![CT鉴别诊断一点通(第三版)](https://wfqqreader-1252317822.image.myqcloud.com/cover/733/25793733/b_25793733.jpg)
二、脑肿瘤与肿瘤样病变的鉴别诊断
1.脑梗死、炎症及脑肿瘤的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image3.jpeg?sign=1739270680-Kg5GW5P0SusoEyupyuqXwAiBuBWWjCbu-0-a40936ea8c464cd1ab943612f22bfd65)
图1-2-1 左侧大脑半球大面积脑梗死
左侧大脑半球扇形低密度病变(→),皮质、髓质均受累,沿大脑中动脉走行分布,左侧脑室受压
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image4.jpeg?sign=1739270680-A6Ry7mDc6FKZ29yntl8V9S0ttEUayEFi-0-efc3bea2c7f20fe06e7e45b917175c81)
图1-2-2 右侧大脑半球出血性脑梗死
右侧大脑半球可见大片状低密度灶(→),其内散在斑点状高密度影, 右侧脑室受压闭塞,中线结构左移
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image5.jpeg?sign=1739270680-LM5B4MDKvXumDCNNLkzOxLuIGvkp91v1-0-224a25a3b8ae95add2d2e3bae95dc2b4)
图1-2-3 左额叶脑脓肿
(A)显示左额叶脑白质内斑片状低密度灶(→),左侧脑室前角受压;(B)显示其内可见薄壁花环状强化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image6.jpeg?sign=1739270680-KIgEwCGeoiIMtAzYMb0Nbryqv2SfKNR6-0-7c324d980c6407ededc86be5dd071099)
图1-2-4 右颞叶胶质母细胞瘤
(A)显示右颞叶不规则低密度影(→),边界模糊,周围明显水肿,侧脑室受压变形,中线结构明显移位;(B)显示增强后病变呈花环状边缘强化(→)
2.脑内肿瘤与脑外肿瘤的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image8.jpeg?sign=1739270680-vysGJrtC0AmphSsgEPgFM5nogeD3a5yE-0-d4ee9b7ae39de4a4c89162f7410d6658)
图1-2-5 脑内肿瘤
(A)显示右颞叶不规则低密度影(→),边界模糊,周围明显水肿,侧脑室受压变形,中线结构明显移位;(B)显示病变呈花环状边缘强化(→)。病理证实为间变型星形细胞瘤
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image9.jpeg?sign=1739270680-Yg5OfRQDkwBovapNJs0PEbfipiLi19Bc-0-c2a0053e527ef7c1d50a419f6ae50c14)
图1-2-6 脑外肿瘤
(A)显示左顶叶等密度结节(→),灶周可见大面积水肿带;(B)显示明显强化,以广基底与硬膜相连(→)。病理证实为脑膜瘤
3.各型脑水肿的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image11.jpeg?sign=1739270680-1PH1TFslQHfvVUvOZLNidHzZqbZzLOlr-0-96ffc7cdd33b778f469c7f5404e07875)
图1-2-7 血管源性脑水肿
CT平扫可见左额叶脑白质密度减低(→),呈“手指状”分布。病理证实为脑转移瘤
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image12.jpeg?sign=1739270680-jM6UjE3L9p49WtmR2XEsuj8sawFGBXsP-0-494dacedcc6141fbe997cfc4ade50169)
图1-2-8 细胞毒性脑水肿
CT平扫可见左大脑半球脑实质密度减低(→),同时累及灰质和白质。为左侧大脑半球脑梗死
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image13.jpeg?sign=1739270680-ob5QYmxZRG57WWaaYECAqkUIMPdDwyOM-0-9c07090430f0e8eb4481e5a271654112)
图1-2-9 间质性脑水肿
脑室扩大,脑室周围条带状低密度灶围绕(→)
4.脑积水与脑萎缩的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image15.jpeg?sign=1739270680-I6ZpyyL1YQnEMY0y2TLJnzV4wbAns33f-0-b7050035d2f6166ea9f6936ac10a4739)
图1-2-10 脑萎缩
脑沟脑裂增宽,侧脑室前后角扩大但不圆钝(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image16.jpeg?sign=1739270680-gwvJsXajSqfzr999J1XHlKo8LVTSllcd-0-32a213c23c27f56eb4a9be466a0f8e32)
图1-2-11 脑积水
侧脑室前后角圆钝,第三脑室呈球形,前后壁上抬
5.各级星形细胞瘤的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image18.jpeg?sign=1739270680-Vla4wrSUPaZCIx55cb4Yj47Fp1e8XdNg-0-74715b5d6fd5a7b898883e8e3ae7ddb4)
图1-2-12 Ⅰ级星形细胞瘤
(A)可见右额叶边界较清的均匀低密度灶(→),无灶周水肿;(B)显示病变未见明显强化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image19.jpeg?sign=1739270680-ghxg6xq0KLaxrVRFzJtoHx4ikFbF3DAH-0-890ddeedca808411dde4f1952fa45eda)
图1-2-13 Ⅱ级星形细胞瘤
CT平扫显示左额叶不均匀混合密度病变(→),其内可见高密度出血灶,邻近脑室受压、闭塞
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image20.jpeg?sign=1739270680-3DSQFOUPIW4NPTKBKkxPE5JcNirbg2rV-0-28be4f22250cc5fc1b74588214de0ec3)
图1-2-14 胶质母细胞瘤
右颞叶可见不规则低密度影(→),边界模糊,周围明显水肿,侧脑室受压变形,增强后病变呈不规则花环状强化,邻近颅板缺损,为胶质母细胞瘤术后1年复发
6.脑实质常见肿瘤及肿瘤样病变的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image22.jpeg?sign=1739270680-DjDCZtoPyqrKnFoqCiPZYQDJm9FRcC1S-0-72b0bebb70f398a9e8af4af26804e889)
图1-2-15 脑膜瘤
CT平扫可见大脑镰前部一边界较清晰的类圆形肿块(→),呈稍高密度,其内可见多发小片状低密度区,病灶周围双侧额叶可见大片状低密度水肿区,双侧脑室前角受压变窄
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image23.jpeg?sign=1739270680-hFlv9FbVMbNBIte9V7zZvrLAjKS83aOl-0-b253f490537bb9c8e073ca4833209947)
图1-2-16 少突胶质细胞瘤
CT平扫可见右额叶不规则 占位性病变(→),其内 多发斑块状钙化,周围 见环形低密度水肿带, 有轻度占位效应
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image24.jpeg?sign=1739270680-RUwvElbWOfUI9KZ7XG3v46IxhaF8BRho-0-6c59fa077f6fcea7c917f398a59eb9e3)
图1-2-17 室管膜瘤
(A)显示左侧脑室三角区囊实性病变(→),跨越脑室和脑实质生长;(B)显示明显花环状强化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image25.jpeg?sign=1739270680-sjZM7s5dvIWlEekKBIUHvo4skZbpg3Bw-0-85d3b20cfe61545eeb1aad7d56650ab0)
图1-2-18 淋巴瘤
CT平扫可见右颞叶及右基底节区结节状高密度灶(→),灶周可见低密度水肿带围绕,右侧脑室受压,中线结构左移
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image26.jpeg?sign=1739270680-py2FCAfywUdBVxr8QGB0AUemsnkSICF3-0-bcd44cf240c8b6d59ed0987dc4c89fcf)
图1-2-19 脑转移瘤
(A)可见脑白质内多发指套状水肿带(→);(B)可见水肿区肿瘤实质呈环形强化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image27.jpeg?sign=1739270680-MBn5HVnwKZ01nhtXpTsXH0AG3j6JrU3H-0-078b6d8d4f18dc9bbc76c0e4c2c50059)
图1-2-20 脑面血管瘤病(Sturge-Weber综合征)
CT平扫可见左大脑半球表面脑回样钙化(→),周围脑实质萎缩
7.鞍区常见囊性病变的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image29.jpeg?sign=1739270680-fa0cg3DMyQYZcInyD9pMVCNWHAfmDJeJ-0-3b59a92bb1458048686b93fdcdd76fb2)
图1-2-21 囊性垂体瘤
蝶鞍扩大,鞍内囊性低密度灶(→),鞍底骨质吸收变薄
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image30.jpeg?sign=1739270680-qlhkOvG4tZv07p2IG3qYP3eIFzLMrKoX-0-316b51a89611ab25ec9738cd8addd536)
图1-2-22 空蝶鞍
CT平扫显示鞍内囊性低密度灶(→),与脑脊液密度相似
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image31.jpeg?sign=1739270680-64rMs03dXOsdi79Sh4GOKVqxJ9xG9OfT-0-71e594d1b878eac518340a6a4bacbe6f)
图1-2-23 垂体脓肿
(A)显示蝶鞍扩大,鞍内囊性低密度灶(→),蝶窦积液;(B)显示蝶鞍骨质侵蚀(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image32.jpeg?sign=1739270680-mqLOLHQtaAXURxnc78BrjRMtabb4Fwu1-0-05c9739ca392f28c6f023eb985829647)
图1-2-24 Rathke囊肿
CT平扫显示蝶鞍内圆形高密度灶(→),病灶边界光滑、清晰
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image33.jpeg?sign=1739270680-7zFA42rjvo7XY3WI1SzM5LQk5e0RE1vR-0-b96aa7e37f140ea9f38b030b67b8d0c8)
图1-2-25 表皮样囊肿
CT平扫显示鞍上池囊性低密度灶,形态不规则(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image34.jpeg?sign=1739270680-m2LqxfmwtV4p4BPZkchCjrhOQa5VqCSN-0-4d76e46a1c243cf0e5fb8a8d68f33566)
图1-2-26 颅咽管瘤
CT平扫显示鞍上高密度灶,形态不规整,其内有爆米花样钙化(→)
8.鞍区常见实性病变的鉴别诊断
注:CTA—CT血管成像;MRA—磁共振血管成像。
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image36.jpeg?sign=1739270680-RwoG36xozHRSPfBZbfQEeDWjBAlNswhj-0-a7fc8277a61c4eb98ef86ef1f27bf4b2)
图1-2-27 垂体腺瘤
CT平扫显示蝶鞍扩大,鞍内可见类圆形等密度肿块影(→),右侧海绵窦包绕
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image37.jpeg?sign=1739270680-Uq16OloLDbfqpVrMJnzYp0Zsxsb2q0n4-0-f028579c589a1f20d9f97104e6af00b6)
图1-2-28 颅咽管瘤
CT平扫显示鞍上椭圆形囊实性密度肿块影,其内可见爆米花样钙化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image38.jpeg?sign=1739270680-EQ11O4a8KOx2aKhG1i8NRr6eXyumSs3K-0-574cc197b6d9f9750a11d2b14fb33ac5)
图1-2-29 生殖细胞瘤
矢状位重建显示鞍上池、松果体区高密度肿块影(→),其内散在低密度坏死区
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image39.jpeg?sign=1739270680-5lBwvoRVi6x3l3N43cSjIH184JIDi8Ih-0-3706c175ba938ae882acc66e537a9922)
图1-2-30 脑膜瘤
CT增强扫描显示鞍上椭圆形稍高密度肿块影(→),增强扫描均匀强化
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image40.jpeg?sign=1739270680-pF1V5AZ6Catx05IEkQclayHtEC32eYfy-0-820585db7581cf0c9b2bf2942e456a07)
图1-2-31 胶质瘤
鞍上等密度软组织肿块影(→),边界不清
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image41.jpeg?sign=1739270680-hlJ2uUu7uYQXsccpoLVkUYZ3AvEboMxF-0-141b811deecbb98b0fe181a8bca69431)
图1-2-32 动脉瘤
(A)显示鞍上圆形等密度肿块影,边缘可见斑点状钙化灶;(B)显示血管瘤样扩张,证实为动脉瘤
9.桥小脑角区肿瘤的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image43.jpeg?sign=1739270680-h4W195qpUmRB6qTceSkPDyDaeiL63iWV-0-2ccfffb98f5d4ecec3f34b4a383abadd)
图1-2-33 听神经瘤
CT增强扫描显示右桥小脑角区可见囊实性肿块影(→),实质部分强化,囊性部分未强化
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image44.jpeg?sign=1739270680-CmrEC2yzkryGiXESMyuwkdo31V6na3F7-0-f59a6bff333d5bd18a45ac20d0bfec34)
图1-2-34 脑膜瘤
(A)显示左桥小脑角区椭圆形高密度灶(→);(B)可见肿瘤内大片状钙化密度(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image45.jpeg?sign=1739270680-yoRk4cCFpzfEpMoUWXO01w1SMztI2ji7-0-0864ab630c1d237402d8c06823bb4d7f)
图1-2-35 三叉神经瘤
CT增强扫描显示左桥小脑角区囊实性占位(→),以低密度为主,病变跨脑叶生长,病灶呈花环状强化
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image46.jpeg?sign=1739270680-nopgy99rtIwUQkgsSbvjWotDQ9FIKghz-0-56bc5903c2102537a665324a789f9cc5)
图1-2-36 胆脂瘤
CT平扫显示左桥小脑角区分叶状囊性低密度灶(→),呈水样密度,边界清晰
10.颅后窝常见肿瘤的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image48.jpeg?sign=1739270680-0Pb4DAEmZOfz7kKsgrqeb5KKk2FiNlk3-0-8c4965c71bf31c26d89cc4a8b7e97b14)
图1-2-37 血管母细胞瘤
小脑半球囊性低密度灶,增强扫描壁结节明显强化,其上方囊壁亦可见强化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image49.jpeg?sign=1739270680-JLZGw063OY3wzX18HJoQzjYUPYqFCbgR-0-e321f0fc58e3e69d91205d52239e8a60)
图1-2-38 毛细胞型星形细胞瘤
CT平扫显示右小脑半球囊性低密度病变(→),其内可见液-液平面(合并出血),囊壁呈高密度
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image50.jpeg?sign=1739270680-fckgF5GHGZijHi9rhhBCWvHJ4KRYC31z-0-a186e7b831bcfd485d0f6e5f986b7406)
图1-2-39 蛛网膜囊肿
枕大池囊性扩大,其内均匀低密度改变(→),与脑脊液密度相近,增强扫描未见强化
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image51.jpeg?sign=1739270680-RXW0pYQodCsmptHUbi0jPEztQYPlh6yV-0-0684f7bab088d5e03249323855b59809)
图1-2-40 皮样囊肿
CT增强扫描幕下可见囊性低密度灶,呈花环状改变,囊壁轻微强化(→)
11.松果体区疾病的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image53.jpeg?sign=1739270680-GjiaWrnoaj6iux3z9G906VQSPJcBGNFx-0-0b35ac247157420616c619086f038e6f)
图1-2-41 正常松果体
CT平扫显示松果体区囊性低密度灶(→),直径小于10mm
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image54.jpeg?sign=1739270680-1RwuhGHOENubrRrrzt25Rs7EulCthbNd-0-fc7815d5cfbf45f610aef57020807982)
图1-2-42 生殖细胞瘤
(A)显示松果体区分叶状高密度肿块影(→);(B)显示肿块明显强化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image55.jpeg?sign=1739270680-ATVRbRIKtrIao8mi6i9SdsGTCbNejJQz-0-88e4379acdcf4ac484b8f005ddc1922f)
图1-2-43 囊性畸胎瘤
CT平扫显示松果体区较大囊性占位性病变(→),其内密度不均,囊壁可见钙化
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image56.jpeg?sign=1739270680-ObIfwQWsH5FFNmJMnjrJHckkBRGowSon-0-8a470d5850a663ac636bfda50cbf2cdc)
图1-2-44 表皮样囊肿
CT平扫显示松果体区较 大囊性低密度灶(→), 与脑脊液密度相似
12.脑干疾病的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image58.jpeg?sign=1739270680-DEZOaX06xPNyVeiAFev6GP1GgrU4f8NE-0-8dc04b17ab4eabc7ba29592353b3bd4b)
图1-2-45 脑干梗死
脑干内弥漫性密度减低(→),脑干无肿胀
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image59.jpeg?sign=1739270680-173DYrKTmNXI2PPvif58L8VrOzyiJ0en-0-7b243ddececfaf2b7aac83bf888f4a2f)
图1-2-46 脱髓鞘疾病
脑干内斑片状低密度灶(→),边界不清,相应脑干肿胀
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image60.jpeg?sign=1739270680-6ELs1PMHhLaOKF7HnuiZ8hGM5HMrwQPH-0-982a268fcfeb2f5d182356e520994938)
图1-2-47 胶质瘤
脑干内囊实性软组织密度肿块影, 其内液化坏死区呈低密度 改变(→),第四脑室受压变窄
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image61.jpeg?sign=1739270680-U1NKh4EcoRyCXdAx9n0JJHrfZ8FFGWyb-0-5fdcc19d6a1fda8da297c53573b46d51)
图1-2-48 脑干转移瘤
脑干弥漫性密度减低,其内 可见花环状软组织密度肿 块影(→),囊壁呈稍高密度