医学影像学课件：中枢04

1、1Central Nervous System2脊柱和脊髓MRI组织分辨率高准确显示各解剖结构显示多种病理改变MRI多平面多参数成像MRI是诊断脊髓病变的最佳选择3腰椎矢状位 T1WI,T2WI456正常影像表现脊椎和椎间盘椎管椎管内结构7Normal anatomy of lumbar spine8Spinal canal脊椎腔Neuroforamen神经孔bonediscDural sac9脊髓病变椎管内肿瘤脊柱脊髓先天畸形和发育障碍10spinal cord neoplasmsIntramedullary spinal cord neoplasms are rare, accountin

2、g for about 4%10% of all central nervous system tumors. Despite their rarity, these lesions are important to the radiologist because MRI is the preoperative study of choice to narrow the differential diagnosis and guide surgical resection. 11椎管内肿瘤分类髓内肿瘤室管膜瘤星形胶质细胞瘤髓外硬膜内肿瘤神经鞘瘤、神经纤维瘤脊膜瘤硬膜外肿瘤转移瘤、淋巴瘤、脂肪瘤

3、12Snake in HouseNormal Anatomy13Three LocationsIntramedullaryIntraduralextramedullaryExtradural14Intramedullary15IntraduralExtramedullary16Extradural1718LEARNING OBJECTIVES List the essential imaging features of intramedullary spinal cord neoplasms. Identify the characteristic imaging appearances of

4、 the different types of intramedullary spinal cord neoplasms that allow a specific diagnosis to be favored. 19Three Important TenetsCord expansion At least some enhancement Cysts are a common associated finding in the setting of an intramedullary spinal tumor 20室管膜瘤Ependymoma占髓内肿瘤60%起源于脊髓中央管室管膜细胞或室管

5、膜残留物好发部位：腰骶段、脊髓圆锥、终丝良性，呈膨胀性生长21CT脊髓密度均匀性降低，不规则膨大边缘模糊，常见囊变轻度强化或不强化22Intramedullary astrocytoma in an 18-year-old woman with progressive paresis, paresthesia of the lower extremities, and difficulty voiding. CT myelogram shows a near-compete block of intrathecal contrast material (arrowheads) secondar

6、y to an intramedullary mass. 23MRI表现脊髓明显局限性增粗T1WI为均匀低信号T2WI为均匀高信号可发生出血、囊变或合并脊髓空洞增强后均匀强化，囊变区无强化室管膜瘤 1390477 女 67岁252627Ependymoma28Ependymoma29Ependymoma30星形细胞瘤Astrocytoma占髓内肿瘤40%，以胸颈段为多病变一般局限，可浸润生长脊髓增粗，与正常无明显界限31CT平扫呈略低密度，少数高密度边界不清增强后强化不均一囊变常见32MRIT1WI低信号T2WI高信号，由于水肿T2范围T1出血、坏死、囊变，信号不均实质部分明显强化星形细胞瘤

7、1405370 男 5岁3435363738肺癌病史396个月后肺癌髓内转移409个月后41增强4259/M 肺癌43神经鞘瘤neurinoma最常见椎管内肿瘤髓外硬膜内肿瘤神经鞘瘤起源于神经鞘膜的雪旺细胞44CT圆形实质性肿块，密度较脊髓略高，脊髓受压移位中等强化椎间孔扩大，椎弓根骨质吸收哑铃状45MRI表现脊髓受压、移位、患侧蛛网膜下腔扩大边缘光滑、境界锐利的圆形、卵圆形或哑铃状肿块影多位于脊髓背侧T1WI低信号，T2WI为高信号可发生囊变、信号不均匀4647C1-2神经鞘瘤484950后纵隔占位F/55515253神经鞘瘤54 F42神经鞘瘤 55 F42神经鞘瘤 56神经鞘瘤57脊膜瘤

8、spinal meningioma髓外硬膜内肿瘤，多位于胸段起源于蛛网膜细胞呈宽基底与硬脊膜粘连较紧58CT胸段蛛网膜下腔后方实质性肿块，局限，椭圆形或圆形，有完整包膜中等率强化59MRI表现病变处脊髓受压移位类圆形肿块，境界清楚T1WI呈低信号或等信号，T2WI呈高信号或等信号合并囊变或钙化，信号可不均匀显著强化，可出现脊膜尾征6061F/286263646566脊膜瘤标记定位67脊膜瘤68脊柱脊髓先天畸形和发育障碍脊膜膨出和脊髓脊膜膨出脊髓空洞征69脊膜膨出meningocele和脊髓脊膜膨出meningomyelocele脊膜通过脊椎缺损部位向外呈囊袋状膨出脊髓脊膜膨出是脊髓、脊神经、马尾与囊壁粘连并同时突出于椎管外腰骶部最常见，颈椎次之70腰骶部脊柱裂、脊膜膨出71脊髓脊膜膨出72脊髓空洞症syringomyelia病理特征脊髓内出现空洞洞壁由增生的胶质组织构成交通性脊髓空洞症脊髓积水、空洞伴有Chiari畸形无肿瘤、外伤或蛛网膜炎伴有肿瘤的脊髓空洞症外伤后脊髓空洞症特发性脊髓空洞症73交通性脊髓空洞症MRI表现空洞位于脊髓中央，呈管状囊腔空洞内见水样信号脊髓增粗，脊髓实质变薄74Chiari 畸形75Chia