1、Intracranial tumors顱內(nèi)腫瘤1Plane film:Cerebral angiography:腦血管造影 CT and MRI: main methods 2Differential diagnosis by location and age通過(guò)位置和年齡鑒別診斷According location: Intraaxial within the brain parenchyma腦實(shí)質(zhì)內(nèi) Extraaxial lying outside of the brain parenchyma (meninges, subarachnoid, subdural or epidural s

2、paces, bony calvarium)腦實(shí)質(zhì)外（腦膜，蛛網(wǎng)膜下，硬膜下，硬膜外間隙，顱骨）3Intraaxial brain tumorsGliomas神經(jīng)膠質(zhì)瘤Metastases轉(zhuǎn)移瘤Primary lymphoma原發(fā)性淋巴瘤Primitive neuroectodermal tumors 原始神經(jīng)外胚層腫瘤4Extraaxial brain tumorsMeningioma腦膜瘤 Pituitary adenoma垂體腺瘤Metastases轉(zhuǎn)移瘤Schwannomas神經(jīng)鞘瘤Chordomas 脊膜瘤Craniopharyngiomas顱咽管瘤 5Predominantly a

3、dult brain tumors主要的成人腦腫瘤Metastases轉(zhuǎn)移瘤Glioblastoma multiforme多發(fā)性惡性膠質(zhì)瘤Anaplastic astrocytoma間變型星形細(xì)胞瘤Fibrillary astrocytoma纖維性星形細(xì)胞瘤Oligodendrogioma少突膠質(zhì)細(xì)胞瘤Pituitary adenoma垂體腺瘤Meningioma hemangioblastoma腦膜成血管細(xì)胞瘤6Predominantly pediatric brain tumorsPNET: medulloblastoma髓母細(xì)胞瘤 pineoblastoma松果體母細(xì)胞瘤Juvenile

4、 pilocytic astrocytoma 少突星形細(xì)胞瘤Lipoma脂肪瘤Germinomas生殖細(xì)胞瘤Craniopharyngioma顱咽管瘤7Astrocytoma星形細(xì)胞瘤Arising from cells of glial origin起源于神經(jīng)膠質(zhì)細(xì)胞Most common in the CNS (about 50%) 大多數(shù)來(lái)自中樞神經(jīng)系統(tǒng)Most common glial tumor is a low grade (grade -) astrocytoma多為低級(jí)別的膠質(zhì)瘤Most malignant form (grade -) is glioblastoma mult

5、iforme (GBM) 大多數(shù)惡性形式是多形性膠質(zhì)母細(xì)胞瘤8CT FINDINGS OF ASTROCYTOMAHypodense mass低密度占位Mass effect占位效應(yīng)Irregular outer margin不規(guī)則邊界Enhancement varies from no enhancement to patchy 從無(wú)強(qiáng)化到斑狀強(qiáng)化 9Astrocytoma post-contrastPre-contrast1011Astrocytoma12MRI FINDINGS OF ASTROCYTOMAT1WI: Hypo-intensity（低信號(hào)）T2WI: Hyper-inte

6、nsity（高信號(hào)）13Astrocytoma1415Glioblastoma multiforme多形性膠質(zhì)母細(xì)胞瘤CT imaging Mixed low density tumor (necross) 混雜低密度（壞死） Hemarrhage Surrounding low density edema 周?chē)兔芏?水腫 Mass effect (compression and displacement) Irregular contrast enhancement16C_C_C+C+171819Glioblastoma multiformeMRI imaging Mixed intens

7、ity on both T1WI and T2WI Hemarrhage Edema Mass effect (compression and displacement) Irregular contrast enhancement20GLIOBLASTOMA MULTIFORME212223Meningioma腦膜瘤 One of the more common intracranial neoplasms常見(jiàn)的顱內(nèi)腫瘤The most common non-glial primary brain tumor最常見(jiàn)的非膠質(zhì)源性腦腫瘤Represent 15%-20% of all prima

8、ry brain tumorsMost are benign, malignant types are uncommon大多為良性，惡性少見(jiàn)Usually grow slowly通常生長(zhǎng)緩慢24Meningioma Most often in adult多見(jiàn)于成人Predominance in female 多見(jiàn)于女性Common location: Cerebral convexities腦的凸面 Falx cerebri大腦鐮 Sphenoid wing蝶骨翼90% are supratentorial 90%幕上25CT findingsFrequently mild high atte

9、nuation (higher than normal brain) 通常是中高密度（比正常腦組織密度高）Extra-axial masses, adjacent to dura matter 與硬腦膜相連 Calcification鈣化Edema, low density水腫，低密度Nearly all meningiomas show intense contrast enhancement 幾乎所有的腦膜瘤均有強(qiáng)化Dural tail sign硬膜尾征Cyst formation is less common囊形成少見(jiàn)Osteoblastic reaction (hyperostosis

10、) 成骨細(xì)胞反應(yīng)（骨質(zhì)增生）26MENINGIOMA 27MENINGIOMA 2829MRI findingsSmoothly marginated broad-based tumor 邊界平滑的寬基底腫瘤T1WI: isointense to gray matter, or hypointense (less common) 與灰質(zhì)相比呈等或略高信號(hào)T2WI: isointense 50% hyperintense 40%Often inhomogeneous呈不均性Enhancement is uniform, rapid, and intense3031POST-CONTRAST32M

11、ENINGIOMAT2WI3334MENINGIOMA 35 acoustic neurilemoma聽(tīng)神經(jīng)瘤36Plain平掃Enhancement 強(qiáng)化37acoustic neurilemoma38聽(tīng)神經(jīng)瘤MRI39acoustic neurilemoma40acoustic neurilemoma41acoustic neurilemoma42METASTASIS轉(zhuǎn)移瘤Hematogenous metastasis血源性轉(zhuǎn)移瘤Other types of metastasis spread (extending, spread through CSF, meningeal spread

12、)其他類(lèi)型的轉(zhuǎn)移瘤播散（擴(kuò)散，通過(guò)腦脊液，腦膜轉(zhuǎn)移）Lung and breast cancer commonly spread to brain肺癌和乳腺癌通常轉(zhuǎn)移到腦43METASTASISOften be found at the gray-white matter junction, but everywhere can be seen通常在灰白質(zhì)交接處較多見(jiàn)Edema Mass effectHemorrhage Multiple44Metastasis45METASTASIS4647METASTASIST1WIT2WI Gd48 ANEURYSM 動(dòng)脈瘤PRE AND POST EN

13、HANCEMENT CTCT ANGIOGRAPHY，CTAMRIMR ANGIOGRAPHY，MRADSA （GOLD STANDARD）49TYPE （WITHOUT THROMBUS）（無(wú)血栓）CT: round, oval, or lobulated lesion similar in attenuation to blood vessels but larger than the adjacent arteries. Calcification is occasionally present within an aneurysm.CT：圓形，或卵圓形，與血管內(nèi)密度相同，但比相鄰動(dòng)脈大。偶爾有鈣化.MRI: flow-void effect50TYPE （WITHOUT THROMBUS）51TYPE I52TYPE I53TYPE I54TYPE （WITH THROMBUS）55 TYPE II56 TYPE II57 ANEURYSMWITH HEMORRHAGE58CERABRAL VASCULAR MAIFORMATION腦血管畸形ARTERIO-VENOUS MALFORMATION動(dòng)靜脈畸形VENOUS MA