolute CBF (A) D= time for BOLD to show the visual cortex中樞神經(jīng)系統(tǒng)影像學診斷10/2/202213BOL

7、D to show the visual corte檢查方法顯示腦代謝 brain metabolismECTSPECTPETtracermost common is 18FDG，analogue of glucoseMRS中樞神經(jīng)系統(tǒng)影像學診斷10/2/202214檢查方法顯示腦代謝 brain metabolism中樞神經(jīng)SPECT中樞神經(jīng)系統(tǒng)影像學診斷10/2/202215SPECT中樞神經(jīng)系統(tǒng)影像學診斷10/2/202215Single pixel MRS中樞神經(jīng)系統(tǒng)影像學診斷10/2/202216Single pixel MRS中樞神經(jīng)系統(tǒng)影像學診斷10/正常影像解剖normal i

8、maging anatomy平片 plain film中樞神經(jīng)系統(tǒng)影像學診斷10/2/202217正常影像解剖normal imaging anatomy平CT掃描技術(shù)及正常影像解剖technique and normal imaging anatomy以聽眥線為基線向上連續(xù)掃描912層層厚10mm中樞神經(jīng)系統(tǒng)影像學診斷10/2/202218CT掃描技術(shù)及正常影像解剖technique and no中樞神經(jīng)系統(tǒng)影像學診斷10/2/202219中樞神經(jīng)系統(tǒng)影像學診斷10/2/202219正常影像解剖normal imaging anatomyMRI定位像(topography，scout ima

9、ge)中樞神經(jīng)系統(tǒng)影像學診斷10/2/202220正常影像解剖normal imaging anatomyMT1WIaxial中樞神經(jīng)系統(tǒng)影像學診斷10/2/202221T1WI中樞神經(jīng)系統(tǒng)影像學診斷10/2/202221T2WIaxial中樞神經(jīng)系統(tǒng)影像學診斷10/2/202222T2WI中樞神經(jīng)系統(tǒng)影像學診斷10/2/202222T1WIcoronalT2WIsagital中樞神經(jīng)系統(tǒng)影像學診斷10/2/202223T1WIT2WI中樞神經(jīng)系統(tǒng)影像學診斷10/2/202223基本病變表現(xiàn)basic imaging sign顱骨平片顱骨破壞顱板增厚顱板變薄骨折線中樞神經(jīng)系統(tǒng)影像學診斷10/2

10、/202224基本病變表現(xiàn)basic imaging sign顱骨平片中depressed skull fracture skull destructionThinningz table中樞神經(jīng)系統(tǒng)影像學診斷10/2/202225depressed skull fracture skullThickness of skull table中樞神經(jīng)系統(tǒng)影像學診斷10/2/202226Thickness of skull table中樞神經(jīng)系統(tǒng)基本病變表現(xiàn) basic imaging signCT平掃密度改變 density changes占位效應 mass effect, space occupy

11、ing effect腦水腫 brain edema, cerebral edema腦積水 hydrocephalus腦萎縮 brain atrophy, cerebral atrophy病灶的強化表現(xiàn) features after contrast inject中樞神經(jīng)系統(tǒng)影像學診斷10/2/202227基本病變表現(xiàn) basic imaging signCT中樞基本病變表現(xiàn) basic imaging signCT平掃密度改變高密度灶：鈣化（腫瘤、血管畸形）、出血出血的演變低密度灶：壞死、水腫、液體、氣體和脂類等密度灶：腫瘤、出血某一階段混雜密度灶：多種成分病變，多見鈣化：正常生理鈣化、血管畸

12、形、少枝膠質(zhì)瘤等中樞神經(jīng)系統(tǒng)影像學診斷10/2/202228基本病變表現(xiàn) basic imaging signCT中樞等密度isodensity低密度水腫Low density占位效應高密度High density占位效應混雜密度 mixed density鈣化 calcification中樞神經(jīng)系統(tǒng)影像學診斷10/2/202229等密度高密度混雜密度 鈣化 calcification中樞神占位效應space occupying effect, mass effectCommon disease腫瘤 tumor出血 bleeding顯著腫脹 edemamanifestation中線結(jié)構(gòu)移位 d

13、isplacement of midline structures腦室與腦池移位變形腦室、腦池擴大 enlargement of ventricle and cistern腦溝變化 fuci腦體積的改變 enlargement of brain volume中樞神經(jīng)系統(tǒng)影像學診斷10/2/202230占位效應space occupying effect, ma腦水腫 cerebral edema炎癥性水腫 inflammatory swelling感染 infection出血 bleeding挫傷 contusion等血腦通透性增加increasing permeability of BBB腫

14、瘤 tumor感染 infection等中樞神經(jīng)系統(tǒng)影像學診斷10/2/202231腦水腫 cerebral edema炎癥性水腫 inflam腦積水 hydrocephalus原因 etiology腦積液產(chǎn)生和吸收失衡腦脊液循環(huán)通路障礙所致腦室系統(tǒng)異常擴大類型 type交通性腦積水communicative hydrocephalus阻塞性腦積水 obstructive hydrocephalus代償性腦積水 compensatory hydrocephalus中樞神經(jīng)系統(tǒng)影像學診斷10/2/202232腦積水 hydrocephalus原因 etiology中樞梗阻性腦積水 正常腦壓性腦積

15、水Normal pressure hydrocephalus中樞神經(jīng)系統(tǒng)影像學診斷10/2/202233梗阻性腦積水 正常腦壓性腦積水中樞神經(jīng)系統(tǒng)影像腦萎縮 cerebral atrophy描述 description各種原因引起腦組織減少而繼發(fā)的腦室和蛛網(wǎng)膜下腔擴大分類 type廣泛性 diffuse局限性 local 皮質(zhì) cortex白質(zhì) white matter中樞神經(jīng)系統(tǒng)影像學診斷10/2/202234腦萎縮 cerebral atrophy描述 descrip增強掃描特征機制 mechanism血腦屏障通透性增加異常血管增生引起血流量增加常見類型 common type均一強化：腦

16、膜瘤、生殖細胞瘤等環(huán)狀強化：腦膿腫、腦轉(zhuǎn)移瘤、星形細胞瘤等斑狀強化：血管畸形、炎癥等不規(guī)則強化：惡性膠質(zhì)瘤等等中樞神經(jīng)系統(tǒng)影像學診斷10/2/202235增強掃描特征機制 mechanism中樞神經(jīng)系統(tǒng)影像學診斷1等密度，均勻強化Isodensity, homogeneous enhancement環(huán)形強化Ring-rim enhancement中樞神經(jīng)系統(tǒng)影像學診斷10/2/202236等密度，均勻強化環(huán)形強化中樞神經(jīng)系統(tǒng)影像學診斷10/2/20顱骨改變增厚thickness變薄 thin破壞 destruction增生 proliferation中樞神經(jīng)系統(tǒng)影像學診斷10/2/202237

17、顱骨改變增厚thickness中樞神經(jīng)系統(tǒng)影像學診斷10/2giant cell reparative granulomatrauma顱骨破壞中樞神經(jīng)系統(tǒng)影像學診斷10/2/202238giant cell reparative granulomMRI基本病變表現(xiàn)basic MRI sign與CT類似的表現(xiàn) the similar sign as to CT占位效應腦積水腦萎縮信號改變復雜，與CT密度改變不同長T1、長T2信號：腫瘤、腦梗死、炎癥等腦脊液信號：囊性變、囊腫（FLAIR序列變黑）短T1、長T2信號：脂肪、黑色素瘤等無信號：鈣化、晚期疤痕組織血管流空信號：多為無信號中樞神經(jīng)系統(tǒng)影像

18、學診斷10/2/202239MRI基本病變表現(xiàn)basic MRI sign與CT類似的MRI基本病變表現(xiàn)水腫 edema T1WI為低信號 low signalT2WI為略高信號 slightly high intensity出血 bleeding信號變化復雜 the change of signal is complex中樞神經(jīng)系統(tǒng)影像學診斷10/2/202240MRI基本病變表現(xiàn)水腫 edema中樞神經(jīng)系統(tǒng)影像學診斷10長T1、長T2病灶，腫瘤水腫 edema鈣化無信號囊性病灶 cystic T2WI高信號中樞神經(jīng)系統(tǒng)影像學診斷10/2/202241長T1、長T2病灶，腫瘤水腫 edema

19、鈣化無信號囊性病灶 MRI基本病變表現(xiàn)增強環(huán)狀均勻不均勻腦回狀中樞神經(jīng)系統(tǒng)影像學診斷10/2/202242MRI基本病變表現(xiàn)增強中樞神經(jīng)系統(tǒng)影像學診斷10/2/202腦內(nèi)血腫 ( intracerebral hematoma)CT分期 staging急性期 acute stage 1周高密度 hyperdensity周圍水腫 surrounding edema吸收期 absorption stage 2周2個月始于37天，密度逐漸減低囊變期 cystic change stage 2個月水樣低密度 water-like density中樞神經(jīng)系統(tǒng)影像學診斷10/2/202243腦內(nèi)血腫 ( i

20、ntracerebral hematomaMRI分期 staging超急性期（Hyperacute hematoma）6小時T1WI等信號，T2WI為等信號急性期（Acute hematoma）7小時3天T1WI呈等信號，血腫內(nèi)緣可見低信號強度的硬膜，T2WI呈低信號亞急性期和慢性期（Subacute hematoma） 3天4周高信號(metahemoglobin)囊變期（Remote hematoma） 4周液體信號周圍有低信號（hemosiderin)血腫影像學表現(xiàn)Imaging presentation of hematoma中樞神經(jīng)系統(tǒng)影像學診斷10/2/202244MRI分期 st

21、aging血腫影像學表現(xiàn)中樞神經(jīng)系統(tǒng)影像學診The evolution of hematoma中樞神經(jīng)系統(tǒng)影像學診斷10/2/202245The evolution of hematoma中樞神經(jīng)系Hyperacute hematomaCT T1WI T2WI中樞神經(jīng)系統(tǒng)影像學診斷10/2/202246Hyperacute hematomaCT CTT2WISubacute to chronic hematomaAcute hematomaGRET1WI中樞神經(jīng)系統(tǒng)影像學診斷10/2/202247CTT2WISubacute to chronic hema常見疾病診斷common diseas

22、e of CNS腦外傷 trauma of brain腦血管病 cerebraovascular disease腦梗死 cerebral infarction腦出血 cerebral hemorrhage腦腫瘤 cerebral tumor中樞神經(jīng)系統(tǒng)影像學診斷10/2/202248常見疾病診斷common disease of CNS腦外腦外傷 trauma of brainCT為首選 first choice顯示骨折、早期出血好方便快速多螺旋可快速形全身檢查MRI的適應癥 indicationCT檢查陰性亞急性期慢性期平片已少用CT未普及的地區(qū)中樞神經(jīng)系統(tǒng)影像學診斷10/2/202249腦

23、外傷 trauma of brainCT為首選 first腦外傷trauma of brain腦挫裂傷 cerebral contusion腦內(nèi)血腫 intracerebral hematoma硬膜下血腫 subdural hematoma硬膜外血腫 epidural hematoma蛛網(wǎng)膜下腔出血 subarachnoid hemorrhage中樞神經(jīng)系統(tǒng)影像學診斷10/2/202250腦外傷trauma of brain腦挫裂傷 cere腦挫裂傷名詞的含義腦挫傷 cerebral contusion腦內(nèi)散在出血灶，靜脈淤血、腦血腫和腫脹腦裂傷 laceration of brain伴有腦膜

24、、腦或血管撕裂發(fā)病部位 location著力點附近 coup site著力點對沖部位 contrecoup病理 pathology腦水腫 壞死液化散在小出血點中樞神經(jīng)系統(tǒng)影像學診斷10/2/202251腦挫裂傷名詞的含義中樞神經(jīng)系統(tǒng)影像學診斷10/2/20225腦挫裂傷CT 低密度病灶內(nèi)散在斑點狀高密度出血灶邊緣模糊 ill-defined rim占位效應 mass effectMRI腦水腫T1WI呈低或等信號T2WI高信號出血bleeding表現(xiàn)與血腫期齡有關中樞神經(jīng)系統(tǒng)影像學診斷10/2/202252腦挫裂傷CT 中樞神經(jīng)系統(tǒng)影像學診斷10/2/202252There is a focal

25、 area of haemorrhagic contusion in the right frontal lobe, with surrounding low density due to infarction or oedema. This is a frequent location for a contrecoup injury following a blow to the back of the head. 中樞神經(jīng)系統(tǒng)影像學診斷10/2/202253There is a focal area of haemo中樞神經(jīng)系統(tǒng)影像學診斷10/2/202254中樞神經(jīng)系統(tǒng)影像學診斷10/2

26、/202254彌漫性軸索損傷 diffuse axonal injury, DAI其他名稱 synonymy剪切傷 shear injury機制 mechanism頭受到旋轉(zhuǎn)暴力致大腦繞中軸發(fā)生旋轉(zhuǎn)運動 白質(zhì)、灰白質(zhì)交界區(qū)、胼胝體、腦干及小腦等受到剪切力損傷 彌漫性軸索斷裂、點片狀出血和水腫臨床 clinical features傷后意識立即喪失，多數(shù)立即死亡部分持續(xù)昏迷，后果嚴重中樞神經(jīng)系統(tǒng)影像學診斷10/2/202255彌漫性軸索損傷 diffuse axonal injury彌漫性軸索損傷 diffuse axonal injuryThis image demonstrates a sm

27、all petechial haemorrhage in a typical location at the grey-white matter interface (arrow). As is often the case, there were multiple such lesions on other slices中樞神經(jīng)系統(tǒng)影像學診斷10/2/202256彌漫性軸索損傷 diffuse axonal injury硬膜下血腫subdural hematoma出血部位 location硬腦膜與蛛網(wǎng)膜之間發(fā)生率 incidence顱腦外傷的56臨床 clinical features急性硬

28、膜下血腫多與腦挫裂傷同時存在癥狀重慢性硬膜下血腫輕微頭痛有或無明確外傷史Epidural spacesubidural spaceDural matter中樞神經(jīng)系統(tǒng)影像學診斷10/2/202257硬膜下血腫subdural hematoma出血部位 lo硬膜下血腫subdural hematoma顱骨下方新月形高密度影占位效應等密度硬膜下血腫低密度硬膜下血腫中樞神經(jīng)系統(tǒng)影像學診斷10/2/202258硬膜下血腫subdural hematoma顱骨下方新月形硬膜外血腫 epidural hematoma部位 location顱骨與硬膜之間發(fā)生率 incidence占顱腦外傷的23臨床 cli

29、nical features急性：85亞急性：12慢性: 少見中樞神經(jīng)系統(tǒng)影像學診斷10/2/202259硬膜外血腫 epidural hematoma部位 loca硬膜外血腫 epidural hematoma顱板下梭形或半圓形高密度影多位于骨折附近不跨越顱縫中樞神經(jīng)系統(tǒng)影像學診斷10/2/202260硬膜外血腫 epidural hematoma顱板下梭形或半蛛網(wǎng)膜下腔出血subarachnoid hemorrhage顱內(nèi)血管破裂進入蛛網(wǎng)膜下腔病因 etiology外傷 trauma 自發(fā)性 spontaneously動脈瘤 51高血壓動脈硬化 15動靜脈畸形 6%臨床 clinical

30、features好發(fā)年齡：3040歲三聯(lián)征劇烈頭痛腦膜刺激征血性腦脊液中樞神經(jīng)系統(tǒng)影像學診斷10/2/202261蛛網(wǎng)膜下腔出血subarachnoid hemorrhag蛛網(wǎng)膜下腔出血 subarachnoid hemorrhage中樞神經(jīng)系統(tǒng)影像學診斷10/2/202262蛛網(wǎng)膜下腔出血 subarachnoid hemorrha蛛網(wǎng)膜下腔出血中樞神經(jīng)系統(tǒng)影像學診斷10/2/202263蛛網(wǎng)膜下腔出血中樞神經(jīng)系統(tǒng)影像學診斷10/2/202263腦血管病cerebrovascular disease腦出血 intracerebral hemorrhage腦梗死 infarct of brai

31、n動脈瘤 aneurysm血管畸形 vascular malformation中樞神經(jīng)系統(tǒng)影像學診斷10/2/202264腦血管病cerebrovascular disease腦出血腦出血 intracranial hemorrhage病因 etiology高血壓 hypertensive intracerebral hemorrhage 占40動脈瘤破裂腦血管畸形出血出血性腦梗死外傷腦腫瘤血液病 等中樞神經(jīng)系統(tǒng)影像學診斷10/2/202265腦出血 intracranial hemorrhage病因 高血壓性腦出血 hypertensive intrcerebral hemorrhage機制

32、微小動脈瘤破裂腦血管玻璃樣變好發(fā)部位 predominated location基底節(jié)、丘腦、腦橋和大腦半球白質(zhì)內(nèi)易破潰入腦室并發(fā)癥 complications腦水腫腦組織受壓壞死中樞神經(jīng)系統(tǒng)影像學診斷10/2/202266高血壓性腦出血 hypertensive intrcere腦出血 intracranial hemorrhage腦內(nèi)血腫破入腦室破入蛛網(wǎng)膜下腔腦積水中樞神經(jīng)系統(tǒng)影像學診斷10/2/202267腦出血 intracranial hemorrhage腦內(nèi)血腦梗死 cerebral infarction原因 etiology腦血栓形成 thrombosis腦栓塞 embolic

33、血壓過低 low blood pressure發(fā)病率 incidence為腦血管病首位腦梗塞？中樞神經(jīng)系統(tǒng)影像學診斷10/2/202268腦梗死 cerebral infarction原因 eti腦梗死cerebral infarctionPathology缺血性腦梗死 ischemic infarction出血性腦梗死 hemorrhage infarction腔隙性腦梗死 lacunar infarction好發(fā)于基底節(jié)區(qū)、腦干、小腦等病灶大?。?15mm中樞神經(jīng)系統(tǒng)影像學診斷10/2/202269腦梗死cerebral infarctionPatholo腦梗死CT低密度灶，其部位和范圍與

34、閉塞血管供血區(qū)一致，可有占位效應23周時可出現(xiàn)“模糊效應（fogging effect ）”增強：腦回樣強化12個月形成邊界清楚的低密度囊腔中樞神經(jīng)系統(tǒng)影像學診斷10/2/202270腦梗死CT中樞神經(jīng)系統(tǒng)影像學診斷10/2/202270腦梗死CT演變過程024hr normal or subtle hypodensity sulca effacement17 daysMass effect( peak at 34 days)Days to months/yearsHypodensity18weeksContrast enhancementWeeks to yearsAtrophy中樞神經(jīng)系統(tǒng)

35、影像學診斷10/2/202271腦梗死CT演變過程024hr中樞神經(jīng)系統(tǒng)影像學診斷10/2腦梗死MRI顯著優(yōu)于CT急性期 acute phase 和超急性期 super acute phaseDWI, PWI 6 hours傳統(tǒng)MRI，F(xiàn)LAIR 8 hours亞急性期 subacute phase慢性期 Chronic phase中樞神經(jīng)系統(tǒng)影像學診斷10/2/202272腦梗死MRI中樞神經(jīng)系統(tǒng)影像學診斷10/2/202272T1WI T2WI FLAIRADC map DWI MRA中樞神經(jīng)系統(tǒng)影像學診斷10/2/202273T1WI Multiphasic perfusion CT o

36、btained 3 hours after the sudden onset of right hemiparesis and aphasia in a 76-year-old woman. F: 2 days follow-up中樞神經(jīng)系統(tǒng)影像學診斷10/2/202274Multiphasic perfusion CT obtaiT1WIT2WIDWIMale, 60years oldOnset 6 hours中樞神經(jīng)系統(tǒng)影像學診斷10/2/202275T1WIT2WIDWIMale, 60years old中樞血管畸形vascular malformation為胚胎期血管的發(fā)育異常，分為動

37、靜脈畸形 arteriovenous malformation, AVM靜脈畸形 venous maformation毛細血管擴張癥 capillary telangiectasia海綿狀血管瘤 cavernous hemangioma 等中樞神經(jīng)系統(tǒng)影像學診斷10/2/202276血管畸形vascular malformation為胚胎期動靜脈畸形(AVM)CT不規(guī)則混雜密度灶鈣化斑點或弧線形強化無水腫和占位效應不敏感Male, 65yr中樞神經(jīng)系統(tǒng)影像學診斷10/2/202277動靜脈畸形(AVM)CTMale, 65yr中樞神經(jīng)系統(tǒng)影像動靜脈畸形（AVM）MRI擴張流空的畸形血管團鄰近腦

38、質(zhì)：混雜低信號（hemosiderin）非常敏感Male, 48 yr中樞神經(jīng)系統(tǒng)影像學診斷10/2/202278動靜脈畸形（AVM）MRIMale, 48 yr中樞神經(jīng)系統(tǒng)Male, 48 yr中樞神經(jīng)系統(tǒng)影像學診斷10/2/202279Male, 48 yr中樞神經(jīng)系統(tǒng)影像學診斷10/2/202海綿狀血管瘤cavernous hemangiomaM，31yr中樞神經(jīng)系統(tǒng)影像學診斷10/2/202280海綿狀血管瘤中樞神經(jīng)系統(tǒng)影像學診斷10/2/202280顱內(nèi)動脈瘤intracranial aneurysm描述為血管的局限性擴張病因先天性 80后天性 20常見年齡 predominated

39、 onset age3060 years oldPredominated locationInternal carotid artery 90%Vertebral and basilar artery system 10%并發(fā)癥蛛網(wǎng)膜下腔出血中樞神經(jīng)系統(tǒng)影像學診斷10/2/202281顱內(nèi)動脈瘤intracranial aneurysm描述中The white arrow on the black card marks the site of a ruptured berry aneurysm in the circle of WillisThe circle of Willis has be

40、en dissected, and three berry aneurysms are seen. 中樞神經(jīng)系統(tǒng)影像學診斷10/2/202282The white arrow on the black c中樞神經(jīng)系統(tǒng)影像學診斷10/2/202283中樞神經(jīng)系統(tǒng)影像學診斷10/2/202283腦腫瘤 Brain tumor概況惡性膠質(zhì)瘤 glioma 4050轉(zhuǎn)移瘤 metastasis 3.1912.92%良性腦膜瘤 meningioma 1520垂體瘤 pituitary adenoma 10%顱咽管瘤 craniopharyngioma聽神經(jīng)瘤 acoustic neurinoma中樞神經(jīng)

41、系統(tǒng)影像學診斷10/2/202284腦腫瘤 Brain tumor概況中樞神經(jīng)系統(tǒng)影像學診斷10腦腫瘤 Brain tumor膠質(zhì)瘤（glioma）星形細胞瘤 astrocytoma 40%少突膠質(zhì)細胞瘤 oligodendroglioma 515%室管膜瘤 ependymoma 髓母細胞瘤 medulloblastoma 48%中樞神經(jīng)系統(tǒng)影像學診斷10/2/202285腦腫瘤 Brain tumor膠質(zhì)瘤（glioma）中樞神經(jīng)星形細胞瘤 astrocytoma臨床 clinical features局灶性或全身性癲癇發(fā)作為最重要表現(xiàn)神經(jīng)功能障礙顱內(nèi)壓增高中樞神經(jīng)系統(tǒng)影像學診斷10/2/2

42、02286星形細胞瘤 astrocytoma臨床 clinical f星形細胞瘤 astrocytomaCT級低密度灶，分界清楚，占位效應輕，無或輕度強化級高、低或混雜密度，可呈囊性斑點鈣化和瘤內(nèi)出血形態(tài)不規(guī)則，邊界不清占位效應和瘤周水腫明顯不規(guī)則環(huán)形伴壁結(jié)節(jié)強化，或不均勻強化中樞神經(jīng)系統(tǒng)影像學診斷10/2/202287星形細胞瘤 astrocytomaCT中樞神經(jīng)系統(tǒng)影像學診斷中樞神經(jīng)系統(tǒng)影像學診斷10/2/202288中樞神經(jīng)系統(tǒng)影像學診斷10/2/202288星形細胞瘤MRIT1WI稍低或混雜信號T2WI均勻或不均勻性高信號惡性程度越高，其T1、T2值愈長，囊壁和壁結(jié)節(jié)強化越明顯中樞神經(jīng)

43、系統(tǒng)影像學診斷10/2/202289星形細胞瘤MRI中樞神經(jīng)系統(tǒng)影像學診斷10/2/202289局灶性彌漫型星形細胞瘤（WHO2級）中樞神經(jīng)系統(tǒng)影像學診斷10/2/202290局灶性彌漫型星形細胞瘤（WHO2級）中樞神經(jīng)系統(tǒng)影像學診斷1間變型星形細胞瘤（WHO3級）F/68平掃瘤體內(nèi)低信號及條狀高信號，累及基底節(jié)及顳葉周圍明顯水腫，增強后明顯不均勻強化中樞神經(jīng)系統(tǒng)影像學診斷10/2/202291間變型星形細胞瘤（WHO3級）F/68平掃瘤體內(nèi)低信號OligodendrogliomaMale, 43 yr中樞神經(jīng)系統(tǒng)影像學診斷10/2/202292OligodendrogliomaMale, 4

44、3 yr中樞腦膜瘤meningiomasex predomination, gender中年女性多見起源于 originated in 蛛網(wǎng)膜粒帽細胞多居于腦外，與硬腦膜粘連好發(fā)部位 location矢狀竇旁、腦凸面、蝶骨嵴、嗅溝、橋小腦角、大腦鐮或小腦幕等，與硬腦膜相鄰部位少數(shù)：腦室、眼眶中樞神經(jīng)系統(tǒng)影像學診斷10/2/202293腦膜瘤meningiomasex predominatio腦膜瘤（meningioma）大體病理 grass pathology腫瘤包膜完整，多由腦膜動脈供血，血運豐富，常有鈣化，少數(shù)有出血、壞死和囊變組織學分型 histologic type上皮型纖維型過渡型砂

45、礫型血管瘤型等15型中樞神經(jīng)系統(tǒng)影像學診斷10/2/202294腦膜瘤（meningioma）大體病理 grass path腦膜瘤meningiomaCT平掃 plain scan等或略高密度常見斑點狀鈣化廣基底與硬腦膜相連邊界清楚可有瘤周水腫顱板：增生或破壞增強掃描 enhancement均勻性顯著強化中樞神經(jīng)系統(tǒng)影像學診斷10/2/202295腦膜瘤meningiomaCT中樞神經(jīng)系統(tǒng)影像學診斷10/腦膜瘤meningiomaMRI平掃T1WI等或稍低信號T2WI等或高信號邊緣清楚與正常腦組織間有時有腦脊液影增強掃描明顯均勻強化腦膜尾癥 dural tail sign中樞神經(jīng)系統(tǒng)影像學診斷10/2/202296腦膜瘤meningiomaMRI中樞神經(jīng)系統(tǒng)影像學診斷10女 653月前出現(xiàn)反應遲鈍，記憶力下降，左下肢無