胼胝体病变的影像学诊断.ppt

《胼胝体病变的影像学诊断.ppt》由会员分享，可在线阅读，更多相关《胼胝体病变的影像学诊断.ppt（54页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体病变影像学诊断胼胝体病变影像学诊断The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体解剖学概述胼胝体解剖学概述胼胝体发育不良胼胝体发育不良胼胝体变性胼胝体变性胼胝体出血胼胝体出血胼胝体梗死胼胝体梗死 胼胝体肿瘤胼胝体肿瘤The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体解剖学概述胼胝体

2、位于大脑半球纵裂的底部连接左右两侧大脑半球的横行神经维束大脑半球中最大的连合纤维神经纤维在两半球中间形成弧形板28 十月 20223The First Affiliated Hospital Zhejiang Chinese Medical University 膝向下弯曲变簿称嘴部膝向下弯曲变簿称嘴部前方弯曲部为膝部前方弯曲部为膝部 中间为体部中间为体部后端为压部后端为压部28 十月 20224胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 膝向下弯曲变簿称嘴部膝向下弯曲变簿称嘴部前方弯曲部为

3、膝部前方弯曲部为膝部 中间为体部中间为体部后端为压部后端为压部28 十月 20225胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 功能功能胼胝体连合纤维能将一侧大脑皮层的活动向另一侧转送发挥左右半球相关各区的联合功能负责沟通两半球的信息出传导28 十月 20226胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 血供血供胼胝体前4/5供血：大脑前动脉前交通动脉胼周动脉胼胝体后1/5供血：大脑后动脉

4、后脉络膜动脉28 十月 20227胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 血供血供大脑前动脉中央短动脉-胼胝体膝部胼胝体动脉-胼胝体压部胼胝体缘动脉-胼胝体28 十月 20228胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 血供血供前交通动脉胼胝体正中动脉-胼胝体下回大脑后动脉胼胝体背侧动脉-胼胝体背侧28 十月 20229胼胝体解剖学概述The First Affiliated Hos

5、pital Zhejiang Chinese Medical University 病理改变：胼胝体缺如胼胝体部分缺如 -仅膝部存在胼胝体萎缩 28 十月 202210胼胝体发育不良The First Affiliated Hospital Zhejiang Chinese Medical University 影像学表现胼胝体缺如：侧脑室周边环绕的白质结构丢失并且导致侧脑室膨胀主要是侧脑室三角区和枕角侧脑室前角旁，由于尾状核头相对坚实，可以维持侧脑室前角的正常形态侧脑室体部变直、平行、分离三脑室高位 半球间裂增宽28 十月 202211胼胝体发育不良The First Affiliated

6、Hospital Zhejiang Chinese Medical University 胼胝体发育不良28 十月 202212侧脑室平行分离，双侧三角区及枕角扩张侧脑室平行分离，双侧三角区及枕角扩张侧脑室表现为新月形侧脑室表现为新月形The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体发育不良28 十月 202213三脑室高位三脑室高位 半球间裂增宽半球间裂增宽The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体发育不良2

7、8 十月 202214 患者，患者，4y 4y，癫痫发作五次，智力比同龄儿低下癫痫发作五次，智力比同龄儿低下The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体发育不良28 十月 202215 The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体发育不良28 十月 202216 仅膝部存在仅膝部存在The First Affiliated Hospital Zhejiang Chinese Medical Universit

8、y 胼胝体发育不良28 十月 202217 正常胼胝体正常胼胝体胼胝体部分缺如胼胝体部分缺如The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体发育不良28 十月 202218 影像学表现影像学表现 -胼胝体缺如并灰质异位胼胝体缺如并灰质异位右侧侧脑室旁结节状脑灰质信号影右侧侧脑室旁结节状脑灰质信号影The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体发育不良28 十月 202219 影像学表现影像学表现 -胼胝体发育不良合

9、并脂肪瘤胼胝体发育不良合并脂肪瘤位于中线位于中线几乎对称的脂肪肿块几乎对称的脂肪肿块The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体发育不良28 十月 202220 胼胝体体部局部变薄胼胝体体部局部变薄 影像学表现影像学表现 -胼胝体萎缩胼胝体萎缩The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性概念：又称原发性胼胝体变性也称为 Marchiafave-Bignami 综合征病理特点:胼胝体对称性脱髓鞘、坏死和萎缩

10、也常累及附近白质和脑桥中央28 十月 202221The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性临床表现：急性：可以表现为突发的意识障碍、精神症状癫痫发作、构音障碍、甚至发展为植物状态慢性：主要表现为进行性全面痴呆、情感淡漠、精神运动迟滞、构音障碍、吞咽困难、部分或完全性大脑半球间失联合综合征 28 十月 202222The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性影像学特征：CT表现：多位于胼胝体压部、体

11、部和(或)膝部；大片对称性低密度影；增强扫描无强化28 十月 202223The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性影像学特征：急性期：胼胝体压部、体部和(或)膝部大片对称性的弥漫性肿胀；T1WI呈等或稍低信号；T2WI呈高信号,代表水肿和脱髓鞘；增强扫描无强化慢性期：T1WI呈低信号；T2WI呈高信号；部分病例可出现胼胝体囊变和萎缩28 十月 202224The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变

12、性28 十月 202225T1WIT1WI呈等稍低信号呈等稍低信号T2WIT2WI呈稍高信号，边界模糊呈稍高信号，边界模糊酒精中毒酒精中毒导致胼胝体变性酒精中毒酒精中毒导致胼胝体变性The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性28 十月 202226增强扫描病灶无强化增强扫描病灶无强化The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性28 十月 202227胼胝体囊变和萎缩胼胝体囊变和萎缩The First

13、 Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性28 十月 202228横断面：胼胝体膝部、压部横断面：胼胝体膝部、压部对称性高信号对称性高信号膝部病灶信号呈脑脊液样膝部病灶信号呈脑脊液样相邻脑室无变形移位相邻脑室无变形移位矢状面：胼胝体萎缩变薄呈低信号矢状面：胼胝体萎缩变薄呈低信号膝部及体前部见囊状、条状脑脊液样信号膝部及体前部见囊状、条状脑脊液样信号 The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性28 十月 202229

14、横断面：胼胝体膝部、压部对称性高信号，境界清晰横断面：胼胝体膝部、压部对称性高信号，境界清晰矢状面：胼胝体弥漫性肿胀呈低信号矢状面：胼胝体弥漫性肿胀呈低信号The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体变性肿瘤样脱髓鞘病变影像学特征：局限性大团状病变；占位效应或周边水肿较轻或没有；脱髓鞘病变表现为一个不完整的环状强化，灰质侧不强化；强化环：代表脱髓鞘的前缘，因此通常面对白质28 十月 202230The First Affiliated Hospital Zhejiang Chinese Medical

15、 University 胼胝体变性肿瘤样脱髓鞘病变28 十月 202231DWI显示病变呈高信号，但有更高信显示病变呈高信号，但有更高信号的环号的环ADC显示弥散受限显示弥散受限影像学特征：环状的边界，周边乏水肿带The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体出血28 十月 202232主要出血原因：胼胝体动静脉畸形；动脉瘤；高血压血管破裂；头部外伤The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体出血28 十月 2

16、02233胼胝体的纤维在中线上越边后，进入半球形成侧脑室顶的大部且与蛛网膜下腔相邻，故胼胝体出血极易破入蛛网膜下腔和脑室临床表现亦酷似蛛网膜下腔出血或原发性脑室出血The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体出血28 十月 202234胼胝体动静脉畸形胼胝体动静脉畸形The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体出血28 十月 202235胼胝体动静脉畸形胼胝体动静脉畸形 破裂出血破裂出血The First A

17、ffiliated Hospital Zhejiang Chinese Medical University 胼胝体出血28 十月 202236大脑前动脉远端动脉瘤破裂大脑前动脉远端动脉瘤破裂The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体出血28 十月 202237男男8 8岁，外伤十余天，头疼、头晕不适，外伤后岁，外伤十余天，头疼、头晕不适，外伤后CTCT正常正常MRIMRI显示胼胝体压部显示片状显示胼胝体压部显示片状T1WIT1WI低信号、低信号、T2WIT2WI内低外高信号、内低外高信号、FLAI

18、RFLAIR高信号高信号The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体梗死胼胝体梗死发病率为25胼胝体梗死的两个经典的症状胼胝体离断综合征：失用、失写、触觉命名不能、异手综合征等额叶型步态障碍：额叶性运动困难、步基宽、小步移动、无上肢摆动等28 十月 202238The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体梗死胼胝体膝部梗死左手意念性失用左手失写左手触觉性命名障碍左侧异手综合症28 十月 202239The F

19、irst Affiliated Hospital Zhejiang Chinese Medical University 胼胝体梗死急性梗死28 十月 202240患者，男，因患者，男，因“双下肢乏力一天双下肢乏力一天”CTCT显示：阴性显示：阴性MRIMRI显示：右侧胼胝体区域异常信号灶显示：右侧胼胝体区域异常信号灶The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体梗死胼胝体压部梗死28 十月 202241右侧胼胝体压部扣带回、右顶叶急性梗死右侧胼胝体压部扣带回、右顶叶急性梗死双半卵圆中心、双基底节、左丘

20、脑多发性腔隙性梗死双半卵圆中心、双基底节、左丘脑多发性腔隙性梗死 左侧颞顶枕区陈旧性梗死左侧颞顶枕区陈旧性梗死The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体梗死急性梗死28 十月 202242DWI:右侧扣带回及胼胝体区高信号的急性梗塞灶。右侧扣带回及胼胝体区高信号的急性梗塞灶。The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤良性：胼胝体脂肪瘤毛细胞型星形细胞瘤恶性：星形细胞瘤（最多见）淋巴瘤转移瘤28 十月

21、202243The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤良性：胼胝体脂肪瘤28 十月 202244The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤良性：胼胝体发育不良 合并脂肪瘤28 十月 202245脂肪瘤外周壳状钙化脂肪瘤外周壳状钙化其中含致密骨其中含致密骨位于中线位于中线几乎对称的脂肪肿块几乎对称的脂肪肿块The First Affiliated Hospital Zhejiang Chinese

22、Medical University 胼胝体肿瘤28 十月 202246胼胝体体部毛细胞型星形细胞瘤胼胝体体部毛细胞型星形细胞瘤The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤恶性：胶质瘤28 十月 202247The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤恶性：胶质瘤28 十月 202248The First Affiliated Hospital Zhejiang Chinese Medical Uni

23、versity 胼胝体肿瘤28 十月 202249胼胝体胶质瘤胼胝体胶质瘤患者，患者，3131岁，男性；岁，男性；MRIMRI提示双额胼胝体肿瘤提示双额胼胝体肿瘤行左侧肿瘤大部切除，病理示少枝行左侧肿瘤大部切除，病理示少枝-星形细胞瘤星形细胞瘤The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤28 十月 202250多形性恶性胶质瘤多形性恶性胶质瘤The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤淋巴瘤28 十月

24、 202251The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤28 十月 202252蝴蝶征蝴蝶征最常见于胼胝体的胶质瘤和淋巴瘤最常见于胼胝体的胶质瘤和淋巴瘤 The First Affiliated Hospital Zhejiang Chinese Medical University 胼胝体肿瘤28 十月 202253肺癌胼胝体转移瘤肺癌胼胝体转移瘤The First Affiliated Hospital Zhejiang Chinese Medical University Thank You Thank You!