中枢02Central Nervous System.ppt

Central Nervous System 南京医科大学第一附属医院放射科 洪汛宁 hongxunning@ Intracranial tumors In the diagnostic work-up of intracranial tumors, the primary goals of the imaging studies are to detect the abnormality, localize and determine its extent, characterize the lesion, and provide a list of differential diagnoses or, if possible, the specific diagnosis. Imaging diagnosis 1. Is there a tumor? 2. If yes, where is it located and what is its functional topography? 3. What does the tumor look like and how does it affect the brain? 4. Could it be something else, i. e., a non-neoplastic lesion? 5. What are the therapeutic options and what might be the prognosis? 6. Can advanced imaging methods contribute to improve therapy and outcome? 基本流程basic flowsheet 核对资料check data 临床资料clinical data 影像资料imaging data 综合分析得出诊断 Analysis to get the diagnosis 临床资料clinical data 姓名、性别、年龄 name 、sex 、 age 不同肿瘤有特定的好发年龄段 新生儿最好发的肿瘤为畸胎瘤、原始神经上皮肿瘤等 2-10岁的儿童原发性脑肿瘤以后颅凹多见，多为良性。最常见的有毛细胞型星形细胞瘤、髓母细胞瘤、脑干胶质瘤和第四脑室室管膜瘤 年轻人，低度恶性星形细胞瘤多见 中年人，间变型星形细胞瘤多见 老年人，多形性胶母细胞瘤多见 临床资料clinical data 病程course 发病特点the onset of illness 既往病史history 实验室资料laboratory data 治疗情况treatment 影像资料imaging data 定位Localization 占位效应mass effect 病灶形态the form 病灶质地（成分） Internal texture 定位Localization 部位location：大脑半球、鞍区、中线和幕下（脑干、桥小脑角、小 脑半球、蚓部） 位置position：脑内、脑外、脑室内 肿瘤发病部位有其特征性 脑内肿瘤可显示局部脑回肿胀、邻近蛛网膜下腔变窄或闭塞、瘤周脑血管受压移位等占位征象 脑外肿瘤:肿块区脑灰白质向中央移位、局部脑血管和硬脑膜向内移位、同侧局部蛛网膜下腔增宽和脑膜尾征等 脑膜瘤累及脑组织，脑转移瘤合并脑膜和颅骨转移时，鉴别较为困难 发病部位 最常见的幕上脑内肿瘤为多形性胶母细胞瘤、转移瘤；脑外肿瘤则为脑膜瘤 最常见的幕下脑内肿瘤为血管母细胞瘤和转移瘤；脑外肿瘤则为神经鞘瘤 占位效应mass effect 有或无要考虑两类不同病变 病灶形态the form 大小dimension 形状shape 轮廓contour 数目number 边缘margin 周围结构Peripheral structure 病灶质地（成分） Internal texture 脂肪fat 囊肿cyst 骨骼skeleton 钙化calcification 液化Liquefaction 坏死necrosis 囊变cystic degeneration 出血hemorrhage 常见脑肿瘤影像诊断 神经胶质瘤glioma 脑膜瘤meningioma 垂体腺瘤pituitary adenoma 颅咽管瘤craniopharyngioma 生殖细胞瘤germinoma 听神经瘤acoustic neuroma 脑转移瘤metastasis 胶质瘤（星形细胞肿瘤） 最常见的脑肿瘤 占颅内肿瘤17%，占神经上皮源性肿瘤40% 幕上多见 主要症状为癫痫 幕上Ⅰ-Ⅱ星形细胞瘤 CT：好发于额叶，其次颞叶、顶叶、小脑和脑干。平扫多表现为脑内均匀的低密度