《医学影像学颅内肿瘤》由会员分享，可在线阅读，更多相关《医学影像学颅内肿瘤（67页珍藏版）》请在金锄头文库上搜索。
1、Intracranial tumors 颅内肿瘤,Plane film: Cerebral angiography:脑血管造影 CT and MRI: main methods,Differential diagnosis by location and age 通过位置和年龄鉴别诊断,According location: Intraaxial within the brain parenchyma脑实质内 Extraaxial lying outside of the brain parenchyma (meninges, subarachnoid, subdural or epidura
2、l spaces, bony calvarium) 脑实质外（脑膜，蛛网膜下，硬膜下，硬膜外间隙，颅骨）,Intraaxial brain tumors,Gliomas神经胶质瘤 Metastases转移瘤 Primary lymphoma原发性淋巴瘤 Primitive neuroectodermal tumors 原始神经外胚层肿瘤,Extraaxial brain tumors,Meningioma脑膜瘤 Pituitary adenoma垂体腺瘤 Metastases转移瘤 Schwannomas神经鞘瘤 Chordomas 脊膜瘤 Craniopharyngiomas颅咽管瘤,Pre
3、dominantly adult brain tumors主要的成人脑肿瘤,Metastases转移瘤 Glioblastoma multiforme多发性恶性胶质瘤 Anaplastic astrocytoma间变型星形细胞瘤 Fibrillary astrocytoma纤维性星形细胞瘤 Oligodendrogioma少突胶质细胞瘤 Pituitary adenoma垂体腺瘤 Meningioma hemangioblastoma脑膜成血管细胞瘤,Predominantly pediatric brain tumors,PNET: medulloblastoma髓母细胞瘤 pineobla
4、stoma松果体母细胞瘤 Juvenile pilocytic astrocytoma 少突星形细胞瘤 Lipoma脂肪瘤 Germinomas生殖细胞瘤 Craniopharyngioma颅咽管瘤,Astrocytoma星形细胞瘤,Arising from cells of glial origin起源于神经胶质细胞 Most common in the CNS (about 50%) 大多数来自中枢神经系统 Most common glial tumor is a low grade (grade -) astrocytoma多为低级别的胶质瘤 Most malignant form (g
5、rade -) is glioblastoma multiforme (GBM) 大多数恶性形式是多形性胶质母细胞瘤,CT FINDINGS OF ASTROCYTOMA,Hypodense mass低密度占位 Mass effect占位效应 Irregular outer margin不规则边界 Enhancement varies from no enhancement to patchy 从无强化到斑状强化,Astrocytoma,post-contrast,Pre-contrast,Astrocytoma,MRI FINDINGS OF ASTROCYTOMA,T1WI: Hypo-i
6、ntensity（低信号） T2WI: Hyper-intensity（高信号）,Astrocytoma,Glioblastoma multiforme 多形性胶质母细胞瘤,CT imaging Mixed low density tumor (necross) 混杂低密度（坏死） Hemarrhage Surrounding low density edema 周围低密度-水肿 Mass effect (compression and displacement) Irregular contrast enhancement,C_,C_,C+,C+,Glioblastoma multiform
7、e,MRI imaging Mixed intensity on both T1WI and T2WI Hemarrhage Edema Mass effect (compression and displacement) Irregular contrast enhancement,GLIOBLASTOMA MULTIFORME,Meningioma脑膜瘤,One of the more common intracranial neoplasms常见的颅内肿瘤 The most common non-glial primary brain tumor最常见的非胶质源性脑肿瘤 Represen
8、t 15%-20% of all primary brain tumors Most are benign, malignant types are uncommon大多为良性，恶性少见 Usually grow slowly通常生长缓慢,Meningioma,Most often in adult多见于成人 Predominance in female 多见于女性 Common location: Cerebral convexities脑的凸面 Falx cerebri大脑镰 Sphenoid wing蝶骨翼 90% are supratentorial 90%幕上,CT findings
9、,Frequently mild high attenuation (higher than normal brain) 通常是中高密度（比正常脑组织密度高） Extra-axial masses, adjacent to dura matter 与硬脑膜相连 Calcification钙化 Edema, low density水肿，低密度 Nearly all meningiomas show intense contrast enhancement 几乎所有的脑膜瘤均有强化 Dural tail sign硬膜尾征 Cyst formation is less common囊形成少见 Ost
10、eoblastic reaction (hyperostosis) 成骨细胞反应（骨质增生）,MENINGIOMA,MENINGIOMA,MRI findings,Smoothly marginated broad-based tumor 边界平滑的宽基底肿瘤 T1WI: isointense to gray matter, or hypointense (less common) 与灰质相比呈等或略高信号 T2WI: isointense 50% hyperintense 40% Often inhomogeneous呈不均性 Enhancement is uniform, rapid, a
11、nd intense,POST-CONTRAST,MENINGIOMA,T2WI,MENINGIOMA,acoustic neurilemoma听神经瘤,Plain平扫,Enhancement 强化,acoustic neurilemoma,听神经瘤MRI,acoustic neurilemoma,acoustic neurilemoma,acoustic neurilemoma,METASTASIS转移瘤,Hematogenous metastasis血源性转移瘤 Other types of metastasis spread (extending, spread through CSF,
12、 meningeal spread) 其他类型的转移瘤播散（扩散，通过脑脊液，脑膜转移） Lung and breast cancer commonly spread to brain肺癌和乳腺癌通常转移到脑,METASTASIS,Often be found at the gray-white matter junction, but everywhere can be seen通常在灰白质交接处较多见 Edema Mass effect Hemorrhage Multiple,Metastasis,METASTASIS,METASTASIS,T1WI,T2WI,Gd,ANEURYSM 动脉
13、瘤,PRE AND POST ENHANCEMENT CT CT ANGIOGRAPHY，CTA MRI MR ANGIOGRAPHY，MRA DSA （GOLD STANDARD）,TYPE （WITHOUT THROMBUS）（无血栓）,CT: round, oval, or lobulated lesion similar in attenuation to blood vessels but larger than the adjacent arteries. Calcification is occasionally present within an aneurysm. CT：圆形
14、，或卵圆形，与血管内密度相同，但比相邻动脉大。偶尔有钙化. MRI: flow-void effect,TYPE （WITHOUT THROMBUS）,TYPE I,TYPE I,TYPE I,TYPE （WITH THROMBUS）,TYPE II,TYPE II,ANEURYSM WITH HEMORRHAGE,CERABRAL VASCULAR MAIFORMATION 脑血管畸形,ARTERIO-VENOUS MALFORMATION动静脉畸形 VENOUS MALFORMATION静脉畸形 GalenS ANGIOMA Galen血管瘤 HEMANGIOMA血管瘤,AVM,ARTERIO-VENOUS MALFORMATION,AVM,ARTERIO-VENOUS MALFORMATION,GalenS ANGIOMA,HEMANGIOMA,HEMANGIOMA,课后复习题： 1、颅内常见肿瘤的CT表现； 2、颅内常见肿瘤的MR表现特点； 3、颅内肿瘤的影像学检查方法比较。,
