膠質(zhì)瘤鑒別診斷課件

膠質(zhì)瘤影像診斷及鑒別診斷大連醫(yī)科大學(xué)第一附屬醫(yī)院郎志謹(jǐn)膠質(zhì)瘤影像診斷及1膠質(zhì)瘤:是腦部常見的腫瘤可分為:星形細(xì)胞瘤,少枝膠質(zhì)細(xì)胞瘤,室管膜瘤,混合性膠質(zhì)細(xì)胞瘤,大腦膠質(zhì)瘤病等他們的影像學(xué)表現(xiàn)是多種多樣的現(xiàn)將分述如下大連醫(yī)科大學(xué)附屬第一醫(yī)院膠質(zhì)瘤:是腦部常見的腫瘤2星形細(xì)胞瘤(Astrocytoma)(一)分類1993年WHO公布新的腦腫瘤組織學(xué)分類(HistologicalClassificationofTumoroftheCentralNervousSystemEdIm)°星形細(xì)胞瘤(Astrocytoma)分為:局限型:I級彌漫型:II-IV級大連醫(yī)科大學(xué)附屬第一醫(yī)院星形細(xì)胞瘤(Astrocytoma)3星形細(xì)胞腫瘤(Astrocytoma)分類級別名稱局限型,良性,如毛細(xì)胞型星形細(xì)胞瘤等;級級級星形細(xì)胞瘤,廣泛浸潤,但分化良好間變性惡性星形細(xì)胞瘤,局限或彌漫性間變,細(xì)胞數(shù)增多.非典型性及核分裂活躍,屬惡性;IV級多形性膠質(zhì)母細(xì)胞瘤,除有三級特征外,尚伴有明顯壞死大連醫(yī)科大學(xué)附屬第一醫(yī)院星形細(xì)胞腫瘤(Astrocytoma)分類4兩種分級法對比WHO新分級法舊分級法I毛細(xì)胞型星形細(xì)胞瘤II星形細(xì)胞瘤(低級)11級(1-II級)IIl間變性星形細(xì)胞瘤Il級(IIl級)IV多形性膠質(zhì)母細(xì)胞瘤IV級大連醫(yī)科大學(xué)附屬第一醫(yī)院兩種分級法對比5(二)星形細(xì)胞瘤病理改變病理:纖維細(xì)胞型、原漿細(xì)胞型、胖細(xì)胞型局限型邊界清楚,含水量高;彌漫型呈浸潤性生長,邊界不清大連醫(yī)科大學(xué)附屬第一醫(yī)院(二)星形細(xì)胞瘤病理改變6三)星形細(xì)胞瘤的影像學(xué)表現(xiàn)6毛細(xì)胞型星形細(xì)胞瘤(/WH0)是一種星形細(xì)胞瘤的特殊類型,以青少年為多,占兒童膠質(zhì)瘤的30%。腫瘤邊界清楚,細(xì)胞伴有致密的纖維組織,腫瘤細(xì)胞形成致密的平行束,腫瘤含有長形的單級或雙級細(xì)胞,血管貧乏,可形成單或多囊。大連醫(yī)科大學(xué)附屬第一醫(yī)院三)星形細(xì)胞瘤的影像學(xué)表現(xiàn)7CT、MR表現(xiàn)局限型級星形細(xì)胞瘤:占5-10%多見于后顱凹,毛細(xì)胞型:兒童多見CT:85%為邊緣清楚囊性病變,20-25Hu鈣化10%;+c:可不增強(qiáng)MRI:TW:低或等信號;TWI:高信號Gd-DTPA增強(qiáng),不均勻增強(qiáng),增強(qiáng)明顯,可見結(jié)節(jié)狀增強(qiáng),大腦皮層者呈實(shí)質(zhì)性或多囊性,增強(qiáng)后可見厚壁環(huán)及結(jié)節(jié)。大連醫(yī)科大學(xué)附屬第一醫(yī)院CT、MR表現(xiàn)8s105orP57.0+CUNIVERSITYISTP1152/2NEXp113大連醫(yī)科大學(xué)附屬第一醫(yī)s1059大連醫(yī)科大學(xué)附屬第一醫(yī)院大連醫(yī)科大學(xué)附屬第一醫(yī)院10膠質(zhì)瘤鑒別診斷課件11膠質(zhì)瘤鑒別診斷課件12膠質(zhì)瘤鑒別診斷課件13膠質(zhì)瘤鑒別診斷課件14膠質(zhì)瘤鑒別診斷課件15膠質(zhì)瘤鑒別診斷課件16膠質(zhì)瘤鑒別診斷課件17膠質(zhì)瘤鑒別診斷課件18膠質(zhì)瘤鑒別診斷課件19膠質(zhì)瘤鑒別診斷課件20膠質(zhì)瘤鑒別診斷課件21膠質(zhì)瘤鑒別診斷課件22膠質(zhì)瘤鑒別診斷課件23膠質(zhì)瘤鑒別診斷課件24膠質(zhì)瘤鑒別診斷課件25膠質(zhì)瘤鑒別診斷課件26膠質(zhì)瘤鑒別診斷課件27膠質(zhì)瘤鑒別診斷課件28膠質(zhì)瘤鑒別診斷課件29膠質(zhì)瘤鑒別診斷課件30膠質(zhì)瘤鑒別診斷課件31膠質(zhì)瘤鑒別診斷課件32膠質(zhì)瘤鑒別診斷課件33膠質(zhì)瘤鑒別診斷課件34膠質(zhì)瘤鑒別診斷課件35膠質(zhì)瘤鑒別診斷課件36膠質(zhì)瘤鑒別診斷課件37膠質(zhì)瘤鑒別診斷課件38膠質(zhì)瘤鑒別診斷課件39膠質(zhì)瘤鑒別診斷課件40膠質(zhì)瘤鑒別診斷課件41膠質(zhì)瘤鑒別診斷課件42膠質(zhì)瘤鑒別診斷課件43膠質(zhì)瘤鑒別診斷課件44膠質(zhì)瘤鑒別診斷課件45膠質(zhì)瘤鑒別診斷課件46膠質(zhì)瘤鑒別診斷課件47膠質(zhì)瘤鑒別診斷課件48膠質(zhì)瘤鑒別診斷課件49膠質(zhì)瘤鑒別診斷課件50膠質(zhì)瘤鑒別診斷課件51膠質(zhì)瘤鑒別診斷課件52膠質(zhì)瘤鑒別診斷課件53膠質(zhì)瘤鑒別診斷課件54膠質(zhì)瘤鑒別診斷課件55膠質(zhì)瘤鑒別診斷課件56膠質(zhì)瘤鑒別診斷課件57膠質(zhì)瘤鑒別診斷課件58膠質(zhì)瘤鑒別診斷課件59膠質(zhì)瘤鑒別診斷課件60膠質(zhì)瘤鑒別診斷課件61膠質(zhì)瘤鑒別診斷課件62膠質(zhì)瘤鑒別診斷課件63膠質(zhì)瘤鑒別診斷課件64膠質(zhì)瘤鑒別診斷課件65膠質(zhì)瘤鑒別診斷課件66膠質(zhì)瘤鑒別診斷課件67膠質(zhì)瘤鑒別診斷課件68膠質(zhì)瘤鑒別診斷課件69膠質(zhì)瘤鑒別診斷課件70膠質(zhì)瘤鑒別診斷課件71膠質(zhì)瘤鑒別診斷課件72膠質(zhì)瘤鑒別診斷課件73膠質(zhì)瘤鑒別診斷課件74膠質(zhì)瘤鑒別診斷課件75膠質(zhì)瘤鑒別診斷課件76膠質(zhì)瘤鑒別診斷課件77膠質(zhì)瘤鑒別診斷課件78膠質(zhì)瘤鑒別診斷課件79膠質(zhì)瘤鑒別診斷課件80膠質(zhì)瘤鑒別診斷課件81膠質(zhì)瘤鑒別診斷課件82膠質(zhì)瘤鑒別診斷課件83膠質(zhì)瘤鑒別診斷課件84膠質(zhì)瘤鑒別診斷課件85膠質(zhì)瘤鑒別診斷課件86膠質(zhì)瘤鑒別診斷課件87膠質(zhì)瘤鑒別診斷課件88膠質(zhì)瘤鑒別診斷課件89膠質(zhì)瘤鑒別診斷課件90膠質(zhì)瘤鑒別診斷課件91膠質(zhì)瘤鑒別診斷課件92膠質(zhì)瘤鑒別診斷課件93膠質(zhì)瘤鑒別診斷課件94膠質(zhì)瘤鑒別診斷課件95膠質(zhì)瘤鑒別診斷課件96膠質(zhì)瘤鑒別診斷課件97膠質(zhì)瘤鑒別診斷課件98膠質(zhì)瘤鑒別診斷課件99膠質(zhì)瘤鑒別診斷課件100膠質(zhì)瘤鑒別診斷課件101膠質(zhì)瘤鑒別診斷課件102膠質(zhì)瘤鑒別診斷課件103膠質(zhì)瘤鑒別診斷課件104膠質(zhì)瘤鑒別診斷課件105膠質(zhì)瘤鑒別診斷課件106膠質(zhì)瘤影像診斷及鑒別診斷大連醫(yī)科大學(xué)第一附屬醫(yī)院郎志謹(jǐn)膠質(zhì)瘤影像診斷及107膠質(zhì)瘤:是腦部常見的腫瘤可分為:星形細(xì)胞瘤,少枝膠質(zhì)細(xì)胞瘤,室管膜瘤,混合性膠質(zhì)細(xì)胞瘤,大腦膠質(zhì)瘤病等他們的影像學(xué)表現(xiàn)是多種多樣的現(xiàn)將分述如下大連醫(yī)科大學(xué)附屬第一醫(yī)院膠質(zhì)瘤:是腦部常見的腫瘤108星形細(xì)胞瘤(Astrocytoma)(一)分類1993年WHO公布新的腦腫瘤組織學(xué)分類(HistologicalClassificationofTumoroftheCentralNervousSystemEdIm)°星形細(xì)胞瘤(Astrocytoma)分為:局限型:I級彌漫型:II-IV級大連醫(yī)科大學(xué)附屬第一醫(yī)院星形細(xì)胞瘤(Astrocytoma)109星形細(xì)胞腫瘤(Astrocytoma)分類級別名稱局限型,良性,如毛細(xì)胞型星形細(xì)胞瘤等;級級級星形細(xì)胞瘤,廣泛浸潤,但分化良好間變性惡性星形細(xì)胞瘤,局限或彌漫性間變,細(xì)胞數(shù)增多.非典型性及核分裂活躍,屬惡性;IV級多形性膠質(zhì)母細(xì)胞瘤,除有三級特征外,尚伴有明顯壞死大連醫(yī)科大學(xué)附屬第一醫(yī)院星形細(xì)胞腫瘤(Astrocytoma)分類110兩種分級法對比WHO新分級法舊分級法I毛細(xì)胞型星形細(xì)胞瘤II星形細(xì)胞瘤(低級)11級(1-II級)IIl間變性星形細(xì)胞瘤Il級(IIl級)IV多形性膠質(zhì)母細(xì)胞瘤IV級大連醫(yī)科大學(xué)附屬第一醫(yī)院兩種分級法對比111(二)星形細(xì)胞瘤病理改變病理:纖維細(xì)胞型、原漿細(xì)胞型、胖細(xì)胞型局限型邊界清楚,含水量高;彌漫型呈浸潤性生長,邊界不清大連醫(yī)科大學(xué)附屬第一醫(yī)院(二)星形細(xì)胞瘤病理改變112三)星形細(xì)胞瘤的影像學(xué)表現(xiàn)6毛細(xì)胞型星形細(xì)胞瘤(/WH0)是一種星形細(xì)胞瘤的特殊類型,以青少年為多,占兒童膠質(zhì)瘤的30%。腫瘤邊界清楚,細(xì)胞伴有致密的纖維組織,腫瘤細(xì)胞形成致密的平行束,腫瘤含有長形的單級或雙級細(xì)胞,血管貧乏,可形成單或多囊。大連醫(yī)科大學(xué)附屬第一醫(yī)院三)星形細(xì)胞瘤的影像學(xué)表現(xiàn)113CT、MR表現(xiàn)局限型級星形細(xì)胞瘤:占5-10%多見于后顱凹,毛細(xì)胞型:兒童多見CT:85%為邊緣清楚囊性病變,20-25Hu鈣化10%;+c:可不增強(qiáng)MRI:TW:低或等信號;TWI:高信號Gd-DTPA增強(qiáng),不均勻增強(qiáng),增強(qiáng)明顯,可見結(jié)節(jié)狀增強(qiáng),大腦皮層者呈實(shí)質(zhì)性或多囊性,增強(qiáng)后可見厚壁環(huán)及結(jié)節(jié)。大連醫(yī)科大學(xué)附屬第一醫(yī)院CT、MR表現(xiàn)114s105orP57.0+CUNIVERSITYISTP1152/2NEXp113大連醫(yī)科大學(xué)附屬第一醫(yī)s105115大連醫(yī)科大學(xué)附屬第一醫(yī)院大連醫(yī)科大學(xué)附屬第一醫(yī)院116膠質(zhì)瘤鑒別診斷課件117膠質(zhì)瘤鑒別診斷課件118膠質(zhì)瘤鑒別診斷課件119膠質(zhì)瘤鑒別診斷課件120膠質(zhì)瘤鑒別診斷課件121膠質(zhì)瘤鑒別診斷課件122膠質(zhì)瘤鑒別診斷課件123膠質(zhì)瘤鑒別診斷課件124膠質(zhì)瘤鑒別診斷課件125膠質(zhì)瘤鑒別診斷課件126膠質(zhì)瘤鑒別診斷課件127膠質(zhì)瘤鑒別診斷課件128膠質(zhì)瘤鑒別診斷課件129膠質(zhì)瘤鑒別診斷課件130膠質(zhì)瘤鑒別診斷課件131膠質(zhì)瘤鑒別診斷課件132膠質(zhì)瘤鑒別診斷課件133膠質(zhì)瘤鑒別診斷課件134膠質(zhì)瘤鑒別診斷課件135膠質(zhì)瘤鑒別診斷課件136膠質(zhì)瘤鑒別診斷課件137膠質(zhì)瘤鑒別診斷課件138膠質(zhì)瘤鑒別診斷課件139膠質(zhì)瘤鑒別診斷課件140膠質(zhì)瘤鑒別診斷課件141膠質(zhì)瘤鑒別診斷課件142膠質(zhì)瘤鑒別診斷課件143膠質(zhì)瘤鑒別診斷課件144膠質(zhì)瘤鑒別診斷課件145膠質(zhì)瘤鑒別診斷課件146膠質(zhì)瘤鑒別診斷課件147膠質(zhì)瘤鑒別診斷課件148膠質(zhì)瘤鑒別診斷課件149膠質(zhì)瘤鑒別診斷課件150膠質(zhì)瘤鑒別診斷課件151膠質(zhì)瘤鑒別診斷課件152膠質(zhì)瘤鑒別診斷課件153膠質(zhì)瘤鑒別診斷課件154膠質(zhì)瘤鑒別診斷課件155膠質(zhì)瘤鑒別診斷課件156膠質(zhì)瘤鑒別診斷課件157膠質(zhì)瘤鑒別診斷課件158膠質(zhì)瘤鑒別診斷課件159膠質(zhì)瘤鑒別診斷課件160膠質(zhì)瘤鑒別診斷課件161膠質(zhì)瘤鑒別診斷課件162膠質(zhì)瘤鑒別診斷課件163膠質(zhì)瘤鑒別診斷課件164膠質(zhì)瘤鑒別診斷課件165膠質(zhì)瘤鑒別診斷課件166膠質(zhì)瘤鑒別診斷課件167膠質(zhì)瘤鑒別診斷課件168膠質(zhì)瘤鑒別診斷課件169膠質(zhì)瘤鑒別診斷課件170膠質(zhì)瘤鑒別診斷課件171膠質(zhì)瘤鑒別診斷課件172膠質(zhì)瘤鑒別診斷課件173膠質(zhì)瘤鑒別診斷課件174膠質(zhì)瘤鑒別診斷課件175膠質(zhì)瘤鑒別診斷課件176膠質(zhì)瘤鑒別診斷課件177膠質(zhì)瘤鑒別診斷課件178膠質(zhì)瘤鑒別診斷課件179膠質(zhì)瘤鑒別診斷課件180膠質(zhì)瘤鑒別診斷課件181膠質(zhì)瘤鑒別診斷課件182膠質(zhì)瘤鑒別診斷課件183膠質(zhì)瘤鑒別診斷課件184膠質(zhì)瘤鑒別診斷課件185膠質(zhì)瘤鑒別診斷課件186膠質(zhì)瘤鑒別診斷課件187膠質(zhì)瘤鑒別診斷課件188膠質(zhì)瘤鑒別診斷課件189膠質(zhì)瘤鑒別診斷課件190膠質(zhì)瘤鑒別診斷課件191膠質(zhì)瘤鑒別診斷課件192膠質(zhì)瘤鑒別診斷課件193膠質(zhì)瘤鑒別診斷課件194膠質(zhì)瘤鑒