【医学】中枢神经系统影像诊断CNS.ppt

中中枢枢神神经经系系统统影影像像诊诊断断协协和和医医院院放放射射科科孔孔祥祥泉泉一、Examinationmethods1.X-rayplainfilmThismethodisverysimpleandcheap.Somelesionscanbefoundbyit.Usuallywecannotreachtoanexactdiagnosisonlybythisexamination2.Tomography2.TomographyExactdiagnosisstillcannotobtained ThemethodcanmanifestedsomeosseousThemethodcanmanifestedsomeosseousdestructionwhichcannotbeshownbyplainfilm.destructionwhichcannotbeshownbyplainfilm.EnhancementEnhancement:3.CT Todisplaytumors,hemorrhage,infarction,infectionandabnormality.Todisplaytumors,hemorrhage,infarction,infectionandabnormality.ToshowtheabnormalToshowtheabnormalisodensityisodensitywhichcannotfoundbytheplainscan.whichcannotfoundbytheplainscan.Toconfirmthequalityofthelesion.Toconfirmthequalityofthelesion.Differentialdiagnosisoftumorandedema.Differentialdiagnosisoftumorandedema.PlainscanPlainscan:Thecharactersofthelesionincludingsize,appearance,number,Thecharactersofthelesionincludingsize,appearance,number,position,anatomyrelation,andsooncanbeshownbyit.position,anatomyrelation,andsooncanbeshownbyit.4.MagneticresonanceimagingPlainscanPlainscan:EnhancementEnhancement:ToshowtheabnormalToshowtheabnormalisodensityisodensitywhichcannotfoundbytheplainscan.whichcannotfoundbytheplainscan.Toconfirmthequalityofthelesion.Toconfirmthequalityofthelesion.Differentialdiagnosisoftumorandedema.Differentialdiagnosisoftumorandedema.MRA:Toshowthevascularlesionssuchasaneurysmandarterialvenousmalformation.Todisplaytumors,hemorrhage,infarction,infectionandabnormality.Todisplaytumors,hemorrhage,infarction,infectionandabnormality.Thecharactersofthelesionincludingsize,appearance,number,Thecharactersofthelesionincludingsize,appearance,number,position,anatomyrelation,andsooncanbeshownbyit.position,anatomyrelation,andsooncanbeshownbyit.5.DSAToshowthevascularlesionssuchasaneurysm,arterialvenousmalformation.,bloodsupplyofneoplasm6.MyelographyToshowwhethertherearetumorsandobstructioninspinalcanal.Itisalsohelpfultoensurethepositionanddegreeofobstruction.一、一、Normalmanifestation（一）、（一）、（一）、（一）、PlainfilmPlainfilm1.Cranium1.Cranium TheinnerandouterplatearedenseandtheTheinnerandouterplatearedenseandthediploediploeisspongy.isspongy.2.2.SkullsutureSkullsuture AllofthesuturesareshownasAllofthesuturesareshownassawtoothsawtoothshadowshadow3.Convolutionalimpressions Multipleroundlowdensityinplainfilm.Multipleroundlowdensityinplainfilm.4.Theimpressionofthemiddle4.Theimpressionofthemiddlemeningealmeningealarteryartery TheTheimpresstionimpresstionofthemiddleofthemiddlemeningealmeningealarteryispresentedasarteryispresentedasstreaksshadowandgooutfromwidetonarrowstreaksshadowandgooutfromwidetonarrow5.5.ImpressionImpressionofofd diploiciploicveinvein7.7.TheTheSellaSella:6.6.ImpressionofImpressionofpacchionianpacchioniangranulationgranulation8.Internalauditory8.Internalauditorymeatusmeatus:About6mmwide,symmetricalcanalAbout6mmwide,symmetricalcanalThefrontalparietalirregularThefrontalparietalirregularhypodensityhypodensitynearthemidline.nearthemidline.TheThediploicdiploicveinsimpressappearsasnetlikeveinsimpressappearsasnetlikehypodensityhypodensityintheintheparietalregion.parietalregion.716mmlong,714mmwideand820mmdeep.716mmlong,714mmwideand820mmdeep.10.calcificationof10.calcificationoffalxfalx cerebricerebri:9.9.CalcificationofCalcificationofpinealbody:pinealbody:11.Calcificationof11.Calcificationofchoroidchoroidplexusplexus12Calcificationof12Calcificationofpetro-clinoidpetro-clinoidligament:ligament:ItispresentedasnodularItispresentedasnodularhyperdensityhyperdensityonthelateralskullradiograph.onthelateralskullradiograph.ThefrontalviewshowthenormalpositionarepresentedtheThefrontalviewshowthenormalpositionarepresentedthezonaryzonarydenseimageonthemidline.denseimageonthemidline.CalcificationofCalcificationofchoroidchoroidplexusarepresentedtheanomalisticdenseplexusarepresentedtheanomalisticdenseimageandlateraltomidline.imageandlateraltomidline.ThedenseshadowbetweenintheanteriorandposteriorThedenseshadowbetweenintheanteriorandposteriorclinoidclinoidprocess.process.1.1.WWhitematter:hitematter:isishypodensehypodensetograymatter.CTvaluesistograymatter.CTvaluesis20-30Hu20-30Hu2.Graymatter:2.Graymatter:isishyperdensehyperdensetowhitematter.CTvaluesistowhitematter.CTvaluesis30-40Hu30-40Hu 3.Ventricleandcistern:3.Ventricleandcistern:arearehypodensehypodense.CTvaluesis.CTvaluesis0-10Hu0-10Hu 4.Skull:4.Skull:isishyperdensehyperdense.CTvalues.CTvalues250Hu250Hu5.Physiologicalcalcification:5.Physiologicalcalcification:Spotorpatchdenseshadow.CTvalues60Hu二、二、CTmanifestation三、三、MRImanifestation1.MorphologicalmanifestationAxial,coronal,sagittalMRIcanclearlyshowtheshapeofbrainandspinalcord,suchaswhitematter,greymatter,ventricle,cerebralfissure,brainstem,cerebralvessel,pituitarybody,etal.Theefficiencyisclosetogrossspecimen.T1WIT2WIT1WIT2WIWHITEMATTERHIGHLOWWHITEMATTERHIGHLOWGREYMATTERLOWHIGHGREYMATTERLOWHIGHCSFLOWHIGHCSFLOWHIGHFATHIGHMEDIUMFATHIGHMEDIUMSKULLTABLELOWSKULLTABLELOWLOWLOWDIPLOEHIGHLOWDIPLOEHIGHLOWMENINGESLOWMENINGESLOWLOWLOWVESSELLOWVESSELLOWLOWLOWCALCIFICATIONLOWCALCIFICATIONLOWLOWLOW MRIsignalintensityFrontallobePituitarybodyCentralsulcusPituitarystalkOpticchiasmGenuofcorpuscallosumMedullaoblongataClivusSphenoidsinusParietallobeThalamusOccipitallobeMamillarybodyQuadrigeminalbodyStraightsimus4thventricleCerebellartonsilGenuofcorpuscallosumFrontallobeSpleniumofcorpuscollosum3rdventricleThalamusHeadofcaudatenucleusGlobuspallidusOccipitallobeOpticradiationsSeptumpellucidumPosteriorhornoflateralventricleAnteriorhornoflateralventricleInterventricularforamenParietooccipitalsulcusThalamusHeadofcaudatenucleusGlobuspallidusOccipitallobeOpticradiationsAnteriorhornoflateralventricleInterventricularforamen3rdventricleGenuofcorpuscallosumSeptumpellucidumSpleniumofcorpuscollosumPosteriorhornoflateralventriclePosteriorlimbofinternalcapsuleGenuofinternalcapsuleAnteriorlimbofinternalcapsuleParietooccipitalsulcusParietallobeSuperiortemporalgyrusMiddletemporalgyrusPonsMedullaoblongataCerebralpeduncleCentrumsemiovale3rdventricleInferiortemporalgyrusPetrousridgeoftemporalboneParahippocampalgyrusAnteriorhornoflateralventricleLateralfissureSuprasellarcisternPituitarybodyTemporallobeInerhemispericfissurecisternCorpuscallosumcaudatenucleusglobuspallidus,putamenOpticchiasmPituitarystalkCavernoussinusDSAmanifestationNormalcerebralartery(anteriorandmiddlecerebralartery)graduallytaperoffwithsymmetricbranchesandsmoothmargin.Thearterieshaveinvariablelocationandcorrespondingbraintissue.Imageologicdiagnosisofthecommondisease（一）（一）BraintumorshavecommoncharacteristicinimageologicmanifestionGlioma,astrocytomaGlioma,astrocytomaMeningiomaMeningiomaPituitarytumorPituitarytumorAcousticAcousticneuromaneuromaMetastasistumorMetastasistumor1、X-raymanifestation、IncreaseofintracranialpressureIncreaseanddeepeningofconvolutionalimpressions,separationofsutures,thinningofbones.、TumorlocationsignDestructionofskull,enlargementofthesellar,displacementofcalcification,dilationofInternalauditoryInternalauditorymeatusmeatus,pathologic,pathologiccacificationcacification2、CTmanifestation、DensityabnormalityThetumorsareslightlyThetumorsareslightlyhypodensehypodensetotoisodenseisodenseonplainscan.onplainscan.、MasseffectDisplacementofmidline,compressionandobstructionofventricle,hydrocephalus.、EdemaHypodensityaroundtumor,moresevereinmalignanttumor.、physiologicalcalcification:physiologicalcalcification:egeg:Irregularcalcificationcanbeenseenin:IrregularcalcificationcanbeenseeninOligodendrogliomaOligodendroglioma、DestructionofboneDefectofbone,decreaseddenstiy,eg:acousticneuroma、EnhancementIncreaseoftumordensity,thereisnoenhancementintheareaofnecrosisandedemaMRImanifestation、SignalabnormalityThetumorsareslightlyThetumorsareslightlyhypointensityhypointensitytotoisointensityisointensityonplainscanonplainscan、MasseffectDisplacementofmidline,compressionandobstructionofventricle,hydrocephalus、EdemaEdemaisaroundtumorwithlongT1andT2relaxingtimes.、Physiologicalcalcification:Physiologicalcalcification:、Destructionofbone、EnhancementIncreaseoftumordensity,thereisnoenhancementintheareaofnecrosisandedemaT1andT2prolongationofboneareacanbeenneartumorsHypointensityinthetumoronT1WIandT2WIDSAmanifestation、MasseffectVesselsdisplacement,separation,gathering,bending,straightening、TumordyeingTumorswithsufficientbloodsupplycanbeenseen1.X-RAYPLAINFILMmanifestation（二）（二）CraniocerebralinjuryTofindthepresenceorabsenceofskullfractureandtoaccessthelocationandtypeoffracture(linearfracture,comminutedfracture,depressedfracture)IntracranialinjurycannotbeenobservedCTmanifestation、EpiduralEpiduralhematomahematoma、SubduralSubdural hematomahematoma、IntracerebralIntracerebral hematomahematoma、CerebralcontusionCerebralcontusionshowsalocalizedbiconvexhighdensityundertheinnertableGeneralizedperipheralhighdensityundertheinnertableRoundorirregularhyperdensityHaemorrhageandedemaareintercurrent,producingmotleydensityMRImanifestation、ChronicepiduralChronicepiduralhematomahematomaShowsalocalizedbiconvexhighintensityundertheinnertable、ChronicChronicsubduralsubdural hematomahematomaGeneralizedperipheralhighintensityundertheinnertable、ChronicChronicintracerebralintracerebral hematomahematomaChronichematomaproducingirregularhyperintensitywithringsign.（三）（三）Vasculardiseases 1 1、IntracranialaneurysmIntracranialaneurysmDSACTMRIDemonstrateroundedhighdensitylinktorelativearterywithirregularsizeandsmoothmarginShowsroundedflowvoidwithsmoothmarginonT1WIandT2WIDisplaysisodensityonplainscanandroundedhyperdensityonCECT2、Intracranialvascularmalformation（Arteriovenousmalformation）DSACTMRIVeinearlyemerging,malformednidus,narrowingoffeedingartery,dilateddrainingvein.Malformedvascularnidusproducingracemoseflowvoidwithnarrowingoffeedingartery,dilateddrainingvein.DisplaysisodensityonplainscanandroundedhyperdensemalformedvascularnidusonCECT3、cerebralinfarctionMRIIschemicinfarctionproducingsectororirregularshapewithT1andT2prolongation.Masseffectcanbeenseeninextensivecases.cerebrallacunahavebeenidentifiedasinfarctionslessthan1cm.CTIschemicinfarctionproducingsectororirregularhypodensitywithblurredmargin.cerebrallacunasarenoteasytofind.四、InfectiousdiseasesSuppurativeinfection:Tuberculousinfection：Viralinfection：Patasiticinfection：Encephalitis,Brainabscess,MeningitisMeningitis,TuberculomaEncephalitis,MeningitisCysticercosis,Schistosomiasis1、BrainabscessCT:Plainscanshowsroundhypodensitywithringlikeperipheralisodensityandedema.Thereisringenhancementoftheuniformthickabscesswall.Thecentralhyodenseareainthecavitydosenotchangeinenhancement.MRI：TheabscesshavelongT1andT2relaxationtimeswithsurroundingedema.Thereisringenhancementoftheuniformthickabscesswall.Theabscesscavityhavenotenhancement.2、cerebralcysticercosisLarvalofTaeniasoliumparasitizeinbrain.Cerebrallarvalinfestationischaracterizedbyafluid-filledcystwithamuralsoft-tissuenodule.thediseasecanbeenclassifiedaslarvallivingstage,larvaldeathstage,calcificationstage.MultipleMultiplespotlikespotlikehigh-densitywithsimilarsizeinbrain.high-densitywithsimilarsizeinbrain.CT:CT:MRI:MRI:Accompaniedbyedema,themultiplecystswithAccompaniedbyedema,themultiplecystswithlongT1andT2signalarenomorethan1cminlongT1andT2signalarenomorethan1cmindiameter,diameter,larvallivingstage:larvallivingstage:Thelow-densitycystsoccuringroupswithThelow-densitycystsoccuringroupswithspotlikespotlike muralnodule.muralnodule.Calcificationstage:Calcificationstage:二二.NormalmanifestationExaminationofspinalcord一、一、ExaminationmethodMRICTCTMyelographyMyelographyX-rayX-rayspinalcanal:11mmlong,16mmwide,Spinalcord:columniform,smoothmargin,homogeneous三、三、三、三、IntramedullaryIntramedullaryIntramedullaryIntramedullary tumor are predominantly tumor are predominantly tumor are predominantly tumor are predominantly ependymomaependymomaependymomaependymoma and and and and astrocytoma.(aboutastrocytoma.(aboutastrocytoma.(aboutastrocytoma.(about 90%of all 90%of all 90%of all 90%of all intraspinalintraspinalintraspinalintraspinal tumors)tumors)tumors)tumors)TheoutlineofMRIdiagnosis1.thespinalcordisenlargedandthelesionisextensive2.Thesubarachnoidspacearoundthespinalcordisnarrowedorblocked3.secondarysyringohydromyelia4.ThetumorsareslightlyhypointenseonT1andslightlyhyperintenseonT2.Enhancementcanbeenseen.4 4、ExtramedullaryExtramedullary intraduralintradural tumor tumorwhichiscomposedprincipallyofmeningiomasandnervesheathtumorsTheoutlineofMRIdiagnosis1.spinalcorddisplacementtothecontralateralside2.Thesubarachnoidspaceonthesideofthetumorisdilated3.Thetumorislocalizationwithclearmargin4.ThetumorisisointensityonbothT1andT2withobviousenhancement.五、五、ExtramedullaryExtramedullary extraduralextradural tumor tumorMalignantlymphomaandmetastasisisusuallyobservedTheoutlineofMRIdiagnosis4.slighthypointensityonT1andslighthyperintensityonT2,enhancementcanbeenseen.3.spinalcorddisplacementtothecontralateralsideandnarrowsubarachnoidspaceonthesideofthetumor2.Duraisshownashypointensitybetweenthetumorandspinalcord.1.Thetumorsareflatandextendtoalargearea.六、六、Spinal cord injurySpinal cord injuryTheoutlineofMRIdiagnosis1.spinalcordedema:hypointensityonT1andhyperintensituonT22.Spinalcordhemorrhage:Thesignalsevolvementwerethesamewithintracerebralhematoma.3.Spinalcordtransectioninjury:thespinalcordsignalsareinterrupted.4.Spinalcordintenerate:hypointensityonT1andhyperintensituonT2ThevertebralcolumnandspinalcordinjuryTheinjuryconsistsoffractureofvertebralbodyandappurtenance,spinalcordconcussion,spinalcordcontusionspinalcordcompression,spinalcordtransverseinjuryandhematoma，nervenerverootsavulsion,rootsavulsion,spinalcordintenerateandsoon.MRIisthefirstofchoice.谢谢