脑感染八年制 Radiology of CNS Infection.ppt

慢性期：大量虫卵沉积和异物反应 →肉芽肿，虫卵死亡，纤 维结节→脑萎缩和瘢痕形 成，虫卵栓塞血管或脉管 炎→脑卒中 平扫：急性期长T1、长T2信号 慢性期肉芽肿 T1WI：等，稍低 T2WI：高，稍高 灶周水肿 增强： ● 斑点及小斑片强化 ● 多个结节强化 MRI 特点 Tongji Hospital Myelitis (脊髓炎) The disease has been associated with viral illness, vasculitides, vaccination and MS The cord swelling and slight expansion, extending over several vertebral body segments hypointensity on T1WI and hyperintensity on T2WI Enhancement is moderate to marked following contrast administration In the later course of the disease, the cord appear normal, but more often atrophic 颈段脊髓炎 Acute Myelitis 多发性硬化(Multiple Sclerosis) 常见的脱髓鞘病变, 与自身免疫反应或病毒感染有关. 缓解与复发反复进行. 20 ~ 40 Y 多发. F：M = 1.7 : 1 ~ 5 -10 : 1 常累及脑实质，脊髓和视神经 病 理 早期: 髓鞘崩解和细胞增生.小胶质细胞增生,吞噬类脂质后形成泡沫细胞. 淋巴细胞、浆细胞和巨噬细胞沿充血的小血管周围浸润，形成所谓血管周围袖套。病灶常以小静脉为中心。疾病发展时，病灶扩大融合。 疾病稳定或好转时，即慢性期或不活动期，细胞浸润消退，髓鞘脱失仍然存在，并有星形细胞和胶质增生，少突胶质细胞减少，轴索相对保存。 影像学特征 CT：病灶较大时为低密度区，圆形/椭圆形 MRI: 脑白质的多发性病灶,T1WI—等低信号, T2WI—高或较高信号, 长条形或椭圆形, 病灶长轴与脑室长轴相垂直---直角征; “病灶中的病灶”—“靶状”：病灶双重信号 脑干、小脑、视神经、脊髓受累；脑萎缩. +C: 急性期/新鲜病灶常出现强化, 实质性或 环状强化. 激素治疗后强化减少或消失. M S – case１ M S – case１ M S – case１ M S – case 2 M S – case 2 MS - Case 3 MS with optic neuritis M S “Subcortical U fibres” Juxta-cortical lesions Juxta-cortical lesions Juxta-cortical lesions Tongji Hospital MS 鉴别诊断 REVIEW Pyogenic Tuberculous Viral Parasitic organisms Myelitis Mutiple sclerosis * * * * Tuberculosis of CNS Spread of the mycobacterium to CNS is hematogenous from a pulmonary source. Three types Meningitis Tuberculoma: 2- 6 cm Military cerebral TB: multiple, small Imaging Features Tuberculous meningitis: thick, gelatinous exudates in the basal cisterns; meningeal thickening and prominent enhancement granulomas: node or ring enha