醫(yī)學(xué)影像學(xué)教學(xué)大綱（七年制）二第二章中樞神經(jīng)系統(tǒng)一、目的與要求.了解顱腦和脊髓的檢查方法；.熟悉顱腦和脊髓的X線、CT和MRI正常解剖；.掌握顱腦和脊髓的基本病變的影像學(xué)表現(xiàn)，尤其CT、MRI表現(xiàn);.掌握常見顱內(nèi)腫瘤、腦血管疾病、外傷、常見感染性疾病的影像學(xué)表現(xiàn)；.熟悉脊髓疾病的影像學(xué)表現(xiàn)。二、教學(xué)內(nèi)容第一節(jié)檢查方法1．顱腦（1）X線檢查：平片、血管造影；（2）CT檢查：平掃、增強(qiáng)、CTA以及CT灌注掃描;（3）MRI檢查：側(cè)重常規(guī)序列的講解，簡(jiǎn)單介紹功能成像。2．脊髓（1）X線平片：常規(guī)正側(cè)位；（2）脊髓造影：了解適應(yīng)癥；（3）CT檢查：平掃、增強(qiáng)以及脊髓造影CT（CTM）；MRI檢查：側(cè)重常規(guī)序列的講解，簡(jiǎn)單介紹MR脊髓成像(MRM)。第二節(jié)正常影像解剖1．頭顱平片的正常表現(xiàn)和變異，側(cè)重講述顱縫、囟門、顱壁壓跡、蝶鞍的表現(xiàn)；.顱腦CT、MRI橫斷面正常表現(xiàn)；.脊髓CT、MRI正常表現(xiàn)。第三節(jié)基本病變的影像學(xué)表現(xiàn)1．顱腦(1)平片：側(cè)重講解顱內(nèi)壓增高、顱內(nèi)腫瘤定位征象；CT和MRI：分別講解顱內(nèi)病變的病灶顯示、強(qiáng)化表現(xiàn)、腦水腫、占位效應(yīng)、腦積水和腦萎縮的表現(xiàn)；.椎管內(nèi)腫瘤簡(jiǎn)單介紹X線平片和脊髓造影的表現(xiàn)。第四節(jié)顱內(nèi)腫瘤1．神經(jīng)膠質(zhì)瘤：熟悉星形細(xì)胞瘤、少突膠質(zhì)細(xì)胞瘤和髓母細(xì)胞瘤的臨床和病理表現(xiàn)，掌握其CT和MRI征象。.腦膜瘤：熟悉其臨床和病理表現(xiàn)，掌握CT和MRI征象。.垂體腺瘤：了解其分類和臨床表現(xiàn)，掌握微腺瘤和大腺瘤的CT和MRI特點(diǎn)。.顱咽管瘤：熟悉其好發(fā)部位、病理特點(diǎn)以及CT、MRI診斷依據(jù)。.生殖細(xì)胞瘤：熟悉其好發(fā)部位、病理特點(diǎn)以及CT、MRI診斷依據(jù)。.聽神經(jīng)瘤：熟悉其病理改變，掌握CT和MRI表現(xiàn)，了解橋小腦角占位的鑒別診斷。.血管母細(xì)胞瘤：了解其病理特點(diǎn)，熟悉CT和MRI表現(xiàn)。.腦轉(zhuǎn)移瘤：熟悉其臨床和病理表現(xiàn)，掌握CT和MRI特點(diǎn)。第五節(jié)腦血管疾病.腦梗死：結(jié)合動(dòng)脈性腦梗死后的病理生理改變，重點(diǎn)掌握常規(guī)CT和MRI表現(xiàn)；熟悉腔隙性腦梗死和出血性腦梗死的CT和MRI診斷要點(diǎn)。.腦出血：結(jié)合腦出血不同時(shí)期的病理改變，著重講述常規(guī)CT和MRI表現(xiàn)；.結(jié)合病例，熟悉蛛網(wǎng)膜下腔出血、動(dòng)靜脈畸形、動(dòng)脈瘤的CT、MRI、DSA的表現(xiàn)。第六節(jié)顱腦外傷.硬膜外血腫：了解本病的發(fā)生機(jī)理、病理改變，掌握其CT和MRI表現(xiàn)。.硬膜下血腫：了解本病的發(fā)生機(jī)理、病理改變，掌握其CT和MRI表現(xiàn)。.腦挫裂傷：了解本病的發(fā)生機(jī)理、病理改變，掌握其CT和MRI表現(xiàn)。.彌漫性軸索損傷：自學(xué)。第七節(jié)顱內(nèi)感染性疾病.化膿性腦膿腫：了解發(fā)病機(jī)制、病理表現(xiàn)，掌握其CT、MRI典型表現(xiàn)。.顱內(nèi)結(jié)核：熟悉CT、MRI表現(xiàn)。.病毒性腦炎：自學(xué)內(nèi)容。.腦囊蟲?。鹤詫W(xué)內(nèi)容。第八節(jié)脫髓鞘疾病本節(jié)簡(jiǎn)單介紹多發(fā)性硬化的影像學(xué)表現(xiàn)。第九節(jié)顱腦先天性畸形及發(fā)育障礙本節(jié)為自學(xué)內(nèi)容。第十節(jié)脊髓疾病結(jié)合病例，介紹常見的脊髓內(nèi)腫瘤（室管膜瘤、星形細(xì)胞瘤）、髓外硬膜下腫瘤（神經(jīng)鞘瘤、神經(jīng)纖維瘤、脊膜瘤）的CT和MRI表現(xiàn)。脊髓損傷、脊髓空洞癥為自學(xué)內(nèi)容。三、實(shí)驗(yàn)內(nèi)容與要求通過(guò)示教片了解中樞神經(jīng)系統(tǒng)的平片、造影檢查、CT和MRI檢查方法；通過(guò)示教片熟悉顱腦和脊髓平片、C^MRI正常影像；熟悉顱腦和脊髓異常表現(xiàn)；11通過(guò)示教片掌握神經(jīng)膠質(zhì)瘤、腦膜瘤、垂體腺瘤、聽神經(jīng)瘤、腦轉(zhuǎn)移瘤、腦梗死、腦出血、顱腦外傷、化膿性腦膿腫、脊髓內(nèi)腫瘤、髓外硬膜下腫瘤的影像學(xué)表現(xiàn)。熟悉顱咽管瘤、生殖細(xì)胞瘤、血管母細(xì)胞瘤、蛛網(wǎng)膜下隙出血、動(dòng)靜脈畸形、動(dòng)脈瘤、顱內(nèi)結(jié)核、脊髓空洞癥的影像學(xué)表現(xiàn)。四、教學(xué)時(shí)數(shù)分配理論課學(xué)時(shí)分配章節(jié)理論課內(nèi)容學(xué)時(shí)第二章第一節(jié)第二節(jié)檢查方法顱腦正常影像表現(xiàn)脊髓正常影像表現(xiàn)1第二章第三節(jié)顱腦基本病變的影像學(xué)表現(xiàn)椎管內(nèi)腫瘤的基本影像學(xué)表現(xiàn)第二章第四節(jié)顱內(nèi)腫瘤：側(cè)重講解神經(jīng)膠質(zhì)瘤、腦膜瘤、垂體腺瘤、聽神經(jīng)瘤、腦轉(zhuǎn)移瘤；簡(jiǎn)單介紹顱咽管瘤、生殖細(xì)胞瘤、血管母細(xì)胞瘤11第二章第五節(jié)腦血管疾?。褐攸c(diǎn)講解腦梗死、腦出血；簡(jiǎn)單介紹蛛網(wǎng)膜下隙出血、動(dòng)靜脈畸形、動(dòng)脈瘤11第二章第六節(jié)顱腦外傷：重點(diǎn)講解硬膜外血腫、硬膜下血腫和腦挫裂傷1第二章第七節(jié)顱內(nèi)感染性疾?。褐攸c(diǎn)講授化膿性腦膿腫，簡(jiǎn)單介紹顱內(nèi)結(jié)核、病毒性腦炎1第二章第八節(jié)第二章第十節(jié)脫髓鞘疾?。汉?jiǎn)單介紹分類和多發(fā)性硬化脊髓疾?。褐攸c(diǎn)講解椎管內(nèi)腫瘤1總學(xué)時(shí)9實(shí)驗(yàn)課學(xué)時(shí)分配序號(hào)實(shí)習(xí)課內(nèi)容實(shí)驗(yàn)類型學(xué)時(shí)1讀片內(nèi)容：顱腦、脊髓正常表現(xiàn)：基本病變；顱內(nèi)腫瘤的影像學(xué)表現(xiàn)演示性實(shí)驗(yàn)22讀片內(nèi)容：腦血管疾病、腦外傷、腦感染性疾病以及脫髓鞘疾病；椎管內(nèi)腫瘤演示性實(shí)驗(yàn)24思考題.顱內(nèi)壓增高的X線診斷？.星形細(xì)胞瘤的組織學(xué)分級(jí)和CT、MRI表現(xiàn)？.腦膜瘤的CT和MRI診斷要點(diǎn)？.垂體大腺瘤的MRI表現(xiàn)？.常見的橋小腦角區(qū)腫瘤的CT和MRI鑒別診斷？.缺血性腦梗死的CT和MRI表現(xiàn)？.不同時(shí)期腦出血的MRI信號(hào)特點(diǎn)？.硬膜外血腫和硬膜下血腫的CT鑒別診斷？Chapter2Centralnervoussystem一、Requirement.Comprehendexaminationmethodsforbrainandspinalcord..Conversantwithnormalanatomyappearanceofbrainandspinalcordinx-ray,CTandMRI..Masterimageappearanceofbasicdiseaseinbrainandspinalcord,especiallyCTandMRIones..Masterimageappearanceofcommonintracranialtumors,cerebrovasculardisease,traumaandcommoninfectivedisease..Conversantwithimageappearanceofspinaldisease.二、TeachingContentSection1Examinationmethod1.Brainx-ray:plainfilmandangiography（comprehend）CT:allexaminationtechnique（comprehend）MRI:emphasizeonconventionalsequenceandsimplypresentfunctionalMRI2.Spine（1）X-rayplainfilm：posterior-anteriorandlateralpositionisroutine.（2）Spinalmyelography（3）CT：plainscan,contrastscanandCTmyelography（CTM）；（4）MRI：emphasizeonconventionalsequenceandsimplypresentMRmyelography.NormalimaginganatomyNormalappearanceandvarianceinskullplainfilm,emphasisoncranialsuture,fontanelles,impressionofcranialboneandsellaturcicaCTandMRIsectionalanatomyofbrainNormalappearanceofspinalcordinCTandMRIImageappearanceofbasicdisease1.Brain（1）Plainfilm:locationsymptomofincreasedintracranialpressureandbraintumors（2）CTandMRI：displayinglesions,enhancementappearance,cranialedema,commonmasseffect,hydrocephalusandbrainatrophy.ntraspinaltumorsComprehendimageappearanceofx-rayfilmandmyelography.Intracranialtumors.Gliomas：Mastermainmanifestationofastrocytoma,oligodendrogliomaandmedulloblastomainCTandMRIafterbefamiliarwiththeirclinicandpathologicfindings..Meningioma：MastermainsigninCTandMRIafterbefamiliarwiththeirclinicandpathologicfindings..Pituitaryadenoma：FirstcomprehenditsclassandclinicfindingsandthenmastermaincharacteristicsinCTandMRI..Craniopharynioma：Befamiliarwithitscommonposition,pathologiccharacteristicsanddiagnosispointsinCTandMRI..Germinoma：Befamiliarwithitscommonposition,pathologiccharacteranddiagnosispointsinCTandMRI..Acousticneurinoma：Befamiliarwithitspathologiccharacteristics,masterCTandMRImanifestation,andthencomprehenddifferentiatingdiagnosisoftumorsincerebral-pontinalanglearea..Hemangioblastoma：ComprehenditspathologiccharacterandknowwellCTandMRIfindings..Metastatictumors：BefamiliarwithitsclinicandpathologicfindingsandmasteritsCTandMRIcharacter.Cerebrovasculardisease.Cerebralinfarction:Combiningphysiologicpathologyofcerebralischemiaresultingfromthrombosisofcerebralartery,emphaseonconventionalimageappearance,andthenknowwelldiagnosticpointsoflacunarinfarctionandhemorrhagicinfarctioninCTandMRIscans..Cerebralhemorrhage:Combiningpathologicalvariationindifferentperiods,emphaseonimageappearanceofCTandMRI..Combiningcases,introducecharacteristicsaboutsubarachnoidspacehemorrhage,arteriovenousmalformationandintracranialaneurysminCTMRIandDSA.InjuryofskullandbrainCombiningpathogenisiswithpathology,introduceimageappearanceespeciallytheCTscansofepiduralhematoma,subduralhematomaandcontusionandlacerationofbrain.Intracranialinfectivedisease1．Cerebralabscess：MastertypicalimageappearanceofinCTandMRI2．Cranialtuberculosis：BefamiliarwithCTandMRImanifestation.DemyelinatingdiseaseIntroducesimplytheimagingappearanceofmultiplesclerosis.CranialcongenitalmalformationSelf-culture.SpinalcorddiseaseCombiningcases,introducecharacteristicsaboutependymatoma,astrocytoma,neurinoma,neurofibromaandmeningiomainCTandMRI.ExperimentContentandRequirementUnderstandingimagingmethodsbyreadingfilm.Understandingthenormalmanifestationsandbasicabnormalfindingsofbrainandspineinplainfilm,CTandMRIbyreadingfilm.Masteringtheimagingfindingsofglioma,meningioma,pituitaryadenoma,acousticneurinoma,metastatictumors,infarction,hemorrhage,trauma,abscess,intraspinaltumorsandsubedrualtumorsbyreadingfilm.Beingfamiliarwithcraniopharynioma,germinoma,hemangioblastoma,sudarachnoidhemorrhage,aterio-venousmalformation,aneurysm,tuberculosisandsyringomyeliabyreadingfilm.CourseplanTheorylessonChapterContentsTimeTwo-One-TwoImagingmethodsNormalimaginganatomyofbrainandspine1Two-ThreeBasalabnormalappearanceofbrainandspine1Two-FourCranialtumors:glioma,meningioma,pituitaryadenoma,acousticneurinoma,metastatictumors2Two-Fivecerebrovasculardiseases:cerebralinfarction,hemorrhage2Two-SixBraintrauma:epiduralhematoma,subduralhematoma,lacerationandcontusionofbrain1Two-SevenCranialinfectivediseases:brainabscess1Two-Eight-TenDemyelinatingdiseases:MultiplesclerosisSpinaldiseases1Alltogether9ExperimentlessonNumberContentsCategoryTime1Readingfilmscontents:Normalimaginganatomyandbasalabnormalappearanceofbrainandspine,cranialtumorsDemonstrating22Readingfilmscontents:cerebrovasculardiseases,braintrauma,Cranialinfectivediseases,DemyelinatingdiseasesandSpinaldiseasesDemonstrating2Alltogether4Questions1．WhatisthelocationsymptomofincreasedintracranialpressureinX-rayplainfilm?2．WhatisthehistologicalclassificationandCTandMRIappearanceofastrocytoma?3．WhatisthediagnosticpointofmeningiomainCTandMRI?4．WhatistheMRIfindingsifpituitaryadenoma?5．Whatisthedifferentiatingdiagnosisofcommontumorsincerebral-pontinalanglearea?6．WhatisthetypicalmanifestationofischemiainfarctioninCTandMRI?7．Combiningpathologicalvariationindifferentperiods,presentMRIintensitycharacteristics?8．DifferentiatingdiagnosisbetweenepiduralandsubduralhematomainCT?第三章頭