![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=1738890953-J8fcJ2DhFwDSXvID6tcOJJBK6FOj6E4O-0-c60c47107d7bca107cd7989ce5a8f5de)
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=1738890953-XfQoG5gJWPF6DPuEAks4aDvxifjBTt9Q-0-5c45f537cdfb9e223fcf46ff63695ffa)
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=1738890953-JizlOukT3946lxVOooOa05l8MEsSlQ91-0-ad73131dce3853787542372afeafe9a7)
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=1738890953-xDWnQZVrQidoqtiOcdtHynVvTPQsTYBU-0-d83fd0ac029bf7e479799fb732384805)
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=1738890953-NNolbd9dawMoizJlGectFfkRLekLBpQB-0-9188e3a82b313665ba8d4e002c88bbf6)
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=1738890953-AixDcCcEbowDfLtLrJsuMZHfLj2bsBrA-0-364e0259fb4d0e31b594556b30647707)
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=1738890953-zy09VR0kgRu8zI5IiZR1ioHnuZk7y2E9-0-3953cc015f588e4f5fc90979b0151d17)
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=1738890953-ieM8l6Ce7yr3ES9le8K4pnzt2auXBHpV-0-22f8227155702c3c4526e99ee70238ec)
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=1738890953-vPCuaHUrRIFIuNLamajNHj4CXlLV2iAF-0-692963b933561896a85147797fe3af4f)
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=1738890953-8M1N9kYD5ivwWgNrJZNwyUjKmHDfU8xt-0-2fc5c6566fee5c051590ca1cd17f01de)
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=1738890953-N2jymVm782z0ZLZtEGYImXTblmJ2V2BG-0-a0bfe3fa8013ceccdf1ffaab76c1fa68)
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=1738890953-pKEygnBSoip0GJHXgIiuSyka8yIZR7yc-0-c5250fcebc6c2f4628d9a152da18cf71)
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=1738890953-lzmotySbZRhNenAU8uRXw75mX6zrthh8-0-0a40b5dd5959757beb915a04e23c10f8)
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=1738890953-zyJKeflsbNHx7rVGlE9DRa1N7ySwf5ap-0-b95100a40e60d1dd75c05cf417e74468)
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=1738890953-csqnbpdmkDMXYwKp85pqnSWvBgYMRyhy-0-3d0019fca9f87cd193548e5de24544f6)
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=1738890953-7Hc9ztfWd7fihVHFDun0ctA0p8zxV2kO-0-89c5849446415113309e0bc67584bc40)
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=1738890953-jKCjIvwll7EoWepPOSiYJewd13lSxeUq-0-091fe535ca95bc1476960c59e4344f60)
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=1738890953-q7zfJrQWpEyjoNZwJKTFgLM8AitQQ6cj-0-adf43e38496157105fae00ceaa3c0fb7)
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=1738890953-D5EVl5ic0iL2NuhW0VMqwvVe0AHkKoXV-0-7a4b9e9e923e051fb002ff73d0dfb770)
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=1738890953-TTZQZRFbvx9D9DHYrqhIjNWYfWtUwNpq-0-aa7cd302b1f7f9ae5bf20bfa3f2e0ef3)
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=1738890953-rJBXVRIvluxrsA1jKsdW2fuEqevQRrIB-0-d3f2771cee318811c1f51b5fbe353dd4)
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=1738890953-991GZm60VWsNuEBQj71EZ4vYhD0IzX79-0-7cc3c6daaec8a8eb061c5c749ec3cc50)
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=1738890953-AWAKRBBV0LzklkG4LUORSAdCOfiqVHOA-0-05c765aabdbb37dd6e50d3f5674d1cff)
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=1738890953-KU21FNqwXDQHIukR3LqR4Frc8GMwZCZ7-0-e3a051690e4a938609417f09f265346e)
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=1738890953-8dKPvEvt5hnBYrR1u94OCQsCQd4TCxyP-0-1fc258c4eed20329a500269f6e9513fa)
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=1738890953-08b5RwYDjgVUF8E4YvSbK9wxwcTPlOzx-0-dc9862edb1b8b03fa474c3468fb3c026)
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=1738890953-du6Ha8AhDzmmhSe2lLrzRIYHlszI8HPr-0-b13a1198c36d0b1e523f3fd2b8386a03)
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=1738890953-wLNvPxxDTKIFfefUpMb4WPEOTwJOqJZL-0-e9b1b93d73a5ab8f10d531826bf382b4)
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=1738890953-nlqcjjmrikaq9dv2Zp968KCwqJbAK0PB-0-dad033a862d707b6189e53d2a027ef51)
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=1738890953-VMFBLJLqQHQLT4r1061x6Eb0g781ocJl-0-621fa10bfad51c70bf12a26d9b31d988)
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=1738890953-QvAEwpdc07yN9Alp9KmwmZPw4yHlILwT-0-0db920228a2c6a50205e1df2f1d0c3d1)
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=1738890953-RIYSGwU3Rv7pGgDUWP29HJNLZzy3c8SL-0-b9164a012c45798dcd748efee2d6e8aa)
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=1738890953-l82ojxN8SkQVodvvUQJcSXg8nM6GAfBM-0-5aa09e9df9ea6b7d10b328342eadc27a)
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=1738890953-EJXlTJmUYIe92bMfK0tgsRpuDXjuJUT6-0-5bb2072d4c053f081734cdae579b94f7)
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=1738890953-gAItWDDREvRlp3n38GiSR6CD78laJ5Kw-0-e27402d533390af355ee133f33bde0a1)
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=1738890953-YtXvniuZ6MdD5NsVwnONO08b00ic4n6Y-0-fc7c0c6810d95acdfbe906a91ca35bd6)
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=1738890953-id62qXPzEVM7BNlRRefH2CnkHeUMQfkW-0-3001bace8ef696802a497d8cfaefb9a6)
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=1738890953-fSHCTlJsFVEiY5gmyyChN8TYKbAM3lmg-0-c16f7754b77e2c60daf95bcec611d105)
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=1738890953-C9lRBG32knf4eC0j9nP7590GOVEe68MJ-0-873180d1c41151f9f2f39923beaa624f)
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=1738890953-kmbRXjhFS0EfGVU1XdCvYTegXq4BRMB7-0-cfcb709de9d759dadcbb512802536f00)
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=1738890953-nVCfnFvUYUrEi1sfNJ00MM2MZcLGI74R-0-0fd03b4da445453ed85198c5d3cf64b6)
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=1738890953-5WiDOjtxiVhentkoUXWEmQqrfLBpAK5f-0-4bda5974e4eede379b51c5dec6a1a24e)
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=1738890953-24MODrcEe5GB3Y2HwY72eNYesodjG3dd-0-9b85180f70e85a10ecd674c4d153f3fc)
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=1738890953-ZPzeZ2QIXyincDBMsQQo6iRsFY21hdYw-0-c8bfde121b2a6fcedd5c5efb9ca9ae3e)
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=1738890953-2s3GjlgzMqkULi9qGWmWMHR07uDdLADI-0-0d8cade77c768de3e6135b98aa3eee31)
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=1738890953-Oeqj6ee6Z3tGbOkI3EVF5ciJ7jMSjdXG-0-2753ecb680f5daeb32175400f18519f0)
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=1738890953-DgSDCfKdZagn75Wnl94gIPVQQ41gmRhD-0-affd2e0b75ca4863ccb3582131d0de6c)
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=1738890953-GtinTXSOGj8eRU8jTDlIQ7urOwqAHnhC-0-d0f7802dcf9eb816c67c7a5162d5bae2)
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