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1、中中枢枢神神经经系系统统影影像像诊诊断断一、Examinationmethods1.X-rayplainfilmThismethodisverysimpleandcheap.Somelesionscanbefoundbyit.Usuallywecannotreachtoanexactdiagnosisonlybythisexamination2.Tomography2.TomographyExactdiagnosisstillcannotobtained ThemethodcanmanifestedsomeosseousThemethodcanmanifestedsomeosseousdest
2、ructionwhichcannotbeshownbyplainfilm.destructionwhichcannotbeshownbyplainfilm.EnhancementEnhancement: :3.CT Todisplaytumors,hemorrhage,infarction,infectionandabnormality.Todisplaytumors,hemorrhage,infarction,infectionandabnormality. Toshowtheabnormalisodensitywhichcannotfoundbytheplainscan.Toshowthe
3、abnormalisodensitywhichcannotfoundbytheplainscan. Toconfirmthequalityofthelesion.Toconfirmthequalityofthelesion. Differentialdiagnosisoftumorandedema.Differentialdiagnosisoftumorandedema.PlainscanPlainscan: : Thecharactersofthelesionincludingsize,appearance,number,Thecharactersofthelesionincludingsi
4、ze,appearance,number,position,anatomyrelation,andsooncanbeshownbyit.position,anatomyrelation,andsooncanbeshownbyit.4.MagneticresonanceimagingPlainscanPlainscan: :EnhancementEnhancement: : Toshowtheabnormalisodensitywhichcannotfoundbytheplainscan.Toshowtheabnormalisodensitywhichcannotfoundbytheplains
5、can. Toconfirmthequalityofthelesion.Toconfirmthequalityofthelesion. Differentialdiagnosisoftumorandedema.Differentialdiagnosisoftumorandedema.MRA:Toshowthevascularlesionssuchasaneurysmandarterialvenousmalformation. Todisplaytumors,hemorrhage,infarction,infectionandabnormality.Todisplaytumors,hemorrh
6、age,infarction,infectionandabnormality. Thecharactersofthelesionincludingsize,appearance,number,Thecharactersofthelesionincludingsize,appearance,number,position,anatomyrelation,andsooncanbeshownbyit.position,anatomyrelation,andsooncanbeshownbyit.5.DSAToshowthevascularlesionssuchasaneurysm,arterialve
7、nousmalformation.,bloodsupplyofneoplasm6.MyelographyToshowwhethertherearetumorsandobstructioninspinalcanal.Itisalsohelpfultoensurethepositionanddegreeofobstruction.一、一、Normalmanifestation（一）、（一）、（一）、（一）、PlainfilmPlainfilm1.Cranium1.Cranium Theinnerandouterplatearedenseandthediploeisspongy.Theinneran
8、douterplatearedenseandthediploeisspongy. 2. 2.SkullsutureSkullsuture AllofthesuturesareshownassawtoothshadowAllofthesuturesareshownassawtoothshadow3.Convolutionalimpressions Multipleroundlowdensityinplainfilm.Multipleroundlowdensityinplainfilm.4.Theimpressionofthemiddlemeningealartery4.Theimpression
9、ofthemiddlemeningealartery TheimpresstionofthemiddlemeningealarteryispresentedasTheimpresstionofthemiddlemeningealarteryispresentedasstreaksshadowandgooutfromwidetonarrowstreaksshadowandgooutfromwidetonarrow5. 5. ImpressionImpressionofdofdiploicveiniploicvein7. 7.TheSella:TheSella:6. 6. Impressionof
10、pacchionianImpressionofpacchioniangranulationgranulation8.Internalauditorymeatus:8.Internalauditorymeatus:About6mmwide,symmetricalcanalAbout6mmwide,symmetricalcanalThefrontalparietalirregularhypodensitynearthemidline.Thefrontalparietalirregularhypodensitynearthemidline. Thediploicveinsimpressappears
11、asnetlikehypodensityintheThediploicveinsimpressappearsasnetlikehypodensityintheparietalregion.parietalregion. 716mmlong,714mmwideand820mmdeep.716mmlong,714mmwideand820mmdeep.10.calcificationoffalxcerebri:10.calcificationoffalxcerebri:9.9.CalcificationofCalcificationofpinealbody:pinealbody:11.Calcifi
12、cationofchoroidplexus11.Calcificationofchoroidplexus12Calcificationofpetro-clinoidligament:12Calcificationofpetro-clinoidligament:Itispresentedasnodularhyperdensityonthelateralskullradiograph.Itispresentedasnodularhyperdensityonthelateralskullradiograph.Thefrontalviewshowthenormalpositionarepresente
13、dtheThefrontalviewshowthenormalpositionarepresentedthezonarydenseimageonthemidline.zonarydenseimageonthemidline.CalcificationofchoroidplexusarepresentedtheanomalisticdenseCalcificationofchoroidplexusarepresentedtheanomalisticdenseimageandlateraltomidline.imageandlateraltomidline.Thedenseshadowbetwee
14、nintheanteriorandposteriorclinoidprocess.Thedenseshadowbetweenintheanteriorandposteriorclinoidprocess.1. 1.WWhitematter:hitematter:ishypodensetograymatter.CTvaluesisishypodensetograymatter.CTvaluesis20-30Hu20-30Hu2.Graymatter:2.Graymatter:ishyperdensetowhitematter.CTvaluesisishyperdensetowhitematter
15、.CTvaluesis30-40Hu30-40Hu 3.Ventricleandcistern:3.Ventricleandcistern:arehypodense.CTvaluesisarehypodense.CTvaluesis0-10Hu0-10Hu 4.Skull:4.Skull:ishyperdense.CTvaluesishyperdense.CTvalues250Hu250Hu5.Physiologicalcalcification:5.Physiologicalcalcification:Spotorpatchdenseshadow.CTvalues60Hu二、二、CTmani
16、festation三、三、MRImanifestation1.MorphologicalmanifestationAxial,coronal,sagittalMRIcanclearlyshowtheshapeofbrainandspinalcord,suchaswhitematter,greymatter,ventricle,cerebralfissure,brainstem,cerebralvessel,pituitarybody,etal.Theefficiencyisclosetogrossspecimen.T1WIT2WIT1WIT2WIWHITEMATTERHIGHLOWWHITEM
17、ATTERHIGHLOWGREYMATTERLOWHIGHGREYMATTERLOWHIGHCSFLOWHIGHCSFLOWHIGHFATHIGHMEDIUMFATHIGHMEDIUMSKULLTABLELOWLOWSKULLTABLELOWLOWDIPLOEHIGHLOWDIPLOEHIGHLOWMENINGESLOWLOWMENINGESLOWLOWVESSELLOWLOWVESSELLOWLOWCALCIFICATIONLOWLOWCALCIFICATIONLOWLOWMRIsignalintensityFrontallobePituitarybodyCentralsulcusPitui
18、tarystalkOpticchiasmGenuofcorpuscallosumMedullaoblongataClivusSphenoidsinusParietallobeThalamusOccipitallobeMamillarybodyQuadrigeminalbodyStraightsimus4thventricleCerebellartonsilGenuofcorpuscallosumFrontallobeSpleniumofcorpuscollosum3rdventricleThalamusHeadofcaudatenucleusGlobuspallidusOccipitallob
19、eOpticradiationsSeptumpellucidumPosteriorhornoflateralventricleAnteriorhornoflateralventricleInterventricularforamenParietooccipitalsulcusThalamusHeadofcaudatenucleusGlobuspallidusOccipitallobeOpticradiationsAnteriorhornoflateralventricleInterventricularforamen3rdventricleGenuofcorpuscallosumSeptump
20、ellucidumSpleniumofcorpuscollosumPosteriorhornoflateralventriclePosteriorlimbofinternalcapsuleGenuofinternalcapsuleAnteriorlimbofinternalcapsuleParietooccipitalsulcusParietallobeSuperiortemporalgyrusMiddletemporalgyrusPonsMedullaoblongataCerebralpeduncleCentrumsemiovale3rdventricleInferiortemporalgy
21、rusPetrousridgeoftemporalboneParahippocampalgyrusAnteriorhornoflateralventricleLateralfissureSuprasellarcisternPituitarybodyTemporallobeInerhemispericfissurecisternCorpuscallosumcaudatenucleusglobuspallidus,putamenOpticchiasmPituitarystalkCavernoussinusDSAmanifestationNormalcerebralartery(anterioran
22、dmiddlecerebralartery)graduallytaperoffwithsymmetricbranchesandsmoothmargin.Thearterieshaveinvariablelocationandcorrespondingbraintissue.Imageologicdiagnosisofthecommondisease（一）（一）BraintumorshavecommoncharacteristicinimageologicmanifestionGlioma,astrocytomaGlioma,astrocytomaMeningiomaMeningiomaPitu
23、itarytumorPituitarytumorAcousticneuromaAcousticneuromaMetastasistumorMetastasistumor1、X-raymanifestation、IncreaseofintracranialpressureIncreaseanddeepeningofconvolutionalimpressions,separationofsutures,thinningofbones.、TumorlocationsignDestructionofskull,enlargementofthesellar,displacementofcalcific
24、ation,dilationofInternalauditorymeatus,pathologicInternalauditorymeatus,pathologiccacificationcacification2、CTmanifestation、DensityabnormalityThetumorsareslightlyhypodensetoisodenseonplainscan.Thetumorsareslightlyhypodensetoisodenseonplainscan.、MasseffectDisplacementofmidline,compressionandobstructi
25、onofventricle,hydrocephalus.、EdemaHypodensityaroundtumor,moresevereinmalignanttumor. 、physiologicalcalcification:physiologicalcalcification:eg:IrregularcalcificationcanbeenseeninOligodendrogliomaeg:IrregularcalcificationcanbeenseeninOligodendroglioma、DestructionofboneDefectofbone,decreaseddenstiy,eg
26、:acousticneuroma、EnhancementIncreaseoftumordensity,thereisnoenhancementintheareaofnecrosisandedemaMRImanifestation、SignalabnormalityThetumorsareslightlyhypointensitytoisointensityonplainscanThetumorsareslightlyhypointensitytoisointensityonplainscan、MasseffectDisplacementofmidline,compressionandobstr
27、uctionofventricle,hydrocephalus、EdemaEdemaisaroundtumorwithlongT1andT2relaxingtimes. 、Physiologicalcalcification:Physiologicalcalcification:、Destructionofbone、EnhancementIncreaseoftumordensity,thereisnoenhancementintheareaofnecrosisandedemaT1andT2prolongationofboneareacanbeenneartumorsHypointensityi
28、nthetumoronT1WIandT2WIDSAmanifestation、MasseffectVesselsdisplacement,separation,gathering,bending,straightening、TumordyeingTumorswithsufficientbloodsupplycanbeenseen1.X-RAYPLAINFILMmanifestation（二）（二）CraniocerebralinjuryTofindthepresenceorabsenceofskullfractureandtoaccessthelocationandtypeoffracture
29、(linearfracture,comminutedfracture,depressedfracture)IntracranialinjurycannotbeenobservedCTmanifestation 、EpiduralhematomaEpiduralhematoma 、SubduralhematomaSubduralhematoma 、IntracerebralhematomaIntracerebralhematoma 、CerebralcontusionCerebralcontusionshowsalocalizedbiconvexhighdensityundertheinnert
30、ableGeneralizedperipheralhighdensityundertheinnertableRoundorirregularhyperdensityHaemorrhageandedemaareintercurrent,producingmotleydensityMRImanifestation 、ChronicepiduralhematomaChronicepiduralhematomaShowsalocalizedbiconvexhighintensityundertheinnertable 、ChronicsubduralhematomaChronicsubduralhem
31、atomaGeneralizedperipheralhighintensityundertheinnertable 、ChronicintracerebralhematomaChronicintracerebralhematomaChronichematomaproducingirregularhyperintensitywithringsign.（三）（三）Vasculardiseases 1 1、IntracranialaneurysmIntracranialaneurysmDSACTMRIDemonstrateroundedhighdensitylinktorelativearteryw
32、ithirregularsizeandsmoothmarginShowsroundedflowvoidwithsmoothmarginonT1WIandT2WIDisplaysisodensityonplainscanandroundedhyperdensityonCECT2、Intracranialvascularmalformation（Arteriovenousmalformation）DSACTMRIVeinearlyemerging,malformednidus,narrowingoffeedingartery,dilateddrainingvein.Malformedvascula
33、rnidusproducingracemoseflowvoidwithnarrowingoffeedingartery,dilateddrainingvein.DisplaysisodensityonplainscanandroundedhyperdensemalformedvascularnidusonCECT3、cerebralinfarctionMRIIschemicinfarctionproducingsectororirregularshapewithT1andT2prolongation.Masseffectcanbeenseeninextensivecases.cerebrall
34、acunahavebeenidentifiedasinfarctionslessthan1cm.CTIschemicinfarctionproducingsectororirregularhypodensitywithblurredmargin.cerebrallacunasarenoteasytofind.四、InfectiousdiseasesSuppurativeinfection:Tuberculousinfection：Viralinfection：Patasiticinfection：Encephalitis,Brainabscess,MeningitisMeningitis,Tu
35、berculomaEncephalitis,MeningitisCysticercosis,Schistosomiasis1、BrainabscessCT:Plainscanshowsroundhypodensitywithringlikeperipheralisodensityandedema.Thereisringenhancementoftheuniformthickabscesswall.Thecentralhyodenseareainthecavitydosenotchangeinenhancement.MRI：TheabscesshavelongT1andT2relaxationt
36、imeswithsurroundingedema.Thereisringenhancementoftheuniformthickabscesswall.Theabscesscavityhavenotenhancement.2、cerebralcysticercosisLarvalofTaeniasoliumparasitizeinbrain.Cerebrallarvalinfestationischaracterizedbyafluid-filledcystwithamuralsoft-tissuenodule.thediseasecanbeenclassifiedaslarvalliving
37、stage,larvaldeathstage,calcificationstage.Multiplespotlikehigh-densitywithsimilarsizeinbrain.Multiplespotlikehigh-densitywithsimilarsizeinbrain.CT:CT:MRI:MRI:Accompaniedbyedema,themultiplecystswithAccompaniedbyedema,themultiplecystswithlongT1andT2signalarenomorethan1cminlongT1andT2signalarenomoretha
38、n1cmindiameter,diameter,larvallivingstage:larvallivingstage:Thelow-densitycystsoccuringroupswithspotlikeThelow-densitycystsoccuringroupswithspotlikemuralnodule.muralnodule.Calcificationstage:Calcificationstage:二二.NormalmanifestationExaminationofspinalcord一、一、ExaminationmethodMRICTMyelographyX-rayCTM
39、yelographyX-rayspinalcanal:11mmlong,16mmwide,Spinalcord:columniform,smoothmargin,homogeneous三、三、三、三、Intramedullary tumor are predominantly Intramedullary tumor are predominantly Intramedullary tumor are predominantly Intramedullary tumor are predominantly ependymoma and astrocytoma.(about 90% of all
40、 ependymoma and astrocytoma.(about 90% of all ependymoma and astrocytoma.(about 90% of all ependymoma and astrocytoma.(about 90% of all intraspinal tumors)intraspinal tumors)intraspinal tumors)intraspinal tumors)TheoutlineofMRIdiagnosis1.thespinalcordisenlargedandthelesionisextensive2.Thesubarachnoi
41、dspacearoundthespinalcordisnarrowedorblocked3.secondarysyringohydromyelia4.ThetumorsareslightlyhypointenseonT1andslightlyhyperintenseonT2.Enhancementcanbeenseen.4 4、Extramedullary intradural tumorExtramedullary intradural tumorwhichiscomposedprincipallyofmeningiomasandnervesheathtumorsTheoutlineofMR
42、Idiagnosis1.spinalcorddisplacementtothecontralateralside2.Thesubarachnoidspaceonthesideofthetumorisdilated3.Thetumorislocalizationwithclearmargin4.ThetumorisisointensityonbothT1andT2withobviousenhancement.五、五、Extramedullary extradural tumorExtramedullary extradural tumorMalignantlymphomaandmetastasi
43、sisusuallyobservedTheoutlineofMRIdiagnosis4.slighthypointensityonT1andslighthyperintensityonT2,enhancementcanbeenseen.3.spinalcorddisplacementtothecontralateralsideandnarrowsubarachnoidspaceonthesideofthetumor2.Duraisshownashypointensitybetweenthetumorandspinalcord.1.Thetumorsareflatandextendtoalarg
44、earea.六、六、Spinal cord injurySpinal cord injuryTheoutlineofMRIdiagnosis1.spinalcordedema:hypointensityonT1andhyperintensituonT22.Spinalcordhemorrhage:Thesignalsevolvementwerethesamewithintracerebralhematoma.3.Spinalcordtransectioninjury:thespinalcordsignalsareinterrupted.4.Spinalcordintenerate:hypoin
45、tensityonT1andhyperintensituonT2ThevertebralcolumnandspinalcordinjuryTheinjuryconsistsoffractureofvertebralbodyandappurtenance,spinalcordconcussion,spinalcordcontusionspinalcordcompression,spinalcordtransverseinjuryandhematoma，nervenerverootsavulsion,rootsavulsion,spinalcordintenerateandsoon.MRIisthefirstofchoice.谢谢
