【医学ppt课件】中枢神经系统影像诊断CNS

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,中枢神经系统影像诊断,中枢神经系统影像诊断,1,一、,Examination methods,1. X-ray plain film,This method is very simple and cheap.,Some lesions can be found by it.,Usually we cannot reach to an exact diagnosis only,by this examination,2. Tomography,Exact diagnosis still cannot obtained,The method can manifested some osseous,destruction which cannot be shown by plain film.,一、Examination methods 1. X-ra,2,Enhancement,:,3. CT,To display tumors, hemorrhage, infarction, infection and abnormality.,To show the abnormal isodensity which cannot found by the plain scan.,To confirm the quality of the lesion.,Differential diagnosis of tumor and edema .,Plain scan,:,The characters of the lesion including size, appearance, number,position , anatomy relation ,and so on can be shown by it.,Enhancement:3. CT To display,3,4. Magnetic resonance imaging,Plain scan,:,Enhancement,:,To show the abnormal isodensity which cannot found by the plain scan.,To confirm the quality of the lesion.,Differential diagnosis of tumor and edema .,MRA:,To show the vascular lesions such as aneurysm and arterial venous,malformation.,To display tumors, hemorrhage, infarction, infection and abnormality.,The characters of the lesion including size, appearance, number,position , anatomy relation ,and so on can be shown by it.,4. Magnetic resonance imagingP,4,5. DSA,To show the vascular lesions such as aneurysm, arterial venous,malformation.,blood supply of neoplasm,6. Myelography,To,show whether there are tumors and obstruction in spinal canal.,It is also helpful to ensure the position and degree of obstruction.,5. DSA To show the vascular l,5,一、,Normal manifestation,（一）、,Plain film,1.Cranium,The inner and outer plate are dense and the diploe is spongy.,2.,Skull suture,All of the sutures are shown as sawtooth shadow,3.Convolutional impressions,Multiple round low density in plain film.,4.The impression of the middle meningeal artery,The impresstion of the middle meningeal artery is presented as,streaks shadow and go out from wide to narrow,一、 Normal manifestation（一）、Pla,6,5.,Impression,of d,iploic vein,7.,The Sella :,6.,Impression of pacchionian,granulation,8. Internal auditory meatus:,About 6mm wide ,symmetrical canal,The frontal parietal irregular hypodensity near the midline.,The diploic veins impress appears as netlike hypodensity in the parietal region .,716mm long, 714mm wide and 820mm deep.,5.Impression of diploic vein,7,10.calcification of falx cerebri :,9.,Calcification of,pineal body :,11.Calcification of choroid plexus,12 Calcification of petro-clinoid ligament :,It is presented as nodular hyperdensity on the lateral skull radiograph.,The frontal view show the normal position are presented the zonary dense image on the midline .,Calcification of choroid plexus are presented the anomalistic dense image and lateral to midline.,The dense shadow between in the anterior and posterior clinoid process.,10.calcification of falx cereb,8,【医学ppt课件】中枢神经系统影像诊断CNS,9,【医学ppt课件】中枢神经系统影像诊断CNS,10,【医学ppt课件】中枢神经系统影像诊断CNS,11,【医学ppt课件】中枢神经系统影像诊断CNS,12,【医学ppt课件】中枢神经系统影像诊断CNS,13,【医学ppt课件】中枢神经系统影像诊断CNS,14,【医学ppt课件】中枢神经系统影像诊断CNS,15,【医学ppt课件】中枢神经系统影像诊断CNS,16,【医学ppt课件】中枢神经系统影像诊断CNS,17,1.,W,hite matter:,is hypodense to gray matter. CT values is,20-30Hu,2. Gray matter:,is hyperdense to white matter . CT values is,30-40Hu,3. Ventricle and cistern :,are hypodense. CT values is,0-10Hu,4. Skull :,is hyperdense. CT values,250Hu,5. Physiological calcification:,Spot or patch dense shadow. CT values60Hu,二、,CT manifestation,1.White matter: is hypodense,18,【医学ppt课件】中枢神经系统影像诊断CNS,19,三、,MRI manifestation,1 . Morphological manifestation,Axial, coronal,sagittal MRI can clearly show the shape of brain and spinal cord,such as white matter,grey matter,ventricle,cerebral fissure,brainstem,cerebral vessel,pituitary body,et al. The efficiency is close to gross specimen .,三、 MRI manifestation1 . Morpho,20,T1WI T2WI,WHITE MATTER HIGH LOW,GREY MATTER LOW HIGH,CSF LOW HIGH,FAT HIGH MEDIUM,SKULL TABLE LOW LOW,DIPLOE HIGH LOW,MENINGES LOW LOW,VESSEL LOW LOW,CALCIFICATION LOW LOW,MRI signal intensity,T1WI,21,Frontal lobe,Pituitary body,Central sulcus,Pituitary stalk,Optic chiasm,Genu of corpus callosum,Medulla oblongata,Clivus,Sphenoid sinus,Parietal lobe,Thalamus,Occipital lobe,Mamillary body,Quadrigeminal body,Straight simus,4th ventricle,Cerebellar tonsil,Frontal lobePituitary bodyCent,22,Genu of corpus callosum,Frontal lobe,Splenium of corpus collosum,3rd ventricle,Thalamus,Head of caudate nucleus,Globus pallidus,Occipital lobe,Optic radiations,Septum pellucidum,Posterior horn of lateral ventricle,Anterior horn of lateral ventricle,Interventricular foramen,Parietooccipital sulcus,Genu of corpus callosumFrontal,23,Thalamus,Head of caudate nucleus,Globus pallidus,Occipital lobe,Optic radiations,Anterior horn of lateral ventricle,Interventricular foramen,3rd ventricle,Genu of corpus callosum,Septum pellucidum,Splenium of corpus collosum,Posterior horn of lateral ventricle,Posterior limb of internal capsule,Genu of internal capsule,Anterior limb of internal capsule,Parietooccipital sulcus,ThalamusHead of caudate nucleu,24,Parietal lobe,Superior temporal gyrus,Middle temporal gyrus,Pons,Medulla oblongata,Cerebral peduncle,Centrum semiovale,3rd ventricle,Inferior temporal gyrus,Petrous ridge of temporal bone,Parahippocampal gyrus,Parietal lobeSuperior temporal,25,Anterior horn of lateral ventricle,Lateral fissure,Suprasellar cistern,Pituitary body,Temporal lobe,Inerhemisperic fissure cistern,Corpus callosum,caudate nucleus,globus pallidus, putamen,Optic chiasm,Pituitary stalk,Cavernous sinus,Anterior horn of lateral ventr,26,DSA manifestation,Normal cerebral artery (anterior and middle cerebral artery) gradually taper off with symmetric branches and smooth margin. The arteries have invariable location and corresponding brain tissue.,DSA manifestationNormal cerebr,27,【医学ppt课件】中枢神经系统影像诊断CNS,28,Imageologic diagnosis of the common disease,（一）,Brain tumors,have common characteristic in imageologic manifestion,Glioma,astrocytoma,Meningioma,Pituitary tumor,Acoustic neuroma,Metastasis tumor,Imageologic diagnosis of the c,29,1,、,X-ray manifestation,、,Increase of intracranial pressure,Increase and deepening of convolutional impressions, separation of sutures,thinning of bones.,、,Tumor location sign,Destruction of skull,enlargement of the sellar,displacement of calcification,dilation of,Internal auditory meatus, pathologic cacification,1、X-ray manifestation 、Incre,30,【医学ppt课件】中枢神经系统影像诊断CNS,31,【医学ppt课件】中枢神经系统影像诊断CNS,32,【医学ppt课件】中枢神经系统影像诊断CNS,33,【医学ppt课件】中枢神经系统影像诊断CNS,34,【医学ppt课件】中枢神经系统影像诊断CNS,35,【医学ppt课件】中枢神经系统影像诊断CNS,36,【医学ppt课件】中枢神经系统影像诊断CNS,37,【医学ppt课件】中枢神经系统影像诊断CNS,38,2,、,CT,manifestation,、,Density abnormality,The tumors are slightly hypodense to isodense on plain scan.,、,Mass effect,Displacement of midline, compression and obstruction of ventricle, hydrocephalus.,、,Edema,Hypodensity around tumor, more severe in malignant tumor.,2、CT manifestation 、Density a,39,、,physiological calcification:,eg: Irregular calcification can been seen in Oligodendroglioma,、,Destruction of bone,Defect of bone, decreased denstiy,eg:,acoustic neuroma,、,Enhancement,Increase of tumor density, there is no enhancement in the area of necrosis and edema, 、physiological calcification,40,【医学ppt课件】中枢神经系统影像诊断CNS,41,【医学ppt课件】中枢神经系统影像诊断CNS,42,【医学ppt课件】中枢神经系统影像诊断CNS,43,【医学ppt课件】中枢神经系统影像诊断CNS,44,【医学ppt课件】中枢神经系统影像诊断CNS,45,【医学ppt课件】中枢神经系统影像诊断CNS,46,MRI,manifestation,、,Signal abnormality,The tumors are slightly hypointensity to isointensity on plain scan,、,Mass effect,Displacement of midline, compression and obstruction of ventricle, hydrocephalus,、,Edema,Edema is around tumor with long T1 and T2 relaxing times.,MRI manifestation 、Signal a,47,、,Physiological calcification:,、,Destruction of bone,、,Enhancement,Increase of tumor density, there is no enhancement in the area of necrosis and edema,T1 and T2 prolongation of bone area can been near tumors,Hypointensity in the tumor on T1WI and T2 WI, 、Physiological calcification,48,【医学ppt课件】中枢神经系统影像诊断CNS,49,【医学ppt课件】中枢神经系统影像诊断CNS,50,【医学ppt课件】中枢神经系统影像诊断CNS,51,【医学ppt课件】中枢神经系统影像诊断CNS,52,【医学ppt课件】中枢神经系统影像诊断CNS,53,【医学ppt课件】中枢神经系统影像诊断CNS,54,【医学ppt课件】中枢神经系统影像诊断CNS,55,【医学ppt课件】中枢神经系统影像诊断CNS,56,【医学ppt课件】中枢神经系统影像诊断CNS,57,【医学ppt课件】中枢神经系统影像诊断CNS,58,【医学ppt课件】中枢神经系统影像诊断CNS,59,【医学ppt课件】中枢神经系统影像诊断CNS,60,DSA manifestation,、,Mass effect,Vessels displacement ,separation,gathering,bending, straightening,、,Tumor dyeing,Tumors with sufficient blood supply can been seen,DSA manifestation 、Mass effec,61,1. X-RAY PLAIN FILM manifestation,（二）,Craniocerebral injury,To find the presence or absence of skull fracture and to access the location and type of fracture(linear fracture,comminuted fracture,depressed fracture),Intracranial injury cannot been observed,1. X-RAY PLAIN FILM manifesta,62,【医学ppt课件】中枢神经系统影像诊断CNS,63,【医学ppt课件】中枢神经系统影像诊断CNS,64,CT,manifestation,、,Epidural hematoma,、,Subdural hematoma,、,Intracerebral hematoma,、,Cerebral contusion,shows a localized biconvex high density under the inner table,Generalized peripheral high density under the inner table,Round or irregular hyperdensity,Haemorrhage and edema are intercurrent,producing motley density,CT manifestation 、Epidural he,65,【医学ppt课件】中枢神经系统影像诊断CNS,66,【医学ppt课件】中枢神经系统影像诊断CNS,67,【医学ppt课件】中枢神经系统影像诊断CNS,68,【医学ppt课件】中枢神经系统影像诊断CNS,69,【医学ppt课件】中枢神经系统影像诊断CNS,70,【医学ppt课件】中枢神经系统影像诊断CNS,71,MRI manifestation,、,Chronic epidural hematoma,Shows a localized biconvex high intensity under the inner table,、,Chronic subdural hematoma,Generalized peripheral high intensity under the inner table,、,Chronic intracerebral hematoma,Chronic hematoma producing irregular hyperintensity with ring sign.,MRI manifestation 、Chronic ep,72,【医学ppt课件】中枢神经系统影像诊断CNS,73,【医学ppt课件】中枢神经系统影像诊断CNS,74,（三）,Vascular diseases,1,、,Intracranial aneurysm,DSA,CT,MRI,Demonstrate rounded high density link to relative artery with irregular size and smooth margin,Shows rounded flow void with smooth margin on T1WI and T2WI,Displays isodensity on plain scan and rounded hyperdensity on CECT,（三） Vascular diseases 1、Intrac,75,【医学ppt课件】中枢神经系统影像诊断CNS,76,【医学ppt课件】中枢神经系统影像诊断CNS,77,【医学ppt课件】中枢神经系统影像诊断CNS,78,【医学ppt课件】中枢神经系统影像诊断CNS,79,2,、,Intracranial vascular malformation,（,Arteriovenous malformation,）,DSA,CT,MRI,Vein early emerging,malformed nidus, narrowing of feeding artery,dilated draining vein.,Malformed vascular nidus producing racemose flow void with narrowing of feeding artery,dilated draining vein.,Displays isodensity on plain scan and rounded hyperdense malformed vascular nidus on CECT,2、Intracranial vascular malfor,80,【医学ppt课件】中枢神经系统影像诊断CNS,81,【医学ppt课件】中枢神经系统影像诊断CNS,82,【医学ppt课件】中枢神经系统影像诊断CNS,83,【医学ppt课件】中枢神经系统影像诊断CNS,84,【医学ppt课件】中枢神经系统影像诊断CNS,85,3,、,cerebral infarction,MRI,Ischemic infarction producing sector or irregular shape with T1 and T2 prolongation. Mass effect can been seen in extensive cases. cerebral lacuna have been identified as infarctions less than 1 cm.,CT,Ischemic infarction producing sector or irregular hypodensity with blurred margin. cerebral lacunas are not easy to find.,3、cerebral infarctionMRIIschem,86,【医学ppt课件】中枢神经系统影像诊断CNS,87,【医学ppt课件】中枢神经系统影像诊断CNS,88,【医学ppt课件】中枢神经系统影像诊断CNS,89,四、,Infectious diseases,Suppurative infection:,Tuberculous infection,：,Viral infection,：,Patasitic infection,：,Encephalitis,Brain abscess, Meningitis,Meningitis, Tuberculoma,Encephalitis,Meningitis,Cysticercosis, Schistosomiasis,四、Infectious diseasesSuppurati,90,1,、,Brain abscess,CT:,Plain scan shows round hypodensity with ringlike peripheral isodensity and edema. There is ring enhancement of the uniform thick abscess wall . The central hyodense area in the cavity dose not change in enhancement.,MRI,：,The abscess have long T1 and T2 relaxation times with surrounding edema. There is ring enhancement of the uniform thick abscess wall . The abscess cavity have not enhancement.,1、Brain abscessCT:Plain scan s,91,【医学ppt课件】中枢神经系统影像诊断CNS,92,【医学ppt课件】中枢神经系统影像诊断CNS,93,2,、,cerebral cysticercosis,Larval of Taenia solium parasitize in brain. Cerebral larval infestation is characterized by a fluid-filled cyst with a mural soft-tissue nodule.the disease can been classified as larval living stage, larval death stage, calcification stage.,2、cerebral cysticercosis,94,Multiple spotlike high-density with similar size in brain.,CT:,MRI:,Accompanied by edema, the multiple cysts with long T1 and T2 signal are no more than 1 cm in diameter,larval living stage:,The low-density cysts occur in groups with spotlike mural nodule .,Calcification stage:,Multiple spotlike high-density,95,【医学ppt课件】中枢神经系统影像诊断CNS,96,【医学ppt课件】中枢神经系统影像诊断CNS,97,【医学ppt课件】中枢神经系统影像诊断CNS,98,二,. Normal manifestation,Examination of spinal cord,一、,Examination method,MRI,CTMyelographyX-ray,spinal canal: 11mm long,16mm wide,Spinal cord: columniform,smooth margin,homogeneous,二. Normal manifestationExamina,99,【医学ppt课件】中枢神经系统影像诊断CNS,100,【医学ppt课件】中枢神经系统影像诊断CNS,101,【医学ppt课件】中枢神经系统影像诊断CNS,102,三、,Intramedullary tumor are predominantly ependymoma and astrocytoma.(about 90% of all intraspinal tumors),The outline of MRI diagnosis,1. the spinal cord is enlarged and the lesion is extensive,2. The subarachnoid space around the spinal cord is narrowed or blocked,3.secondary syringohydromyelia,4. The tumors are slightly hypointense on T1 and slightly hyperintense on T2. Enhancement can been seen.,三、Intramedullary tumor are pre,103,【医学ppt课件】中枢神经系统影像诊断CNS,104,【医学ppt课件】中枢神经系统影像诊断CNS,105,【医学ppt课件】中枢神经系统影像诊断CNS,106,【医学ppt课件】中枢神经系统影像诊断CNS,107,【医学ppt课件】中枢神经系统影像诊断CNS,108,【医学ppt课件】中枢神经系统影像诊断CNS,109,4,、,Extramedullary intradural tumor,which is composed principally of meningiomas and nerve sheath tumors,The outline of MRI diagnosis,1.spinal cord displacement to the contralateral side,2. The subarachnoid space on the side of the tumor is dilated,3. The tumor is localization with clear margin,4. The tumor is isointensity on both T1 and T2 with obvious enhancement.,4、Extramedullary intradural tu,110,【医学ppt课件】中枢神经系统影像诊断CNS,111,【医学ppt课件】中枢神经系统影像诊断CNS,112,【医学ppt课件】中枢神经系统影像诊断CNS,113,【医学ppt课件】中枢神经系统影像诊断CNS,114,【医学ppt课件】中枢神经系统影像诊断CNS,115,【医学ppt课件】中枢神经系统影像诊断CNS,116,五、,Extramedullary extradural tumor,Malignant lymphoma and metastasis is usually observed,The outline of MRI diagnosis,4. slight hypointensity on T1 and slight hyperintensity on T2,enhancement can been seen.,3.spinal cord displacement to the contralateral side and narrow subarachnoid space on the side of the tumor,2. Dura is shown as hypointensity between the tumor and spinal cord.,1. The tumors are flat and extend to a large area.,五、Extramedullary extradural tu,117,【医学ppt课件】中枢神经系统影像诊断CNS,118,【医学ppt课件】中枢神经系统影像诊断CNS,119,六、,Spinal cord injury,The outline of MRI diagnosis,1.spinal cord edema: hypointensity on T1 and hyperintensitu on T2,2.Spinal cord hemorrhage:The signals evolvement were the same with,intracerebral hematoma.,3.Spinal cord transection injury: the spinal cord signals are interrupted.,4.Spinal cord intenerate: hypointensity on T1 and hyperintensitu on T2,六、Spinal cord injuryThe outlin,120,The vertebral column and spinal cord injury,The injury consists of fracture of vertebral body and appurtenance,spinal cord concussion ,spinal cord contusion spinal cord compression, spinal cord transverse injury and hematoma,，,nerve roots avulsion ,spinal cord intenerate and so on. MRI is the first of choice.,The vertebral column and spina,121,【医学ppt课件】中枢神经系统影像诊断CNS,122,【医学ppt课件】中枢神经系统影像诊断CNS,123,【医学ppt课件】中枢神经系统影像诊断CNS,124,【医学ppt课件】中枢神经系统影像诊断CNS,125,【医学ppt课件】中枢神经系统影像诊断CNS,126,【医学ppt课件】中枢神经系统影像诊断CNS,127,【医学ppt课件】中枢神经系统影像诊断CNS,128,谢谢,谢谢,129,