脑瘤脑血管病脑外伤研究生课件学生拷贝用.pptVIP

神经系统常见病的影像诊断Imaging of Common CNS Diseases T1-Weighted Images Images whose design (timing of radio pulses and data readout) is to produce contrast between gray matter, white matter, and CSF Zooming In Can follow GM cortex fairly well Can measure thickness of cortex and try to quantify vs age and/or disease and/or genes Bright spots and lines: arterial inflow artifact Leads to idea of MRA = Magnetic Resonance Angiography = acquire images to make arteries stand out even more Higher spatial resolution is possible At the cost of scan time T2-Weighted Images Often better than T1-weighting in detecting tumors and infarcts (usually radiologists look at both types of scans) T2*-Weighted Images Designed to make venous blood (with lots of deoxy-hemoglobin) darker than normal tissue = venography Brain Activation Map DTI Results 脑肿瘤brain tumor 常见颅内肿瘤common intracranial tumors 1、 胶质瘤 glioma 2、 神经鞘瘤和神经纤维瘤 neurinoma and neurofibroma 3、 脑膜肿瘤 meningioma 4、 淋巴瘤和造血系统肿瘤 lymphoma 5、 生殖细细胞瘤 germinoma 6 、鞍区肿瘤 tumors in sella and parasella region 7、 转移性肿瘤 metastatic tumor 胶质瘤 glioma 星形细胞肿瘤 astrocytoma 胶质母细胞瘤 glioblastoma 少突胶质细胞瘤 oligodendroglioma 室管膜瘤 ependymoma 混合性胶质瘤 mixed glioma 星形细胞肿瘤 astrocytoma 星形细胞肿瘤是颅内常见肿瘤，好发于中青年和儿童，发病部位随年龄而异，儿童多见于后颅窝，成人发病者以幕上居多。按肿瘤分化程度分为四级（Ⅰ－Ⅳ 级 ） Ⅰ－Ⅱ级肿瘤生长缓慢 ，边缘较清楚，占位及水肿均不明显，CT平扫表现为低密度，MRI T1WI呈低信号， T2WI呈均匀高信号，增强检查，无或轻度强化。 Ⅲ－ Ⅳ级肿瘤呈弥漫浸润生长，肿瘤轮廓不规则，境界不清，易发生坏死、出血和囊变。肿瘤最常发生于幕上(super- tentorium)，可以累及中央区白质结构如胼胝体，或经中线延伸至对侧，呈蝶翼状(aliform)改变。肿瘤占位及水肿均明显。CT平扫常呈混杂低密度，MRI T1WI呈低信号或混杂信号，T2WI呈不均匀或均匀性高信号。增强多呈不规则花环状(race; ring)强化。 脑膜瘤meningeoma 脑膜瘤起源于蛛网膜的帽状细胞(arachnoidal codocyte) ，为颅内常见肿瘤之一，好发于中青年女性。脑膜瘤为脑外肿瘤，血供丰富。可见于: 大脑凸面convexity of brain、 矢状窦旁parasaggital sinus、 嗅沟olfactory groove、 蝶骨嵴sphenoidal crest、 鞍结节tuberculum sellae、 桥小脑角cerebellopontine angle、 天幕 tentorium等。 IMAGING FINDINGS CT : 平扫肿瘤呈等密度或略高密度，瘤周水肿少见，肿瘤钙化常见，局部颅骨可见增生(hyperplasia)、破坏或颅板(cranium; skull) 增厚。增强扫描，病灶显著均匀强化，境界清晰。 MR: T1WI呈等或略低信号，T2WI呈等或略高信号，信号均匀。水肿和占位一般不明显。肿瘤强化显著，有时可见“脑膜尾征”。So ca