课件：肿瘤样脱髓鞘病变影像特征以及鉴别诊断.ppt

胶母 Glioblastoma Multiforme: no dark line of advancing demyelination 胶母 TDL MR imaging and CT findings in 32-year-old man with TDL. A, Axial T2-weighted and, B, contrast- enhanced axial T1-weighted MR images demonstrate white matter lesions with heterogeneous enhancement in the parietal lobe and corpus callosum. The signal intensity of the enhancing components of the right parietal lobe is mixed (isointense plus hyperintense) on the T2-weighted image. C,Unenhanced axial CT image shows hypoattenuation (grade 1) of both the enhanced and unenhanced components of the lesions (arrows). 与淋巴瘤鉴别 MR imaging and CT findings in 65-year-old woman with lymphoma. A, Axial T2-weighted and,B, contrast-enhanced axial T1-weighted MR images demonstrate bilateral lesions with diffuse enhancement in the white matter of both parieto-occipital lobes. Signal intensities of the enhancing lesions are hyperintense on the T2-weighted image. C, Unenhanced axial CT image demonstrates isoattenuation (grade 2) of the lesion in the left parietal lobe (arrowhead). 淋巴瘤 T1WI C+,肿瘤位于侧脑室旁，形状和轮廓均不规则，明显增强。 （例２） 脓肿 女性，47岁，出现持续数个月的虚弱 The mass has well defined borders and partially effaces the atrium (trigone) of the left lateral ventricle. There is mild patchy enhancement. DWI images demonstrate increased signal throughout, but only the even more hyperintense rim demonstrates true restricted diffusion on ADC images. The remainder of the mass is increased signal on ADC images, indicating increased diffusivitiy. 脓肿 多发性硬化 多发病灶与MS难鉴别，占位效应明显 肿瘤样脱髓鞘病变长期随访复发少见（Kepes等随访31例9-12年，28例未复发） F 28Y，病灶呈类圆形，病灶位于两侧脑室旁、右侧颞叶及胼胝体。 MS 多发病灶 “黑洞”、“核心”+“晕环”现象 转移瘤 皮髓交界处多见，水肿广泛，而肿瘤样脱髓鞘病变分布在深部脑白质 年龄 1，病灶多发 2，两侧脑室旁及额顶叶深部白质 3，病灶较大，部分病灶呈融合状 4，信号：与急性MS病灶相似 5，强化：结节状 急性或亚急性起病，多见于儿童及青少年。 病前多有病毒感染或疫苗接种史，病变以静脉性脱髓鞘主 ．累及范围广泛．常同时累及脑和脊髓．病程急 急性播散性脑脊髓炎 播散性脑脊髓炎 Balos concentric sclerosis （BCS）同心圆硬化  一种少见的脱髓鞘病变，被认为是多发性硬化的一种变异 病理学上表现为环状正常髓磷脂或髓鞘再生与脱髓鞘病变相交替，累及大脑半球、脑干、脊髓和视交叉。 病变位于脑室周，类似于其他的多发性硬化，常多发以顶叶半卵圆中心多见 层状（洋葱皮样