肿瘤样脱髓鞘病变影像特征以及鉴别诊断.pptVIP

2021/8/23 TDLs 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. 肿瘤样脱髓鞘病变（Tumefactive demyelinating lesions ，TDLs ） 影像特征以及鉴别诊断 MRI增强 中枢神经系统原发性炎性脱髓鞘病 特点：以神经纤维脱髓鞘及小血管周围炎性细胞浸润为主要病理表现的一组疾病 典型表现为白质内多发、弥散的异常信号，病灶通常无明显占位效应 包括 多发性硬化 视神经脊髓炎 急性播散性脑脊髓炎等 肿瘤样脱髓鞘性病变(Tumefactive demyelinating lesions ，TDLs） 但一些非典型病例，表现为占位性肿块的脱髓鞘性病变，从临床、影像学甚至病理学冰冻切片都很难与中枢神经系统肿瘤如胶质瘤、淋巴瘤等鉴别 Tumefactive demyelinating lesions 1979年，Van Dor Velden首次对该病进行了报告。 关于这种临床综合症是否属于一种独立的疾病仍然存在争论，目前归类为多发性硬化和急性播散性脑脊髓炎之间的独立中间型。 肿瘤样炎性脱髓鞘性病变(tumor-like inflammatory dem