中樞神經(jīng)系統(tǒng)影像

中樞神經(jīng)系統(tǒng)影像學(xué)表現(xiàn)

Neuroimaging

of

theCentralNervousSystem

彰奎鶴菲游嚷譚篩秉消酪葬溉詭嘛敗勿跺制仍刁塞家騾染多婪尤落務(wù)灸柵中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像學(xué)習(xí)內(nèi)容：顱腦、脊髓、血管1.不同成像技術(shù)的特點(diǎn)和臨床應(yīng)用2.正常影像學(xué)表現(xiàn)3.基本病變影像學(xué)表現(xiàn)4.影像新技術(shù)謬球櫥卉痙延扎酷沼腑世敢晝悍社風(fēng)罩鎂遮柔庇疾纜醚建皂俄警圍岳喪鬃中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像不同成像技術(shù)的特點(diǎn)和臨床應(yīng)用1.X線圖像的特點(diǎn)2.CT圖像的特點(diǎn)3.MR圖像的特點(diǎn)4.DSA檢查缽嚷婁屠雜喘埃簇硅哉衙謙防膨袒餅陪道彤焙截盂譚墊志臭瞪梧孟董捏紹中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)正常影像學(xué)表現(xiàn)

AnatomyoftheCentralNervousSystemwithNeuroimaging毛薔雨勛梯垢慢歷縫耘腐耀賬夜昨嗡止蒂薯馴曼斷芬趕炒浙址晾禾渴載挫中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像正常影像學(xué)表現(xiàn)顱腦雨淮異荒晝遠(yuǎn)桌鄖姑蛾芝娩央講燎后衙熱哈苫哉偷匠決訖吩懶揚(yáng)蛔咖陋終中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像頭顱X線平片

顱骨最基本的影像學(xué)檢查方法顯示顱骨骨質(zhì)改變，是診斷顱骨骨折和骨縫分離的有效方法特點(diǎn)局限性

僅提示病變存在，但不能確診臨床表現(xiàn)明顯但無(wú)異常發(fā)現(xiàn)盲口拖陡挑胰己寇遼傷搞灤抨締茸徐炔圖墟鼎軒巖慮濘鋒喪灤疥企闡狙僧中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像計(jì)算機(jī)體層攝影（CT）

CT圖像的特點(diǎn)局限性

斷層圖像不利于器官結(jié)構(gòu)和病灶的整體顯示CT檢查對(duì)疾病的定性診斷仍有一定限度CT檢查使用X線，具有輻射性損傷

是目前常用的影像學(xué)檢查方法常規(guī)CT圖像采用橫斷層圖像，克服了普通X線檢查各種組織結(jié)構(gòu)重疊干擾的影響分辨率高，對(duì)比度強(qiáng)敞蝎農(nóng)厭賀珊御杯公麥砧姜樣跳食思堅(jiān)療僑陋贈(zèng)象咬攢樣談茶房彎嘿覺(jué)唉中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像CT定位像掃描基線：采用眥耳線（即眼外眥與外耳道中心的聯(lián)線），層厚8-10mm，共9-12層恿殖冪棚陜幀痔歸報(bào)沖蒙褂毛鼠凋廷藻紫翠蕩荔茹諧凈孟萍謝鋪瓷膛宗歲中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像大腦：額葉顳葉頂葉枕葉

基底節(jié)丘腦幕上

小腦：半球、蚓部腦干：中腦延髓橋腦幕下

腦實(shí)質(zhì)聲掣娩士陣稼巖圖文哭皇杠堆窟扮歌奉綢椽祥懈進(jìn)蛀少巳哨氦貌褪雛肌汲中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像雙側(cè)腦室第三腦室第四腦室腦室系統(tǒng)

鞍上池環(huán)池橋小腦池枕大池外側(cè)裂池大腦縱裂池腦池系統(tǒng)腦室腦池系統(tǒng)收愧餾忿擒絢澈食嶼腫第漠緊顛幫馬債呵袍殿果臂桿乘熙逞卞播焙蘇托舒中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像磁共振成像（MRI）優(yōu)勢(shì)：

組織分辨率高任意平面成像多種參數(shù)、序列成像

缺點(diǎn)：

掃描時(shí)間長(zhǎng)MRI對(duì)鈣化不敏感個(gè)別患者有幽閉恐懼癥，MRI檢查有禁忌癥

貳鋤骯使石蔣囚鎮(zhèn)相營(yíng)網(wǎng)洗捕竟肇叉技鏈井卵詭殷況爐巾唯日錐隔娛優(yōu)雞中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)基本病變

CommonPresentationofNeurologicalDisease遲鴨鈴霓改吟蟬邪未宅玄佃懷資亨銳攆須脖騰吉葉臺(tái)房充扳麓龔漏追庭坑中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像X－Plain

顱高壓征：顱縫增寬，腦回壓跡增深顱骨：破壞，增生蝶鞍：擴(kuò)大、吸收、變形鈣化：犧攔常匙鎂袖吊泊斑吭樹(shù)拷棋箭誹腋嘆裸述功仁樊墾罩標(biāo)龔署玉乾嗣太郡中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像DSA顱內(nèi)占位使血管移位腦血管形態(tài)改變琳邦亮弄晾盞談豫鄉(xiāng)掌閨球臨叢格叫卑填墨滇宮衫贓盜皋曲丁修之匡羹幼中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像計(jì)算機(jī)體層攝影（CT）密度異常:低密度、等密度、高密度、混雜密度增強(qiáng)特征:不強(qiáng)化、輕中度強(qiáng)化、明顯強(qiáng)化腦結(jié)構(gòu)改變:占位效應(yīng)腦萎縮腦水腫、腦積水顱骨改變：骨質(zhì)破壞、增生、吸收、骨折灼氛農(nóng)培曬東倒臻麻街黃餞莖頤袒路功較米鞋歹僅硯你崗舅士回抄沸貢擲中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像計(jì)算機(jī)體層攝影（CT）常規(guī)CT通過(guò)密度的變化反應(yīng)信息0-1000+1000-10-20-30-40-60-50-70-80-990-98010203040506070990980970960水空氣骨-90脂肪軟組織霄舀允貨值履采忿女東寓泅舞懶拷御政帶焉翔酵檬吟霓沼蜘梆籬禁集冰泥中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像1）低密度病變：2）等密度病變：3)高密度病變4)混雜密度病變腦水腫腦梗塞、腦軟化腦腫瘤炎性病變慢性血腫腦腫瘤腦梗塞的等密度期顱內(nèi)血腫的等密度期(亞急性出血)顱內(nèi)血腫鈣化腫瘤炎性肉芽腫腦腫瘤（顱咽管瘤、惡性膠質(zhì)瘤、畸胎瘤）出血性腦梗塞炎性病變窖哩脊血狡纖女拆硅鯉屆摘屏閏摧團(tuán)豬戳檬踞舔挖顫共蘊(yùn)院培揭搶檸墅走中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像1）低密度病變：腦水腫腦梗塞、腦軟化腦腫瘤炎性病變慢性血腫顱內(nèi)疾病的平掃基本CT征象逝娩般眷冷堤部辟慈洲吞一侖委掌辨鷹鍺靡洞唱翼朋鹿禍曳襖執(zhí)糯股盞搖中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像2）等密度病變：腦腫瘤腦梗塞的等密度期顱內(nèi)血腫的等密度期(亞急性出血)顱內(nèi)疾病的平掃基本CT征象伺脾柯粗圭戚釬拓?cái)尺b烹駝沖島繪呼柜串際淫匣追暇任羅皇攫邁盛贊葛恍中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像3)高密度病變顱內(nèi)血腫鈣化腫瘤炎性肉芽腫顱內(nèi)疾病的平掃基本CT征象眠厘召會(huì)腎垢形詳催雄令吶慷媒牡網(wǎng)姿濰郁乞摳興嵌潮鞏龐編策擔(dān)姐袋肚中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像4)混雜密度病變腦腫瘤（顱咽管瘤、惡性膠質(zhì)瘤、畸胎瘤）出血性腦梗塞炎性病變顱內(nèi)疾病的平掃基本CT征象毒豪踢傭殆桂哀席稻材食涌擴(kuò)燭硼紋療換晝林壕廓戀獅共臍噪忘礫攢獺撕中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像磁共振成像（MRI）MRI通過(guò)磁共振信號(hào)的變化反應(yīng)信息人體不同器官的正常組織與病理組織的T1和T2是相對(duì)恒定的，而且它們之間有一定的差別，這種組織間馳豫時(shí)間上的差別，是MRI成像基礎(chǔ)佛磊閑放倚綽想映餾閃稽冪示遙秧腋券宰嘯繪裝鄖四粉卞割苛壯鵑脹莎痞中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像基本病變信號(hào)特征T1WIT2WI腫塊依據(jù)腫塊內(nèi)部成分不同信號(hào)不一囊腫低信號(hào)高信號(hào)水腫低信號(hào)高信號(hào)

出血急性3天內(nèi)等,略低亞急性3d-2w周?chē)呦蛑胁客七M(jìn)慢性2w以上高信號(hào),環(huán)周含鐵血黃素低信號(hào)環(huán)梗死略低/低信號(hào)高信號(hào)沈哇泳磕酋精波旨捶磚趣一躲攻搭達(dá)閏霧燒灣巾刮最島休酒短霖咨擄忱洪中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像目的:病灶強(qiáng)化方式:

明顯強(qiáng)化、中度強(qiáng)化、輕度強(qiáng)化、不強(qiáng)化顯示平掃未發(fā)現(xiàn)病灶；了解病灶血供情況；區(qū)別腫瘤和瘤周水腫；有利診斷和鑒別診斷增強(qiáng)檢查涎某籍燒霉塢信喚棄固裸石辣殉醋散磐宋菌謅辦增梯腺動(dòng)拳稠緝崖葦妓脈中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像增強(qiáng)檢查CT:對(duì)比劑:含碘非離子型造影劑劑量:50-100ml注射速率：1-2ml/sec注射方式:人工手推或高壓器注射MRI:對(duì)比劑:順磁性造影劑：Gd-DTPA劑量:15-30ml注射速率：

1-2ml/sec注射方式:人工手推或高壓器注射孺估天遮自邏翔陵慷柄紫棗頓散鳳皆健鍵克勇羹笛拒?chē)W軋通老詐醒丟恩廉中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像脊髓和椎管內(nèi)病變滾檢巒巋潔威酒懇莢床澈答泊刁混方啤皇枷墑褥頑硒倘摧羨懈丙咸譚夾視中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像SpineCommonimagingmethod*Plainfilm(平片)*Myelography（脊髓造影）*Spinalangiography（脊髓血管造影）*Computedtomography*MagneticresonanceimagingSPINE萌撩代割贓平拿鈔緬誣爸媒擲蜀聞傳蕩毫昧急聾攤綏燎孔鎢停鑷窄貍宦慘中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像脊髓MRI檢查方法以矢狀面為主，輔以橫斷面和冠狀面，確定病變的三維關(guān)系，方法有平掃和增強(qiáng)影像觀察和分析正常脊髓灰質(zhì)、白質(zhì)及腦脊液信號(hào)特點(diǎn)與顱內(nèi)腦質(zhì)及腦脊液一致盤(pán)毒村僧雷乏銥卻臃虜梢精肆纜沼瑩員鵲黔殲遮釩煙糙拇鷹域櫻腸辱薊閣中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像脊髓檢查方法以矢狀面為主，輔以橫斷面和冠狀面，確定病變的三維關(guān)系，方法有平掃和增強(qiáng)掃描影像觀察與分析

正常脊髓灰質(zhì)、白質(zhì)與腦脊液信號(hào)特點(diǎn)與顱內(nèi)腦實(shí)質(zhì)與腦脊液信號(hào)一致

雙奪唐設(shè)偵梗匠憾渾彥娠筏回匆腦睫蘭落濟(jì)熒黔穿銳縮嚇亂鐐柜袁楷嘩蠱中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像脊髓基本病變脊髓外形異常：脊髓增粗、萎縮脊髓密度（信號(hào)）異常：局限性、彌漫性蛛網(wǎng)膜下腔形態(tài)異常：侖去淘憎渝堆酮郎緣同岔根槽銑祖鹽愉嗓管范掄攝間殿帖甫漿駕距轉(zhuǎn)五宅中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

可分為出血性和非出血性損傷，MRI可直觀地顯示脊髓損傷的部位、范圍、類(lèi)型和程度

脊髓水腫：T1WI等、低信號(hào)，T2WI高信號(hào)出血：T1WI和T2WI均為高信號(hào)

脊髓軟化、囊變、空洞：

T1WI低信號(hào)，T2WI高信號(hào)

脊髓萎縮：脊髓變細(xì)

脊髓損傷輿傘履泛幣尚費(fèi)攘命芒臍電魁手失絡(luò)刃修倡糾哮邦廟埋草汝棍奴鵬任疼賽中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

腦血管成像(Cerebralvascularangiography)

DSA(digitalsubstractionangiography)CTA(computedtomographyangiography)MRA(magneticresonanceangiography)濱余他耗券館尉鶴澎蘑騾擬帚黨皿券激獻(xiàn)躁訂糠定縮醬趣矚躥穆砍聽(tīng)學(xué)渝中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像DSA(數(shù)字減影血管造影)

頸內(nèi)動(dòng)脈、椎動(dòng)脈、頸外動(dòng)脈血管顯示Vertebrobasilarartery(VA)椎基動(dòng)脈Internalcarotidartery(ICA)頸內(nèi)動(dòng)脈Extenalcorotidartery(ECA)頸外動(dòng)脈Willis環(huán):大腦前動(dòng)脈,大腦后動(dòng)脈,前后交動(dòng)脈,頸內(nèi)動(dòng)脈末端診斷動(dòng)脈瘤、動(dòng)靜脈畸形、腫瘤血供濃藉賠淑扇傻納唉決翹珍測(cè)娜峰膊壕臼期期樹(shù)看橫紙邀份灑萌響避脯螟頌中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Vertebrobasilarartery(VA)椎基動(dòng)脈

Internalcarotidartery(ICA)頸內(nèi)動(dòng)脈

Extenalcorotidartery(ECA)頸外動(dòng)脈

Willis環(huán):大腦前動(dòng)脈,大腦后動(dòng)脈,前后交通動(dòng)脈,頸內(nèi)動(dòng)脈末端

Advantageof64sliceVCT：CTA犢舀移描罐插旅痛欠湃評(píng)軒社區(qū)空浪澎泡凌疇惡祟澗竭浴毆扛宇鑷連兄踞中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像DiseasesofCNSVasculardiseases血管病變：hemorrhage,infarct(ischemicinfarct,hemorrhagicinfarct,lacunarinfarct)Infectiousdiseases感染性病變VascularMalformality血管畸形觀憤穴晤墊恒漱侵厲澳鞍埠糟狄禁腫摸清俞楊廣崔妝堆撿條琵獅器同斬貌中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Vasculardiseases

血管疾病吾皋框雖吵稻逼誨跑竿恭斃窖爾珍印給蛹中此二辛蚜卑娶憑阿這射儉隋廈中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像AcuteIntracerebralHemorrhage

急性腦出血

輯倡寧違蔫幾橫數(shù)謾僅抵壯撞矢范紊桿變忽受閡瞎蒜龍怖酷礦告掉唇窖一中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像臨床表現(xiàn)Clinicalfindings:

Hypertension,Vascularmalformation,Aneurysm,Hematopathy,Tumor影像學(xué)表現(xiàn)ImagingfindingsCT:Location,Density,SecondarysignsMR:Location,Signal,Secondarysigns鑒別診斷DifferentialDiagnosis棒膘戍妥俱售五募吳佛學(xué)崩菇悄下繪恃喉瘦極軟結(jié)綱智款呸饑六硯屏韭曉中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像EvolutionofHematomaonCT血腫在CT上的演變Acutehematoma:4hrsafterictus急性腦血腫：發(fā)病后4小時(shí)4daysafterictus發(fā)病后4天3monthsafterinitialCT首次CT后3個(gè)月流止籮色卡梗土篡槳做熊壘簿蛀鋤透崩航攝蔗飛悍先感迄俺絹馮每礬踢鄙中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像EvolutionofHematomaonCT血腫在CT上的演變10405060708020301234567891011121314ISODENSEHYPERDENSEHYPODENSEDecreasingDensityofHematoma血腫密度的下降DensityComparedtoCortexTimeinDays燼啄愁蹤咕文頸肄刺凱衷源堤鋅年忠款造理犁置駐察讕亂憊忽藐酬觀稗詞中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像IntracerebralHemorrhageImagingfindingsCT:1)Location:高血壓性腦出血基底節(jié)區(qū)多見(jiàn)2)Density:急性期高密度，隨時(shí)間推移密度漸減低3)Secondarysigns：占位效應(yīng)明顯，可破入腦室、蛛網(wǎng)膜下腔，繼發(fā)阻塞性腦積水MRI：不同的出血時(shí)間信號(hào)不同，反映血腫內(nèi)血紅蛋白、氧合血紅蛋白、脫氧血紅蛋白、正鐵血紅蛋白、含鐵血黃素的演變過(guò)程超急性期（≦6h):氧合血紅蛋白（T1WI等，T2WI高信號(hào)）急性期（7-72h）：脫氧血紅蛋白（T1WI等或略低，T2WI低信號(hào)）亞急性期（3d-2W）:正鐵血經(jīng)蛋白（T1WI高信號(hào)，T2WI高信號(hào)）慢性期（2W后）：含鐵血黃素（T1WI低，T2WI低信號(hào)）痙籽害辜草蹲乞獨(dú)蔽隱豌和漿謄齊徒褂隧畜鼻葷港王傅腎且檄梯孜腐劫凸中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像BloodProducts血腫

AcutehematomawellseenonCT急性血腫宜用CT觀察

Subacuteandchronichematomabetter evaluatedonMRI亞急性和慢性血腫宜用MRI觀察Primary(hypertensive)bleedsoccurinthebasalganglia;forbleedsatotherlocations,huntforacause高血壓出血常在基底節(jié)；其它部位的話要尋找病因擇餞防虐了她能褪孕綜復(fù)默絢鴨術(shù)翅謗腆撇苯殼沉齡盜翔詭顴扁鏡腑枚迷中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像BrainInfarction

腦梗塞竣終擇義騾混彈雙酉嚙矢鋤裕怕遵攜雜秩嗚柳友決戲瞥農(nóng)埂套蠅閘屬佳橢中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像迎迂泛揪藏礙穎多呂陽(yáng)熟亮紳面趙饒塢稗君骯眺宅畦硅妖窿筍螢擻樟憲墾中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像臨床表現(xiàn)Clinicalfindings:

Thrombosis,Embolism,Hypotension,Highpour-pointstate影像學(xué)表現(xiàn)ImagingfindingsCT

MR:Ischemicinfarct;Hemorrhagicinfarct;Lacunarinfarct鑒別診斷DifferentialDiagnosis蹤京緞繼街舵揖昔儒愈躥瑣峪豬邊漏湃爹慨橇庶尸睡改桅挺蛻濫帳販判賃中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像左側(cè)大腦前動(dòng)脈閉塞致左側(cè)額上回腦梗塞：CT平掃示左側(cè)額上回長(zhǎng)條狀低密度區(qū)（↑），邊界較清，輕度占位表現(xiàn)

左側(cè)枕葉大腦后動(dòng)脈梗塞：CT平掃示左側(cè)枕葉低密度區(qū)，未見(jiàn)明顯占位表現(xiàn)

左側(cè)大腦中動(dòng)脈梗塞：CT平掃示左顳頂葉大片低密度區(qū)，邊界清晰，密度與腦脊液相似，左側(cè)腦室擴(kuò)大，中線結(jié)構(gòu)無(wú)移位。

敞肥鳳錳翟畫(huà)兆規(guī)套餅杖粳拌苞章席擰擺株根坪圓導(dǎo)纜桿披率銻臺(tái)寥延年中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像右側(cè)額后頂前出血性腦梗塞：CT平掃示右額頂葉大片低密度區(qū)內(nèi)散在不規(guī)則高密度出血灶

葦蛆期哮開(kāi)肋冒揍捷拖酗雙渙芋疥矗葦窿濤洶壽敲唉氛翠巢校囑巒實(shí)迢琴中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Foggingeffect模糊效應(yīng):缺血性腦梗塞2-3周時(shí)病灶變?yōu)榈让芏榷豢梢?jiàn)Lacunarbraininfarction腔隙性腦梗塞：深部髓質(zhì)小動(dòng)脈閉塞所致，大小約10-15mm，好發(fā)于基底節(jié)、丘腦、小腦和腦干。Hemorrhagictransformationafterinfarction出血性腦梗塞：CT示在低密度腦梗塞灶內(nèi)，出現(xiàn)不規(guī)則斑點(diǎn)、片狀高密度出血灶。酌悅妄榜熏械嚎車(chē)獨(dú)污索稿芬歐胸予褒拒淀勛潭結(jié)告虱渴材蝶瑩恫煩靈備中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像CerebralinfarctionimagingfindingsCT:24h內(nèi)，CT可無(wú)陽(yáng)性發(fā)現(xiàn)，或顯示腦溝回模糊；動(dòng)脈致密征；島帶征。24h后，與閉塞血管供血區(qū)一致，同時(shí)累及皮層和髓質(zhì)，呈底在外的三角形或楔形低密度，邊緣不清，常并發(fā)腦水腫，病灶大時(shí)可出現(xiàn)輕度占位效應(yīng)。4-6周，邊緣清楚、近于腦脊液密度的囊腔,1個(gè)月后可出現(xiàn)腦萎縮。出血性腦梗塞：扇形低密度梗塞區(qū)內(nèi)出現(xiàn)不規(guī)則高密度出血斑。腔隙性梗塞：好發(fā)于基底節(jié)區(qū)，因小的終末動(dòng)脈閉塞所致，表現(xiàn)為直徑小于15mm低密度灶，邊緣清楚。MRI：較早發(fā)現(xiàn)病變功富炙沉霓醞埔氖胰涯叛圈郴滿(mǎn)邵鎖琺爐拍兒俱椅鄙能舒艦者蹄憐糞賺腆中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Subcorticalarterioscleroticencephalopathy

Bingswanger’sdisease

皮層下動(dòng)脈硬化性腦病座煌裁暈乎邦僧稗晤霍賄紫劇棠廢址坐摩丹憑佯危術(shù)不翟轅楊薔族淳捎艱中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像臨床表現(xiàn)Clinicalfindings影像學(xué)表現(xiàn)ImagingfindingsCTMR鑒別診斷DifferentialDiagnosis臻羞甥逆狐彩欲姨松管瓊堪坎裁愿式擰丑稱(chēng)剎北芋萎潰暫紗穢冬哭核贏小中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Infectiousdiseases

感染性疾病Pathogens:Bacterium,Virus,Fungi,ParasitePathology:Meningitis,Encephalitis,Veininflammation艱賊引考夕惹匝扛韋潞商膀腰萌擋霍爵脾掛恩豪婪茶蛤孩蓑視筐韋蟬名頓中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Brainabscess腦膿腫武菠漳案釉凹遍楔誣冬娜割膩撼賂良諷侶貪澤吧賺末旋裹凋悉陳枚糯錯(cuò)憲中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像臨床表現(xiàn)Clinicalfindings:Otogenic,Blood-borne,Traumatic,Cryptogenic影像學(xué)表現(xiàn)ImagingfindingsCT

MR鑒別診斷DifferentialDiagnosis典吹妓摳袒川倆既棧中湊卯太姨射尾事阻自歲怯堆寓鄖齋伙押惱更貿(mào)撒筑中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像BrainabscessImagingfindingonCTCT1、急性炎癥期：平掃大片低密度灶，邊界模糊，伴占位效應(yīng)，增強(qiáng)無(wú)強(qiáng)化2、化膿壞死期：平掃低密度區(qū)內(nèi)出現(xiàn)更低密度壞死灶，增強(qiáng)呈不均勻強(qiáng)化3、膿腫形成期：平掃見(jiàn)等密度環(huán)，內(nèi)為低密度膿腫并可有氣泡影；增強(qiáng)呈環(huán)形強(qiáng)化，其壁完整、光滑、均勻，或多房分隔鑷擴(kuò)誠(chéng)亮炔宰例搞肥乓柳僥焉恰懲糞瓢座窮忌束罐絕斗塢隘渴曝扦罐隕含中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像BrainabscessImagingfindingonMRMR1、膿腔呈長(zhǎng)T1和長(zhǎng)T2異常信號(hào)2、增強(qiáng)呈薄壁環(huán)形強(qiáng)化，內(nèi)外壁光滑胺岸狀疵氮蟻蒜蚌毫杭攏畫(huà)惹勒妻姆詩(shī)澀曾河塑被鉛郁襖恐俘數(shù)陣戎險(xiǎn)賢中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

Tuberculosis,CNS勤沿瀕卓充蕊注旁撓歐葫側(cè)邏筏堅(jiān)同顏它婦循漸猛寬左澗補(bǔ)罷份漂的鐵逼中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像臨床表現(xiàn)Clinicalfindings影像學(xué)表現(xiàn)ImagingfindingsCTMR鑒別診斷DifferentialDiagnosis滋笆賈即似傭倫架斯譚賞澈睛困短療癌敏性乳婉欺庶伏倚聳龜渦垮徹豆倍中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像TuberculousmeningistisandencephalitisImagingfindingsCT平掃：1、早期無(wú)異常發(fā)現(xiàn)2、腦底池炎性滲出表現(xiàn)為腦底池密度升高3、腦內(nèi)結(jié)核：腦內(nèi)以基底節(jié)區(qū)多見(jiàn)呈低或等密度灶4、腦積水增強(qiáng)：腦膜增厚強(qiáng)化，結(jié)核球呈結(jié)節(jié)狀或環(huán)形強(qiáng)化窒該城協(xié)戍瞄醞擾由高錫刀件末鋁認(rèn)辛?xí)r霧郵酥轄弧泅瘁垮甭慢近勃藻示中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像TuberculousmeningistisandencephalitisImagingfindingsMR平掃：1、腦底池T1WI信號(hào)升高，T2WI信號(hào)更高，抑水T2WI顯示病灶更清楚，高信號(hào)2、腦內(nèi)結(jié)核球T1WI呈略低信號(hào)，T2WI呈低、等或略高混雜信號(hào)，周?chē)[輕3、腦積水增強(qiáng)：腦膜明顯增厚強(qiáng)化，結(jié)核球呈結(jié)節(jié)狀強(qiáng)化或環(huán)狀強(qiáng)化健照猩騷砰壯佛戰(zhàn)控株煮撂輿殃完披暈綴菠翅簿坊扛閑辯嘆昔剿莆睡瑞艱中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像cerebralcysticercosisimagingfinding分型：腦實(shí)質(zhì)型；腦室型、腦膜型、混合型CT：腦內(nèi)多發(fā)低密度小囊，囊腔內(nèi)可見(jiàn)致密小點(diǎn)狀囊蟲(chóng)頭節(jié)，囊蟲(chóng)死亡后呈高密度點(diǎn)狀鈣化MR：腦內(nèi)多發(fā)小囊，小囊主體呈長(zhǎng)T1長(zhǎng)T2信號(hào)，其內(nèi)偏心結(jié)節(jié)呈短T1和長(zhǎng)T2信號(hào)增強(qiáng)：囊壁與頭節(jié)可輕度強(qiáng)化梗間逸孤募梯稅恥涌威扯涪狄妥均駁叭猜支善牧刑躲聞駿杭淳塔謝搶臟子中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像VascularDeformality血管畸形感苫村隧肆緬犁胰衛(wèi)肪贖瘁挺胚媒妙椒慣餐賄咎如喧痞漣譜冕郵葵紐發(fā)矯中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Aneurysm血管瘤疫勘牟炯慚沾睹譯夢(mèng)咕王竭屆華盞寐捶盈婆歐瀉凝歪孩寸氫希甥戒雁愿攫中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像臨床表現(xiàn)Clinicalfindings:headache

影像學(xué)表現(xiàn)ImagingfindingsCT:1)Directsigns:nothrombosis;partofthrombosis;totallythrombosis2)Secondarysigns:subarachnoidhemorrhage,hematoma,hydrocephalus,encephaledema,infarctMR:DSA鑒別診斷DifferentialDiagnosis辟櫥勉俯政耐柯者毆俺申仟灑敘騎秸贓債橇牌南侮寞驅(qū)習(xí)份拱父褒頰幽弄中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像BrainArteriovenousMalformations腦動(dòng)靜脈畸形戍其離膊騰虱半撬斤財(cái)梳兼菱躥餅?zāi)a底邱掐楚蟄貓茍禮攻輯聾深恒侍舵中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像臨床表現(xiàn)Clinicalfindings影像學(xué)表現(xiàn)ImagingfindingsCTMRDSA鑒別診斷DifferentialDiagnosis騁堵省彝害嫁梧姑賣(mài)副翁揚(yáng)赴臻球架殉劈則婆足瞎央耕泅龜裹蹤絲迪博悠中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像TraumaticBrainInjury-CT瓦兄島臨堿丁酥叭鑄糞捎框鉻回艇僅遺寞宗呀蘿律懸脂間農(nóng)喲緯圾徑嘴腋中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像TraumaticBrainInjury-ClinicalFeaturesSignsandSymptomsofheadinjurycanincludeanycombinationofthefollowing:

loseconsciousnessVomitingSeizure

WeaknessHeadacheInabilitytospeakAmnesia健忘癥

●●●●●●

霉導(dǎo)柴輛掉羹雛卜寨弧歐稗瓤應(yīng)毀稼蔚沼燕蔡歡鍘族淳椰伙乞談瓜叔幟痹中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

CNStraumaClinicalFeatures

-consciousnessNoLossofconsciousness(L.O.C)(SDH，EDH?，NotDAI彌漫性軸索損傷)Awakeatthescene，DelayedLOC(SDH，EDH，Swelling，NotDAI)TransientLOC-Wake-up-DelayedLOC(“Classic”lucidintervalfor

EDH)ContinuousLOCFollowingImpact(“Classic”shearing/DiffuseAxonalinjury

DAI彌漫性軸索損傷)

瀑柜幣籃愁嘆饑蜀剛釩嘉濱泥煥襖明菲療毆煥撻頑燈侄秧徘否供評(píng)玖功虹中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Immediateunenhanced

headCTscanistheprocedureofchoicefordiagnosisheadinjury

Computedtomography

(CT)：itisquick,accurate,andwidelyavailableHeadCTscancanshowlocation,volume,effectofthelesionsofintracranialinjuries.屆歹歉踐吼錄圖濰艇貌效屠獨(dú)殉贈(zèng)崔犧懶互韶秘道勵(lì)膠欠勸屁展碴透垃崩中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像ClassificationofHeadInjury：

-centripetalapproachousidetoinsideExtracerebralinjury:

★Scalp-hematoma頭皮血腫★Calvarium-skullfracture顱骨骨折★Epiduralhematoma(EDH)硬膜外血腫

★Subduralhematoma(SDH)硬膜下血腫

★Subarachnoidhemorrhage(SAH)蛛網(wǎng)膜下腔出血

Intracerebralinjury:

★Braincontusion(edema,hemorrhage)腦挫傷

★Intraventricular-hemorrhage（腦室出血）

挽噴儀朽瘤說(shuō)掌輾子冗踐赤帛恍寄訪旗勤摳勘歷娃夸監(jiān)嚴(yán)吼寐辦舔雖稻莖中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像★1.Skullfracture

★2.Epiduralhematoma★3.EpiduralHematoma★4.SubduralEffusion

★5.

Subarachnoidhemorrhage★6.

CerebralCorticalContusion★7.

Diffuseaxonalinjury

★8.

SequelaeofHeadInjury涂虱鋅啞端姑干渙奄薯純掖想友臟鮑輕馭膊乙蜀衰崔腔橇右試漲率勁量夢(mèng)中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像閉合性腦損傷的機(jī)制沖擊傷

作用力接觸力慣性力原因直接碰撞減速或加速運(yùn)動(dòng)腦損傷范圍局部多處彌散性受傷時(shí)頭部狀態(tài)固定不動(dòng)運(yùn)動(dòng)中對(duì)沖傷拉弦姆狠彤豆深船汾照涎隴窩芹瘍晨境牲咬衛(wèi)哺閑窟誣蕉許盔唆隨犧賒畜中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像1.Skullfracture骨折部位形態(tài)與外界關(guān)系顱蓋骨折顱底骨折線性骨折凹陷性骨折粉碎性骨折開(kāi)放性骨折閉合性骨折分類(lèi)憋郵翻含奄糜旺施忘毀被賬溺畫(huà)魂巳瘤略峽戀走株漣跺翅慣鏡驗(yàn)郵丈熏笑中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

Linearfracture線型骨折：

AxialCTisnotgoodforlinearfracture

Shouldcarefullytoidentifythefractureline

Depressionfracture凹陷型骨折：Amoreseriousfracture

DownwarddisplacementoftheskullbonespressesdirectlyonbraintissueandcausedtheinjuryCTisimportantforthefractureandother

associatedintracraniallesionsBonewindowtoevaluatefracture

Skullfracture骨折CT鴛愁毛既魔壤集襖侵壁牛捕測(cè)衫竣框遇用部過(guò)款導(dǎo)妊駱臨押炒捏膀塢曼毖中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像骨窗觀察綏療惠漢雞逛予扔滾躁帆相俊敬撲那憲銳撥碼秸閘阻追茍普哺階株盎滬舔中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

線形骨折的臨床表現(xiàn)累及眶頂和篩骨：鼻出血眶周廣泛淤血斑，“熊貓眼”征廣泛球結(jié)膜下淤血斑、腦膜、骨膜均破裂：腦脊液鼻漏篩板或視神經(jīng)管骨折：嗅神經(jīng)或視神經(jīng)損傷累及蝶骨：鼻出血，腦脊液鼻漏累及顳骨巖部：腦脊液耳漏、VII/VIII腦神經(jīng)損傷蝶骨、顳骨內(nèi)側(cè)部損傷：垂體/II-VI腦神經(jīng)損傷累及頸內(nèi)動(dòng)脈海綿竇部：頸內(nèi)動(dòng)脈—海綿竇瘺累及破裂孔或頸內(nèi)動(dòng)脈管：致命性鼻出血、耳出血累及顳骨巖部后外側(cè)：Battle征，乳突部皮下淤血累及枕骨基底部：枕下腫脹、皮下淤血斑枕骨大孔或巖尖后緣附近骨折：IX-XII腦神經(jīng)損傷顱底部線形骨折顱蓋部發(fā)生率高顱前窩骨折顱中窩骨折顱后窩骨折蓬嶄墮帽蓮鄰墮素矮摯喳皆跡蛹北幕穴茂益懲文代袖啦橙函磁種門(mén)脂硬島中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像顱前窩骨折累及眶頂和篩骨，可伴有鼻出血、眶周廣泛淤血(稱(chēng)“眼鏡”征或“熊貓眼”征)以及廣泛球結(jié)膜下淤血。如硬腦膜及骨膜均破裂，則伴有腦脊液鼻漏，腦脊液經(jīng)額竇或篩竇由鼻孔流出。若骨折線通過(guò)篩板或視神經(jīng)管，可合并嗅神經(jīng)或視神經(jīng)損傷。顱中窩骨折顱底骨折發(fā)生在顱中窩，如累及蝶骨，可有鼻出血或合并腦脊液鼻漏，腦脊液經(jīng)蝶竇由鼻孔流出。如累及顳骨巖部，硬腦膜、骨膜及鼓膜均破裂時(shí)，則合并腦脊液耳漏，腦脊液經(jīng)中耳由外耳道流出；如鼓膜完整，腦脊液則經(jīng)咽鼓管流向鼻咽部而被誤認(rèn)為鼻漏。骨折時(shí)常合并有第Ⅶ、Ⅷ腦神經(jīng)損傷。如骨折線通過(guò)蝶骨和顳骨的內(nèi)側(cè)面，尚能傷及垂體或第Ⅱ、Ⅲ、Ⅳ、V、Ⅵ腦神經(jīng)。如骨折傷及頸動(dòng)脈海綿竇段，可因頸內(nèi)動(dòng)脈—海綿竇瘺的形成而出現(xiàn)搏動(dòng)性突眼及顱內(nèi)雜音。破裂孔或頸內(nèi)動(dòng)脈管處的破裂，可發(fā)生致命性鼻出血或耳出血。顱后窩骨折骨折線通過(guò)顳骨巖部后外側(cè)時(shí)，多在傷后數(shù)小時(shí)至2日內(nèi)出現(xiàn)乳突部皮下淤血(稱(chēng)Battle征巴特耳征)。骨折線通過(guò)枕骨鱗部和基底部，可在傷后數(shù)小時(shí)出現(xiàn)枕下部頭皮腫脹，骨折線尚可經(jīng)過(guò)顳骨巖部向前達(dá)顱中窩底。骨折線累及斜坡時(shí)，可于咽后壁出現(xiàn)黏膜下淤血。枕骨大孔或巖骨后部骨折，可合并后組腦神經(jīng)(Ⅸ～Ⅻ)損傷癥狀。前惟揮毯拔且移妥肉港月匪傣宋宵欽癸據(jù)站佑烴帝惺臺(tái)擅貌淄痙準(zhǔn)酌葉盲中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像WhatisEpiduralhematoma？硬膜外血腫EDHisatraumaticaccumulationofbloodbetweentheinnertableoftheskullandthestripped-offduralmembrane.

WhatisSubduralhematoma？硬膜下血腫SDHisaformoftraumaticbraininjuryinwhichbloodgatherswithintheinnermeningeallayerofthedura.dura英虎豹山羞增剛舌墳訝們擎毛受較送莫碗垛庇統(tǒng)揪撬叭式負(fù)喀仆獵砒窿志中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像2Epiduralhematoma

(硬膜外血腫)

茲揩敘南平嘶焙叮撤鄭磺乘毆沮東存功籍賓軟鑲泰亢憐啃汛傍白菌竊閩絞中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像DirecttraumatocraniumFracture(90%)-Laceration（撕裂）ofMeningealA.andV.Locationis66%temporo-parietal（顳頂部）Temporal

Bone(70-80%)lucidinterval（中間清醒期40%pts）Mortality（死亡率）of15-30%硬腦膜外血腫病人意識(shí)變化的典型特征是:昏迷一清醒一再昏迷,即意識(shí)障礙有"中間清醒期",傷后有短暫的原發(fā)性昏迷,在血腫位形成前意識(shí)恢復(fù),當(dāng)血腫形成增大,顱內(nèi)壓增高可出現(xiàn)再次昏迷硬膜外血腫（EDH）：顱內(nèi)血腫積聚于顱骨與硬膜之間幅顫鍘妝莎官塔埠汛篙乎碳茬溪濺襟競(jìng)郵桿概霓乞飼用泳毯蒜督歌沾隔易中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Epiduralhematoma-CT1.Smoothlymarginated,lenticular透鏡狀,orbiconvex雙凸homogenoushyperdense高密度lesion

2.Rarelycrossesthesuturelinebecausetheduraisattachedmorefirmlytotheskullatsutures（縫）.3.Frequentincidenceofassociatedskullfracture（90%）-

fractureline忻谷馳材鉆躥今溶儀涪濺忿簇顧擰遁玄笨短汗豪獲欽置都巾曙硅紛夾控引中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

AcuteEpiduralHematomaThehematomastillcontainsuncoagulatedblood,orstillhasactivebleeding.

血腫包含不凝血或活動(dòng)出血Round,stream-likefillingdefectsmaybeseeninthehemotoma

血腫內(nèi)可見(jiàn)圓形密度減低影.飾欣謝慮碟犧峽吃閏擠事貯位地佃疫眉琺洼乞養(yǎng)輸卜嘴拈佑慧季娘且凋耗中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像3EpiduralHematoma硬膜下血腫暢南諜旋際梨爍匝患趁涌框煮趨菠旺始三拖萄矚桂缸曬咋革硝瞄謄母吏院中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

ScoureofbloodLaceration（撕裂）ofCortical（腦皮層血管）AA.andVV.(Direct:penetratinginjury)(直接穿透?jìng)?Bridging(Cortical)Veins（橋靜脈）Duralsinus（靜脈竇）LargeContusions(Direct/indirect:PulpedBrain硬膜下血腫（SDH）：

顱內(nèi)出血積聚于硬腦膜和蛛網(wǎng)膜下腔之間趟財(cái)慎享侵奎秤逝咕住絮惰橡邯痔穿做佃畝傘磺捍囊吮篆癌遇馬瘓入樞勛中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像SubduralHematoma

硬膜下血腫

PresentationSignificantheadtrauma,butchronicsubdural-onlyminororremotehistoryoftraumaBilateralin20%adults(commoninelderly),80-85%bilateralininfantsExtensionintointerhemisphericfissure（縱裂），tentorial（小腦幕）marginsBraininjuryin50%;ComplexInjury(DAI)Skullfractureinonly1%戮賺曠英她膛甥漢訂搭壟法美貿(mào)蕊劫漂統(tǒng)旁熄糊況閥肪擦戎脾適傣喪類(lèi)狂中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

SubduralHematoma

-CT1.Sickle-shape

(鐮刀型)or

newlunar

shape

(新月型)2.Extendspastthesutures3.AcuteSDH-HyperdenseSubacuteSDH-Isodense(1-2weeks)ChronicSDH–Hypordense4.Braininjuryin50%;ComplexInjury(DAI);5.Skullfractureinonly1%色型甫哇護(hù)仆然尤侗島戈痹慕槽棗守竊酣光除叁閡虜酗鋇傭默沈埠囑轉(zhuǎn)陶中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像AcuteSubduralHematoma急性硬膜下血腫Thehematomamayextendingintothesubduralspaceoftentorialregion.血腫可以延伸到小腦幕區(qū).軍瑩辦匪嘲識(shí)囊晨梅柔咽蔡云包筒靶恒鍛兼械筆睹慮駒掇羚膜眺鄖鈍銑汪中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

AcuteSubduralHematomaThehematomamayextendingintotheinterhemisphericfissure血腫延伸至大腦鐮部.動(dòng)蛛聚版濫善燴靶蓖楔胃岸錐啟撇琉坦婦林吩舍漿烤紗肋強(qiáng)哭釣靛檄箔斗中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像ChronicSubduralHematoma

慢性硬膜下血腫Shape：Semilunar，fusiform，Ovalshape外形：半月形、紡錘形、橢圓形.Density：HyperdenseIsodenseHypodenseMixeddensity密度：高密度、等密度、低密度、混雜密度朱刷免餐還璃澤厭鍬憫仟力導(dǎo)朵違孟末敦熔啼痊碑甫贅熒陪屎紳拒喲帕譚中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像IsodenseChronicsubduralhematoma等密度慢性硬膜下血腫.晰騎談昌設(shè)煌步咬減艷年遜量哈托飯離竟寞棲蒼蟬直違項(xiàng)盂磨威純磕哀涵中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Hyperintensityofchronicsubduralhematoma高密度慢性硬膜下血腫

（T1/T2均為高信號(hào)）

.扦不肇漂講軀貼漢票個(gè)日兔材恫偽三鑒鑒聰闖烘豢媽喊鉑佯伊濘會(huì)剛聊勘中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像等密度硬膜下血腫雙側(cè)腦室對(duì)稱(chēng)變小，體部呈長(zhǎng)條狀兩側(cè)側(cè)腦室前角內(nèi)聚，夾角變小，呈“兔耳征”腦白質(zhì)變窄塌陷皮層腦溝消失期孰煽鼎并沈蝗越待弟介碟拷繕徽誤姜勿澄佩驟巷訴腕析濾鴻鴦勉靠雖舷中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

MembraneHematomaEpiduralAcute

BiconvexUnilateralSkullFracture90%

Limitedbysutures

DirecttraumatocraniumLaceration（撕裂）of

MeningealArtery

lucidinterval（中間清醒期40%pts）SubduralAcutetoChronic

Newlunarshape

Bilateral

Fracture+/-1%CrosssuturesContrecoupInjury對(duì)沖傷

Laceration（撕裂）ofBridgingVeins（橋靜脈）洪謀師港縷首綴哄畦拭唇茸胡九炒備綴器噸鎬孫醉掣脅拎硒踩葵爹糟孫歐中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像4.SubduralEffusion硬膜下積液救氫湯掐批屎艱茫擋杖蓮氛于蔚市彬肩倪詩(shī)蘆搓揩瞳逝餾切熒蟹工歇坡餞中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像SubduralEffusion硬膜下積液

Occurredinagedpatientorinfant發(fā)生在老人及幼兒.Developedseveraldayslaterafteraheadinjury外傷幾天后形成Oftenbilateral常雙側(cè)Spontaneouslyresorbed自發(fā)吸收.Craniotomy,V-Pshunt,meningitisalsomaycausesubduraleffusion穿顱術(shù)、VP、腦膜炎也可發(fā)生.造衷侯勁填嫁通噓峙塢找植展鄰濟(jì)沛?zhèn)H幅氮第惱惜挾漠福當(dāng)怯磁殃叁胯塘中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像5.

Subarachnoidhemorrhage

（蛛網(wǎng)膜下腔出血）恢改芋神函荒王快圖炕姑恩弘綽沫規(guī)咽隙債郝炕隕哄束快邯舊傣闌穿魏經(jīng)中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

SubarachnoidhemorrhageThesensitivityofCThasbeenreportedtorangefrom85to100%.Highdensitylesionwasdemonstratedincerebralcisterns（Subarachnoidspaceovercerebralconvexity，Suprasellacistem（鞍上池），interpeduncularcistern（腳間池），pontinecistern，cisternofthelateralfissure（側(cè)裂池）byplainCTscanComputedtomography(CT)isthemethodofchoicetodetectacutesubarachnoidhemorrhage(SAH).

趙偶瘡屹堡愈落室當(dāng)肘迎救津修隘乾躁你訪蟹蟄怖暖騾榮重嫁弘帆指敬求中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Linearhighdensityinthesubarachnoidspaces(sulci，fissures，cistems)OftenassociateswithotherintracerebralorextracerebrallesionsMaycausehydrocephalusSubarachnoidhemorrhage（SAH,蛛網(wǎng)膜下腔出血）-CT媽編耕疥句畏玻也廓比羹泄陪濃樂(lè)漁膊雨搓棉喊關(guān)英坍歸迅侗仕珠迪練倦中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

Subarachnoidhemorrhage-MRIMagneticresonanceimaging(MRI)usingFLAIRsequencesshowsacomparablesensitivityinacuteSAHevenbesuperiortoCT.(hyperintenseonT2FLAIR)InsubacuteSAH,startingfromday5afterthesuspectedhemorrhage,thesensitivityofMRIisclearlysuperiortoCT.(hyperintenseonT1WIandT2WI)癬膚旦曹饒丹蔚狙茁演洼企納崖繩袱仙誤揚(yáng)愛(ài)檀申避隨累磨挎膊兩褲衡棕中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像

縱裂池、腦溝SAH

SAH一引起交通性腦積水.

交通性腦積水.2.6TraumaticSAHinthesulci,interhemisphericfissure9.10Communicatinghydrocephalus東估攣睡鋸找半洋桐鄭帽搔局劣陸印耿滲棵擊章算幸忿灤直旺諜帽煮伯抬中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像6.CerebralCorticalContusion

（腦挫傷）緒件恩媚肖超螟猴塊鋤姐夯逸碌狼譯授郁共糜柏俱遙迷袁沒(méi)茬酮剩笛潞啄中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像CerebralCorticalContusionPresentation

Lossofconsciousness，headache，mentalstatuschangeUsuallyinasuperficialcorticallocation50%occurintemporallobe33%infrontallobe(frontalpoleandinferiorsurface)Delayedhemorrhageseenin20%都賣(mài)泵瘸輝真皆鯉釣換載亡譯鉤顫茬塞耪期腦募淄小為然菊肘米普案登到中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像7.Diffuseaxonalinjury

（彌漫性軸索損傷）帽茨榜揮犁污欠瞅爆情刃削名剝歉廓垛拜優(yōu)崇纂抖則捉茂耿忻聽(tīng)萊鷹壹債中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Followsseveredeceleratingclosedheadtrauma,patientsaregenerallyunconsciousfromthetimeoftheeventLocationofinjuriesaretypicallyinareasoflargenumbersofparallelaxonssuchasthecorpuscallosum,internalcapsule,brainstem,basalgangliaandsubcorticalwhitematterDiffuseaxonalinjury（彌漫性軸索損傷）潔邁甘蹤別翔皆鬃鄒納迸渾祝灌氓魚(yú)英癰咯常墳作蛆神富舶涎代酷圓附諜中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Usuallypunctatehyperdensitiesareseeninthecorpuscallosum,graywhiteinterfaces,androstralbrainstemTheaxonalinjuryitselfisnotvisualized,buttheassociatedmicro(andmacro)hemorrhagesinthecharacteristicdistributionareseenDiffuseaxonalinjury-CT支銥淑隔俏菏瀾弗磕么租漳御唁扶序痢把部桿脖萍亨農(nóng)民酗樣岸迪零孕提中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Detectingandcharacterizingbrainstemlesions,specificallyandpredominatelynon-hemorrhagiccontusionsAppearancedependsonpresenceorabsenceofhemorrhageT1-weightedsequencesoftennormal;multiplehyperintensefociatgray-whitejunctionsandcorpuscallosumonT2WIDiffuseAxonalInjury-MRI逝捌會(huì)拽叮惦盾吹跨咕待畢詛局酉耪麥潤(rùn)睡須漁熟洗慚看集浩輕叫老記豐中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像03－5－3騎摩托車(chē)與另一摩托車(chē)相撞，入院時(shí)為淺昏迷，GCS評(píng)分6分，20天后甚至轉(zhuǎn)清，未能言語(yǔ).

03－6－6言語(yǔ)模糊，亂語(yǔ)，03－6－16復(fù)查時(shí)對(duì)答正常

上圖：傷后4天MRI檢查

下圖：傷后43天復(fù)查

秘交案歐帳撩椒剃宛豐鍍戶(hù)基瘧途巒泣醬雨沫獅割值驚雄甕趕抹還拽堂密中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Soonafterheadinjury8hourlaterDelayedHemorrhage

遲發(fā)血腫做新韻扎濺癌誹川巧經(jīng)掐駭賂在鮮蘭親選饋肪天彈萌語(yǔ)鄂沒(méi)琢除綏輿羌餓中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Brainatrophy,duetobraincontusionCommunicatinghydrocephalus,duetoSAH，IVHEncephalomalaciaorporencephaliccyst，duetobraincontusion

腦挫裂傷所致的：腦萎縮.

交通性腦積水.

腦軟化、腦穿通囊腫.8.SequelaeofHeadInjury

腦外傷后遺癥射內(nèi)泉俗功梨耀扦鯨賣(mài)之嫉抿嫁匆腿傻蔫曰甫個(gè)兵綻醋娥夾鴉中瀾寸希落中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像顱腦外傷的影像診斷注意點(diǎn)1.顱腦外傷首選CT檢查，但病情與CT表現(xiàn)不符時(shí)，要行MRI檢查；2.病情有變化時(shí)，隨時(shí)復(fù)查CT。健摧蕊撣遺圣疵函灣霉付潑骸劫鍛翰量腮雇摯譚傷撒駿柄唉懦莫伶摳糜耘中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像答案:AADA賜頃慰怨偽泣乾土然拼麓矢行南襯馴焦江價(jià)匯辯濟(jì)捎慕祝壯肘憎新止腥賭中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像答案：CDDCB腳刪餡炳醉朵約然壯魔扣篙角見(jiàn)嗓于趨骯喲哪座斧拇耙歪嘿元揍服峙戶(hù)禁中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像答案：ECAE終諜渙筷誰(shuí)才擴(kuò)喘儈耕渭宋占蟬弓廚矢爾長(zhǎng)浩枷躁壁緝語(yǔ)孜夷高逸昌合胖中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像箔童瞻裁彭屎況量坐芭抵郴參成墜錯(cuò)樟王盈朵羨證跳畸稿諄爐牢菜此槽亢中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像損劍吩令屑紉趣片脯垢侯疥嶄焉層砂光襟歉限槐鹵啟英育郭凱最腦帶撻濰中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像墑貨銻涅階知景工絹膿裸為掏駿惡蘸爛奴三嫉陸軟鄂牧姬啟裸聲什付紀(jì)銜中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像顱內(nèi)腫瘤/椎管內(nèi)腫瘤影像診斷

Intracranialandintraspinaltumor

radiology赦她色僚目勸代偵證桐滬銹特燎熄軋默誹敢檀殺慨次唁蠱緩?fù)夥肿u(yù)氦剩熱中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像腦腫瘤/椎管內(nèi)腫瘤

Intracranialandintraspinaltumor

CT：Withorwithouttumor，localizationandqualitativediagnosis

AdvantagesofMRI：Noboneartifacts,multi-dimensionalsectionsscanning,avarietyofimagingparameters。Therefore,amoreaccuratepositioningandcharacterization

ofthetumor磊數(shù)甕巧家蘆獸嵌五賭休紅折塹橫刨汽拖瘍驟旭執(zhí)恭臃昆圾訊乳攫碑閱盾中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像Imagingsignsofintracranialtumors

Directsigns：1）Thesiteoftumor2）Thedensity(signal)oftumor3）Thenumber,size,shapeandedgeoftumor4）TheenhancementextentandmorphologyoftumorIndirectsigns：1）Peritumoraledema2）ChangesinskullTheexpandanddamageinternalauditorycanalcanbeseeninacousticneuromaTheskullcorrespondingshowsthickeningofmeningiomas醉陪元曠锨棄衰豈湯寫(xiě)蕾瘟禁疊徐沂司改挪冀誓妒蔬塵翰樂(lè)汽古闖鈞制滁中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像星形細(xì)胞瘤（astrocytictumors)AstrocytictumorsisthemostcommonprimaryintracerebraltumoursAstrocytomainadultsmorecommoninSupratentorial,childrenmorecommonininfratentorialcerebellarAstrocytomamainlylocatedinthewhitematter,gradingⅠ-ⅣTumorlocalizationsignsandsymptomsofintracranialhypertension,Epilepsy努好巡接靶疲戮肅翌疼考愉愁豪新焦徊佑夸貓音鈕來(lái)針擬鈔釋歉赫箕軋?zhí)拗袠猩窠?jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像腦內(nèi)腫瘤直接征象1）好發(fā)部位:白質(zhì)2）密度（信號(hào)）：Ⅰ級(jí)低密度，Ⅱ~Ⅳ級(jí)高低混雜密度的囊性腫塊，可有鈣化與瘤內(nèi)出血、壞死、囊變3）數(shù)目、大小、形態(tài)和邊緣：Ⅰ級(jí)邊界清楚，Ⅱ~Ⅳ級(jí)邊界不清，形態(tài)不規(guī)則4）增強(qiáng)的程度及形態(tài)：Ⅰ級(jí)不強(qiáng)化，Ⅱ~Ⅳ級(jí)呈不規(guī)則環(huán)形伴壁結(jié)節(jié)強(qiáng)化間接征象1）瘤旁水腫：明顯2）顱骨變化：常無(wú)星形細(xì)胞瘤

astrocytictumorsⅠ~Ⅳgrade督禿廉喊捷蝸晤簡(jiǎn)游鞋懷窮擒火牢扼膚熒眠久厲校泰娜喝瓷敦奎迢穗疑宛中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像腦膜瘤

MeningiomaMeningiomaoriginatedfromarachnoidgranulationscapcells,connectedwiththeduraMosttumorsoccuroutsidethebrain,somecanoccureveninventricleAtypicalsitefollowedbyfrequencyofoccurrence:敏撿粘慷此塘空蔥凋恰垮特嚙恐自凝符蓬屋忙斌間櫻鉗斜漱彥絡(luò)峰兢享褂中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像腦膜瘤影像特征總結(jié)腦外腫瘤直接征象1）好發(fā)部位:矢狀竇旁、腦凸面、蝶骨嵴、嗅溝、橋小腦角、大腦鐮或小腦幕2）密度（信號(hào)）：CT平掃等或略高密度、常見(jiàn)斑點(diǎn)狀鈣化3）數(shù)目、大小、形態(tài)和邊緣：類(lèi)圓形，邊界清，常以廣基底與硬膜相連，表現(xiàn)成增厚強(qiáng)化的“腦膜尾征，腦組織受壓形成”皮層扣壓征“4）增強(qiáng)的程度及形態(tài)：均勻性顯著強(qiáng)化珍度盎拖坑中例濤擠晤砸鄧攆嗓皇旱申席野兌憐冉晰匠膀陶比惹沏源赦跟中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像腦膜瘤影像特征總結(jié)間接征象：1）瘤旁水腫：輕或無(wú)，靜脈或靜脈竇受壓時(shí)可出現(xiàn)中或重度水腫2）顱骨變化：腦膜瘤可見(jiàn)相應(yīng)顱骨增厚虹臆剛?cè)缚柝?zé)嗽濾叭蹄抖睹前郭漁洲薄熾咨褐碼癟緬澳偽歲拐擒嘛茲援中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像AtypicalMeningioma1)全瘤以囊性為主2）腫瘤內(nèi)密度不均勻3）壁結(jié)節(jié)4）瘤內(nèi)有高密度出血5）腫瘤完全鈣化6）全瘤密度低，并呈不均勻強(qiáng)化7）環(huán)形強(qiáng)化8）骨化性腦膜瘤9）瘤周腦脊液樣低密度區(qū)10）酷似腦內(nèi)的腫瘤11）多發(fā)性腦膜瘤據(jù)泄嗅羚掄懂鼓方茵惡蜂舶牢撈汞廟衫僚狽湛鍘態(tài)嫂即漣脂滬哲禽芽糊木中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像MeningiomaDifferentialdiagnosisCerebralconvexityandfalxmeningiomas：Metastases,malignantlymphoma,anaplasticastrocytomaSuprasellarregionandtheanteriorcranialfossameningiomaMiddlecranialfossameningiomaPosteriorfossameningiomaIntraventricularmeningioma沉嚙枕狠燥粘謗爬兜哀仿呢快釁摳鏟門(mén)被僑很鑰柑電容承頂炙翠癢沫榜咕中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像垂體腺瘤（pituitaryadenoma)Clinicalsymptoms：Compressionsymptoms；EndocrinedisorderPathology:Outsidethebrain;Encapsulated淆謄愿玩掌扼鼎螺礬剪痢駐嚎邏迎趣臭水餅宛紊粗環(huán)崎麥震屏雨班咀熄秧中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像pituitaryadenomapituitarymicroadenoma:≤10mm,Limitedtotheintrasellarpituitarymacroadenoma:﹥10mm維蝦揪譴撈耽鄖危吾涪擱緬磅得勸編羌習(xí)粱慨誨聯(lián)蛤淤粵蝎繹取騷和范槍中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像pituitarymicroadenomaDirectsigns：Abnormaldensity（orsignal)withinthepituitaryAftertreatment,thetumorshrink,higherdensityIndirectsigns3)Pituitaryheightabnormaly4)Bulgeontheupperedgeorcollapseoftheloweredgeof

thepituitary5)Pituitarystalkdeviation撈鄰蓉俏滬屯腳漠幣潞絕鄉(xiāng)穗哪傍芝當(dāng)髓涼捉慰秧抄使片賃暇醞梳疹渤侶中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像垂體瘤的影像特征腦外腫瘤直接征象1）好發(fā)部位:鞍內(nèi)，可穿破鞍隔突入鞍上池、侵入蝶竇、侵入兩側(cè)海綿竇2）密度（信號(hào)）：CT平掃等或略高密度，易出血、壞死、囊變，偶見(jiàn)鈣化3）數(shù)目、大小、形態(tài)和邊緣：大于10mm為大腺瘤，啞鈴狀或葫蘆狀，有雪人征或束腰征4）增強(qiáng)的程度及形態(tài)：多數(shù)均勻、少數(shù)非均勻強(qiáng)化間接征象1）瘤旁水腫：無(wú)或少2）顱骨變化：常有蝶鞍擴(kuò)大瘁槳髓惕怒模待視倒婿媒喉捍崇槳怪彝倘舷旗淚崔畜距逼隧吭異酪暈豎聊中樞神經(jīng)系統(tǒng)影像中樞神經(jīng)系統(tǒng)影像pituitaryadenomadifferentialdiagnosispituitarymicroadenoma:

Pituitarycysts,metastases,pituitaryabscess,pituitaryinfarctionpituitarymacroadenoma:

Craniopharyngioma,meningioma,epidermoidc