中枢神经系统影像学诊断课件

第十八章第十八章 中枢神经系统影像学诊断中枢神经系统影像学诊断Radiology of Central Nervous Systeml l河北医科大学第三医院河北医科大学第三医院l lHebei Medical University 3rd Hospital l l 第十八章 中枢神经系统影像学诊断Radiology o1中枢神经系统中枢神经系统l脑脑l脊髓脊髓中枢神经系统脑2检查方法检查方法Modalitiesl l头颅头颅头颅头颅MRIMRIl l头颅头颅头颅头颅CTCTlECT，emission computed tomographySPECT,single photon emission computed tomographyPET,positron emission tomographyl脑血管造影脑血管造影,cerebral angiographyl经颅经颅Doppler,transcranial doppler，TCD l头颅平片头颅平片,plain film最好的检查方法，为首选最好的检查方法，为首选最好的检查方法，为首选最好的检查方法，为首选First choiceFirst choice检查方法Modalities头颅MRI最好的检查方法，为首3检查方法检查方法 Modalitiesl l显示脑实质显示脑实质 parenchyma MRIMRI，Magnetic Resonance Imaging CTCT,Computed Tomography检查方法 Modalities显示脑实质 parenchym4检查方法检查方法 Modalitiesl显示脑实质显示脑实质 Parenchyma MRIMRIl l是颅脑最好的检查方法是颅脑最好的检查方法是颅脑最好的检查方法是颅脑最好的检查方法 first choicefirst choicel l优点：优点：优点：优点：advantageadvantage软组织分辨率最高任意面成像，有利于观察解剖关系检查序列多T1WI,T2WI,PDWI等l l缺点：缺点：缺点：缺点：disadvantagedisadvantage钙化、骨化、早期出血灶显示不如CT价格贵检查方法 Modalities显示脑实质 Parenchym5检查方法检查方法Modalitiesl显示脑实质显示脑实质 parenchyma CTCTl是最常用的检查方法l l优点优点优点优点显示骨和钙化一般比MRI好显示早期出血比MRI好l l缺点缺点缺点缺点对脑组织的分辨率不如MRI检查方法Modalities显示脑实质 parenchym6检查方法检查方法 Modalitiesl显示脑血管显示脑血管 blood vessel 脑血管造影脑血管造影脑血管造影脑血管造影 cerebral angiographycerebral angiographylDSA，digital substractive angiography MRA,MRA,magnetic resonance angiography CTA,CTA,computed tomography angiography TCD,TCD,transcranial Doppler检查方法 Modalities显示脑血管 blood ves7DSA MRADSA MRA8Transcranial Doppler，TCDTranscranial Doppler，TCD9CT angiographyCT angiography10检查方法检查方法l显示脑功能显示脑功能 brain function DWIDWI,diffusion weighted imaging PWIPWI,perfusion weighted imaging BOLDBOLD,blood oxygenation level dependentblood oxygenation level dependent ECTECT,emission computed tomography检查方法显示脑功能 brain function11DWI in cerebral infarctDWI in cerebral infarct12Absolute 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 ImagingPerfusion ImagingAbsolute CBF(A)D=time for 13BOLD to show the visual cortexBOLD to show the visual corte14检查方法检查方法l显示脑代谢显示脑代谢 brain metabolismECTlSPECTlPETtracermost common is 18FDG，analogue of glucoseMRS检查方法显示脑代谢 brain metabolism15SPECTSPECT16Single pixel MRSSingle pixel MRS17正常影像解剖正常影像解剖normal imaging anatomyl l平片平片 plain film正常影像解剖normal imaging anatomy平18CT扫描技术及正常影像解剖扫描技术及正常影像解剖technique and normal imaging anatomy以听眦线为基线向上连续扫描以听眦线为基线向上连续扫描以听眦线为基线向上连续扫描以听眦线为基线向上连续扫描9 91212层层层层层厚层厚层厚层厚10mm10mmCT扫描技术及正常影像解剖technique and no19中枢神经系统影像学诊断课件20正常影像解剖正常影像解剖normal imaging anatomylMRIl定位像(topography，scout image)正常影像解剖normal imaging anatomyM21T1WIaxialT1WI22T2WIaxialT2WI23T1WIcoronalT2WIsagitalT1WIT2WI24基本病变表现基本病变表现basic imaging signl l颅骨平片颅骨平片颅骨破坏颅板增厚颅板变薄骨折线基本病变表现basic imaging sign颅骨平片25depressed skull fracture skull destructionThinningz tabledepressed skull fracture skull26Thickness of skull tableThickness of skull table27基本病变表现基本病变表现 basic imaging signlCTl平扫密度改变 density changes占位效应 mass effect,space occupying effect脑水肿 brain edema,cerebral edema脑积水 hydrocephalus脑萎缩 brain atrophy,cerebral atrophy病灶的强化表现 features after contrast inject基本病变表现 basic imaging signCT28基本病变表现基本病变表现 basic imaging signlCT平扫密度改变l高密度灶：钙化（肿瘤、血管畸形）、出血出血的演变l低密度灶：坏死、水肿、液体、气体和脂类l等密度灶：肿瘤、出血某一阶段l混杂密度灶：多种成分病变，多见l钙化：正常生理钙化、血管畸形、少枝胶质瘤等基本病变表现 basic imaging signCT29等密度isodensity低密度水肿Low density占位效应高密度High density占位效应混杂密度 mixed density钙化 calcification等密度高密度混杂密度 钙化 calcification30l l占位效应占位效应占位效应占位效应space occupying effect,mass effectCommon diseasel肿瘤 tumorl出血 bleedingl显著肿胀 edemamanifestationl中线结构移位 displacement of midline structuresl脑室与脑池移位变形l脑室、脑池扩大 enlargement of ventricle and cisternl脑沟变化 fucil脑体积的改变 enlargement of brain volume占位效应space occupying effect,ma31脑水肿脑水肿 cerebral edemal炎症性水肿 inflammatory swelling感染 infection出血 bleeding挫伤 contusion等l血脑通透性增加increasing permeability of BBB肿瘤 tumor感染 infection等脑水肿 cerebral edema炎症性水肿 inflam32脑积水 hydrocephalusl原因 etiology脑积液产生和吸收失衡脑脊液循环通路障碍所致脑室系统异常扩大l类型 type交通性脑积水communicative hydrocephalus阻塞性脑积水 obstructive hydrocephalus代偿性脑积水 compensatory hydrocephalus脑积水 hydrocephalus原因 etiology33梗阻性脑积水 正常脑压性脑积水Normal pressure hydrocephalus梗阻性脑积水 正常脑压性脑积水34脑萎缩脑萎缩 cerebral atrophyl描述 description各种原因引起脑组织减少而继发的脑室和蛛网膜下腔扩大l分类 type广泛性 diffuse局限性 local 皮质 cortex白质 white matter脑萎缩 cerebral atrophy描述 descrip35增强扫描特征增强扫描特征l机制 mechanism血脑屏障通透性增加异常血管增生引起血流量增加l常见类型 common type均一强化：脑膜瘤、生殖细胞瘤等环状强化：脑脓肿、脑转移瘤、星形细胞瘤等斑状强化：血管畸形、炎症等不规则强化：恶性胶质瘤等等增强扫描特征机制 mechanism36等密度，均匀强化Isodensity,homogeneous enhancement环形强化Ring-rim enhancement等密度，均匀强化环形强化37颅骨改变l增厚thicknessl变薄 thinl破坏 destructionl增生 proliferation颅骨改变增厚thickness38giant cell reparative granulomatrauma颅骨破坏giant cell reparative granulom39MRI基本病变表现基本病变表现basic MRI signl与CT类似的表现 the similar sign as to CT占位效应脑积水脑萎缩l信号改变复杂，与CT密度改变不同长T1、长T2信号：肿瘤、脑梗死、炎症等脑脊液信号：囊性变、囊肿（FLAIR序列变黑）短T1、长T2信号：脂肪、黑色素瘤等无信号：钙化、晚期疤痕组织血管流空信号：多为无信号MRI基本病变表现basic MRI sign与CT类似的40MRI基本病变表现基本病变表现l水肿 edema T1WI为低信号 low signalT2WI为略高信号 slightly high intensityl出血 bleeding信号变化复杂 the change of signal is complexMRI基本病变表现水肿 edema41长T1、长T2病灶，肿瘤水肿 edema钙化无信号囊性病灶 cystic T2WI高信号长T1、长T2病灶，肿瘤水肿 edema钙化无信号囊性病灶 42MRI基本病变表现基本病变表现l增强环状均匀不均匀脑回状MRI基本病变表现增强43脑内血肿脑内血肿(intracerebral hematoma)lCT分期分期 staging 急性期急性期急性期急性期 acute stage 1周l高密度 hyperdensityl周围水肿 surrounding edema 吸收期吸收期吸收期吸收期 absorption stage 2周2个月l始于37天，密度逐渐减低 囊变期囊变期囊变期囊变期 cystic change stage 2个月l水样低密度 water-like density脑内血肿(intracerebral hematoma44l lMRI分期分期 staging 超急性期超急性期超急性期超急性期（Hyperacute hematoma）6小时小时lT1WI等信号，T2WI为等信号 急性期急性期急性期急性期（Acute hematoma）7小时小时3天天lT1WI呈等信号，血肿内缘可见低信号强度的硬膜，T2WI呈低信号 亚急性期和慢性期亚急性期和慢性期亚急性期和慢性期亚急性期和慢性期（Subacute hematoma）3天天4周周l高信号(metahemoglobin)囊变期囊变期囊变期囊变期（Remote hematoma）4周周l液体信号l周围有低信号（hemosiderin)血肿影像学表现血肿影像学表现Imaging presentation of hematomaMRI分期 staging血肿影像学表现45The evolution of hematomaThe evolution of hematoma46Hyperacute hematomaCT T1WI T2WIHyperacute hematomaCT 47CTT2WISubacute to chronic hematomaAcute hematomaGRET1WICTT2WISubacute to chronic hema48常见疾病诊断常见疾病诊断common disease of CNSl l脑外伤脑外伤 trauma of brainl l脑血管病脑血管病 cerebraovascular disease脑梗死 cerebral infarction脑出血 cerebral hemorrhagel l脑肿瘤脑肿瘤 cerebral tumor常见疾病诊断common disease of CNS脑外49脑外伤脑外伤 trauma of brainl lCTCT为首选为首选为首选为首选 first choicefirst choice显示骨折、早期出血好方便快速多螺旋可快速形全身检查l lMRIMRI的适应症的适应症的适应症的适应症 indicationindicationCT检查阴性亚急性期慢性期l l平片已少用平片已少用平片已少用平片已少用CT未普及的地区脑外伤 trauma of brainCT为首选 first50脑外伤脑外伤trauma of brainl l脑挫裂伤脑挫裂伤 cerebral contusionl l脑内血肿脑内血肿 intracerebral hematomal l硬膜下血肿硬膜下血肿 subdural hematomal l硬膜外血肿硬膜外血肿 epidural hematomal l蛛网膜下腔出血蛛网膜下腔出血 subarachnoid hemorrhage脑外伤trauma of brain脑挫裂伤 cere51脑挫裂伤脑挫裂伤l l名词的含义名词的含义名词的含义名词的含义 脑挫伤脑挫伤脑挫伤脑挫伤 cerebral contusion脑内散在出血灶，静脉淤血、脑血肿和肿胀 脑裂伤脑裂伤脑裂伤脑裂伤 laceration of brain伴有脑膜、脑或血管撕裂l发病部位发病部位 location着力点附近 coup site着力点对冲部位 contrecoupl病理病理 pathology脑水肿 坏死液化散在小出血点脑挫裂伤名词的含义52脑挫裂伤脑挫裂伤lCT 低密度病灶内散在斑点状高密度出血灶边缘模糊 ill-defined rim占位效应 mass effectlMRI脑水肿lT1WI呈低或等信号lT2WI高信号出血bleedingl表现与血肿期龄有关脑挫裂伤CT 53There is a focal 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.There is a focal area of haemo54中枢神经系统影像学诊断课件55弥漫性轴索损伤弥漫性轴索损伤 diffuse axonal injury,DAIl其他名称其他名称 synonymy剪切伤 shear injuryl机制机制 mechanism头受到旋转暴力致大脑绕中轴发生旋转运动 白质、灰白质交界区、胼胝体、脑干及小脑等受到剪切力损伤 弥漫性轴索断裂、点片状出血和水肿l临床临床 clinical features伤后意识立即丧失，多数立即死亡部分持续昏迷，后果严重弥漫性轴索损伤 diffuse axonal injury56弥漫性轴索损伤弥漫性轴索损伤 diffuse axonal injuryThis image demonstrates a small 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弥漫性轴索损伤 diffuse axonal injury57硬膜下血肿硬膜下血肿subdural hematomal l出血部位出血部位出血部位出血部位 locationlocation硬脑膜与蛛网膜之间l l发生率发生率发生率发生率 incidenceincidence颅脑外伤的56l l临床临床临床临床 clinical featuresclinical features急性硬膜下血肿l多与脑挫裂伤同时存在l症状重慢性硬膜下血肿l轻微头痛l有或无明确外伤史Epidural spacesubidural spaceDural matter硬膜下血肿subdural hematoma出血部位 lo58硬膜下血肿硬膜下血肿subdural hematomal颅骨下方新月形高密度影l占位效应等密度硬膜下血肿低密度硬膜下血肿硬膜下血肿subdural hematoma颅骨下方新月形59硬膜外血肿硬膜外血肿 epidural hematomal l部位部位 location颅骨与硬膜之间l l发生率发生率 incidence占颅脑外伤的23l l临床临床 clinical features急性：85亚急性：12慢性:少见硬膜外血肿 epidural hematoma部位 loca60硬膜外血肿硬膜外血肿 epidural hematoma颅板下梭形或半圆形高密度影多位于骨折附近不跨越颅缝硬膜外血肿 epidural hematoma颅板下梭形或半61蛛网膜下腔出血蛛网膜下腔出血subarachnoid hemorrhagel颅内血管破裂进入蛛网膜下腔l病因 etiology外伤 trauma 自发性 spontaneouslyl动脉瘤 51l高血压动脉硬化 15l动静脉畸形 6%l临床 clinical features好发年龄：3040岁三联征l剧烈头痛l脑膜刺激征l血性脑脊液蛛网膜下腔出血subarachnoid hemorrhag62蛛网膜下腔出血蛛网膜下腔出血 subarachnoid hemorrhage蛛网膜下腔出血 subarachnoid hemorrha63蛛网膜下腔出血蛛网膜下腔出血64脑血管病脑血管病cerebrovascular diseasel l脑出血脑出血 intracerebral hemorrhagel l脑梗死脑梗死 infarct of brainl l动脉瘤动脉瘤 aneurysml l血管畸形血管畸形 vascular malformation脑血管病cerebrovascular disease脑出血65脑出血脑出血 intracranial hemorrhagel病因病因 etiology高血压高血压 hypertensive intracerebral hemorrhage 占占40动脉瘤破裂动脉瘤破裂脑血管畸形出血脑血管畸形出血出血性脑梗死出血性脑梗死外伤外伤脑肿瘤脑肿瘤血液病血液病 等等脑出血 intracranial hemorrhage病因 66高血压性脑出血高血压性脑出血 hypertensive intrcerebral hemorrhagel机制机制微小动脉瘤破裂脑血管玻璃样变l l好发部位好发部位好发部位好发部位 predominated locationpredominated location基底节、丘脑、脑桥和大脑半球白质内易破溃入脑室l l并发症并发症并发症并发症 complicationscomplications脑水肿脑组织受压坏死高血压性脑出血 hypertensive intrcere67脑出血脑出血 intracranial hemorrhagel脑内血肿脑内血肿破入脑室破入蛛网膜下腔脑积水脑出血 intracranial hemorrhage脑内血68脑梗死脑梗死 cerebral infarctionl原因原因 etiology 脑血栓形成脑血栓形成脑血栓形成脑血栓形成 thrombosis 脑栓塞脑栓塞脑栓塞脑栓塞 embolic 血压过低血压过低血压过低血压过低 low blood pressurel发病率发病率 incidence为脑血管病首位脑梗塞？脑梗塞？脑梗死 cerebral infarction原因 eti69脑梗死脑梗死cerebral infarctionlPathology 缺血性脑梗死缺血性脑梗死缺血性脑梗死缺血性脑梗死 ischemic infarction 出血性脑梗死出血性脑梗死出血性脑梗死出血性脑梗死 hemorrhage infarction 腔隙性脑梗死腔隙性脑梗死腔隙性脑梗死腔隙性脑梗死 lacunar infarctionl好发于基底节区、脑干、小脑等l病灶大小：515mm脑梗死cerebral infarctionPatholo70脑梗死脑梗死l lCT 低密度灶低密度灶低密度灶低密度灶，其部位和范围与闭塞血管供血区一致，可有占位效应23周时可出现“模糊效应模糊效应模糊效应模糊效应（fogging effect）”增强：脑回样强化脑回样强化脑回样强化脑回样强化12个月形成边界清楚的低密度囊腔低密度囊腔低密度囊腔低密度囊腔脑梗死CT71脑梗死脑梗死CT演变过程演变过程l l0 024hr24hr normal or subtle hypodensity sulca effacementl l17 days17 daysMass effect(peak at 34 days)l lDays to months/yearsDays to months/yearsHypodensityl l18weeks18weeksContrast enhancementl lWeeks to yearsWeeks to yearsAtrophy脑梗死CT演变过程024hr72脑梗死脑梗死lMRI显著优于显著优于CTl l急性期急性期急性期急性期 acute phase acute phase 和超急性期和超急性期和超急性期和超急性期 super acute phasesuper acute phaseDWI,PWI 6 hours传统MRI，FLAIR 8 hoursl l亚急性期亚急性期亚急性期亚急性期 subacute phasesubacute phasel l慢性期慢性期慢性期慢性期 Chronic phaseChronic phase脑梗死MRI73T1WI T2WI FLAIRT1WI T2WI FLAIRADC map DWI MRAADC map DWI MRAT1WI 74Multiphasic perfusion CT obtained 3 hours after the sudden onset of right hemiparesis and aphasia in a 76-year-old woman.F:2 days follow-upF:2 days follow-upMultiphasic perfusion CT obtai75T1WIT2WIDWIMale,60years oldOnset 6 hoursT1WIT2WIDWIMale,60years old76血管畸形血管畸形vascular malformationl为胚胎期血管的发育异常，分为 动静脉畸形动静脉畸形动静脉畸形动静脉畸形 arteriovenous malformation,AVM静脉畸形 venous maformation毛细血管扩张症 capillary telangiectasia 海绵状血管瘤海绵状血管瘤海绵状血管瘤海绵状血管瘤 cavernous hemangioma 等血管畸形vascular malformation为胚胎期77动静脉畸形动静脉畸形(AVM)CT不规则混杂密度灶钙化斑点或弧线形强化无水肿和占位效应不敏感不敏感不敏感不敏感Male,65yr动静脉畸形(AVM)CTMale,65yr78动静脉畸形动静脉畸形（AVM）l lMRI扩张流空的畸形血管团邻近脑质：混杂低信号（hemosiderin）非常敏感非常敏感非常敏感非常敏感Male,48 yr动静脉畸形（AVM）MRIMale,48 yr79Male,48 yrMale,48 yr80海绵状血管瘤cavernous hemangiomaM，31yr海绵状血管瘤81颅内动脉瘤颅内动脉瘤intracranial aneurysml l描述描述描述描述 为血管的局限性扩张为血管的局限性扩张为血管的局限性扩张为血管的局限性扩张l病因先天性 80后天性 20l常见年龄 predominated onset age3060 years oldlPredominated locationInternal carotid artery 90%Vertebral and basilar artery system 10%l l并发症并发症并发症并发症l蛛网膜下腔出血颅内动脉瘤intracranial aneurysm描述82The white arrow on the black card marks the site of a ruptured berry aneurysm in the circle of WillisThe circle of Willis has been dissected,and three berry aneurysms are seen.The white arrow on the black c83中枢神经系统影像学诊断课件84脑肿瘤脑肿瘤 Brain tumorl l概况概况 恶性恶性恶性恶性l胶质瘤 glioma 4050l转移瘤 metastasis 3.1912.92%良性良性良性良性l脑膜瘤 meningioma 1520l垂体瘤 pituitary adenoma 10%l颅咽管瘤 craniopharyngiomal听神经瘤 acoustic neurinoma脑肿瘤 Brain tumor概况85脑肿瘤脑肿瘤 Brain tumorl l胶质瘤胶质瘤（glioma）星形细胞瘤 astrocytoma 40%少突胶质细胞瘤 oligodendroglioma 515%室管膜瘤 ependymoma 髓母细胞瘤 medulloblastoma 48%脑肿瘤 Brain tumor胶质瘤（glioma）86星形细胞瘤星形细胞瘤 astrocytomal l临床临床 clinical features局灶性或全身性癫痫发作为最重要表现神经功能障碍颅内压增高星形细胞瘤 astrocytoma临床 clinical f87星形细胞瘤星形细胞瘤 astrocytomalCT 级级级级l低密度灶，分界清楚，占位效应轻，无或轻度强化 级级级级l高、低或混杂密度，可呈囊性l斑点钙化和瘤内出血l形态不规则，边界不清l占位效应和瘤周水肿明显l不规则环形伴壁结节强化，或不均匀强化星形细胞瘤 astrocytomaCT88中枢神经系统影像学诊断课件89星形细胞瘤星形细胞瘤lMRI T1WIT1WI稍低或混杂信号 T2WIT2WI均匀或不均匀性高信号l恶性程度越高，其T1、T2值愈长，囊壁和壁结节强化越明显星形细胞瘤MRI90局灶性弥漫型星局灶性弥漫型星形细胞瘤形细胞瘤（WHO2WHO2级）级）级）级）局灶性弥漫型星形细胞瘤（WHO2级）91间变型星形细胞瘤间变型星形细胞瘤间变型星形细胞瘤间变型星形细胞瘤（WHO3WHO3级）级）级）级）F/68F/68平扫瘤体内低信号平扫瘤体内低信号平扫瘤体内低信号平扫瘤体内低信号及条状高信号，累及条状高信号，累及条状高信号，累及条状高信号，累及基底节及颞叶周及基底节及颞叶周及基底节及颞叶周及基底节及颞叶周围明显水肿，增强围明显水肿，增强围明显水肿，增强围明显水肿，增强后明显不均匀强化后明显不均匀强化后明显不均匀强化后明显不均匀强化间变型星形细胞瘤（WHO3级）F/68平扫瘤体内低信号92OligodendrogliomaMale,43 yrOligodendrogliomaMale,43 yr93脑膜瘤脑膜瘤meningiomal lsex predomination,gendersex predomination,gender 中年女性多见中年女性多见中年女性多见中年女性多见l l起源于起源于起源于起源于 originated in originated in 蛛网膜粒帽细胞多居于脑外脑外脑外脑外，与硬脑膜粘连l l好发部位好发部位好发部位好发部位 locationlocation矢状窦旁、脑凸面、蝶骨嵴、嗅沟、桥小脑角、大脑镰或小脑幕等，与硬脑膜相邻硬脑膜相邻硬脑膜相邻硬脑膜相邻部位少数：脑室、眼眶脑膜瘤meningiomasex predominatio94脑膜瘤脑膜瘤（meningioma）l大体病理大体病理 grass pathology肿瘤包膜完整，多由脑膜动脉供血，血运丰富，常有钙化，少数有出血、坏死和囊变l组织学分型组织学分型 histologic type上皮型纤维型过渡型砂砾型血管瘤型l等15型脑膜瘤（meningioma）大体病理 grass path95脑膜瘤脑膜瘤meningiomalCT 平扫平扫平扫平扫 plain scanplain scanl等或略高密度l常见斑点状钙化l广基底与硬脑膜相连l边界清楚l可有瘤周水肿l颅板：增生或破坏 增强扫描增强扫描增强扫描增强扫描 enhancementenhancementl均匀性显著强化脑膜瘤meningiomaCT96脑膜瘤脑膜瘤meningiomalMRI 平扫平扫平扫平扫lT1WI等或稍低信号lT2WI等或高信号l边缘清楚l与正常脑组织间有时有脑脊液影 增强扫描增强扫描增强扫描增强扫描l明显均匀强化l脑膜尾症 dural tail sign脑膜瘤meningiomaMRI97女 653月前出现反应迟钝，记忆力下降，左下肢无力CT plain scanT2WIT1WIT1WIenhancement女 65CT plain scanT2WIT1WIT1WIe98Femal,61yr右下肢无力2年，加重2月脑膜瘤侵犯颅骨Femal,61yr脑膜瘤侵犯颅骨99中枢神经系统影像学诊断课件100中枢神经系统影像学诊断课件101转移瘤转移瘤metastasisl l易发人群易发人群 predominated population中老年人l l易发病部位易发病部位 location顶枕区皮髓质交界处l l原发灶原发灶 primary lesionlung,breast,prostate,kidney,and so on转移瘤metastasis易发人群 predominate102Metastasis of Brainl lCT表现表现多发或单发结节 multipl or single nodule等或低密度 isodensity or low density出血时：高密度 hyperdensity瘤周水肿 surrounding edema结节或环形强化 nodular or ring enhancementl lMRI长T1、长T2信号Metastasis of BrainCT表现103增强容易发增强容易发增强容易发增强容易发现转移瘤！现转移瘤！现转移瘤！现转移瘤！增强容易发现转移瘤！104垂体腺瘤垂体腺瘤（pituitary adenoma）l l功能性腺瘤功能性腺瘤功能性腺瘤功能性腺瘤l泌乳素、生长激素、性激素和促肾上腺皮质激素瘤l l非功能性腺瘤非功能性腺瘤非功能性腺瘤非功能性腺瘤l l微腺瘤微腺瘤微腺瘤微腺瘤：直径10mm 病理病理病理病理l包膜完整l较大可坏死、囊变、出血，偶可钙化l向四周侵犯 临床临床临床临床：l压迫症状:视力障碍、垂体功能低下、阳痿、头痛等l内分泌症状：泌乳素、生长激素、促肾上腺皮质激素等垂体腺瘤（pituitary adenoma）功能性腺瘤105垂体腺瘤垂体腺瘤(pituitary adenoma)l l影像表现影像表现 MRIMRI为首选检查方法为首选检查方法为首选检查方法为首选检查方法l l垂体向周围彭隆，特别向上彭隆垂体向周围彭隆，特别向上彭隆垂体向周围彭隆，特别向上彭隆垂体向周围彭隆，特别向上彭隆l l垂体柄移位垂体柄移位垂体柄移位垂体柄移位l l增强增强增强增强 多均匀强化多均匀强化多均匀强化多均匀强化 少数中心坏死少数中心坏死少数中心坏死少数中心坏死 CTCT必须增强扫描必须增强扫描必须增强扫描必须增强扫描垂体腺瘤(pituitary adenoma)影像表现106中枢神经系统影像学诊断课件107Pituitary gland tumorMale,41yrPituitary gland tumor108Thank You2006年年11月月1日日青岛青岛Thank You2006年11月1日青岛109lThank You青岛八大关秋色Thank You青岛八大关秋色110DSADSA111Cranial Metastasis of Hepatocellular CarcinomaHydatid cyst of the brain Cranial Metastasis of Hydatid 112