![MRI鉴别诊断一点通](https://wfqqreader-1252317822.image.myqcloud.com/cover/826/25793826/b_25793826.jpg)
五、脑膜及颅骨疾病鉴别诊断
1.脑膜疾病的鉴别诊断
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image120.jpeg?sign=1738894143-30CRkf272qMb0DIA35kYweXXjV9mqq3L-0-06dc48b51d0cc376dde75f70b7f6efe5)
图1-5-1 化脓性脑膜炎MRI表现
双侧半卵圆区脑沟、脑裂模糊、消失(→),FLAIR呈条带状高信号改变;DWI信号增高,提示水分子弥散受限,T1WI增强扫描脑沟内多发脑回状强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image122.jpeg?sign=1738894143-FQZVkVcBFpFafOfc9GRAYquGrKUEPtny-0-4a21bced78ff921ee304f7e9c838d708)
图1-5-2 病毒性脑膜炎MRI表现
双侧岛叶、右侧颞叶脑沟、脑裂模糊,呈云絮状稍长T2信号改变,边界模糊,双侧丘脑、尾状核头、壳核亦受累(→);FLAIR信号增高、病灶显示清晰;DWI未见弥散受限高信号改变
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image123.jpeg?sign=1738894143-c1WlwrXeOQV18TKNBrumU1RXE94GIjH1-0-9759b3ce000758b3c18d1c76906f81ad)
图1-5-3 结核性脑膜炎MRI表现
脑桥基底部、脚间池及鞍上池见团块状混杂信号影(→),以长T2信号为主,其内散在斑片状T2WI低信号灶,FLAIR呈等及稍低信号(→);T1WI增强扫描显示软脑膜强化,病灶呈不均匀强化,部分呈花环样强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image124.jpeg?sign=1738894143-IeN859zgAS6eQhd6WZrkBzdO0BdB0ul2-0-3b9a1ce73f646b925a2d4312c40136fb)
图1-5-4 脑膜转移瘤MRI表现
T2WI可见小脑脑沟增宽,FLAIR脑沟内脑回样高信号改变,增强扫描沿软脑膜分布的多发结节样、线样强化(→)
2.颅骨常见疾病的鉴别诊断
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image126.jpeg?sign=1738894143-bYxp6UfKH8NMyvM8Lo6Jd990qDRqRlc6-0-42e64c043d8fc88f78dd6bae26441371)
图1-5-5 骨髓瘤MRI表现
左侧额骨巨大软组织肿块影(→),T1WI、T2WI稍低于骨髓信号,肿块向颅内及颅外蔓延,额叶皮质扣压改变,增强扫描明显强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image127.jpeg?sign=1738894143-lQoAQ49H2ZQUHnSJN4xgvjF4QKUutDwT-0-74b490cd9a7aa9be0c3dbcdfca755734)
图1-5-6 血管瘤MRI表现
右侧额骨内可见梭形软组织肿块影,呈长T1、长T2信号改变(→),边界清晰,局部骨质膨胀,增强扫描明显强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image129.jpeg?sign=1738894143-Fcpq8UCIRatqb1wDZs1ED3QJTtG5MjpE-0-0695a04ed86b70270dd3c09c9eb63d26)
图1-5-7 转移瘤MRI表现
肺癌患者,左侧枕骨骨质破坏,见混杂稍长T1、稍短T2肿块影,小脑实质轻度受压改变,增强病灶明显强化,病理证实为颅骨转移
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image130.jpeg?sign=1738894143-9kALSksTP4wbRmJZS0GlE4ESn7Fh7Efq-0-055c5c65e9b8b808aeca9c97a177f88b)
图1-5-8 嗜酸性肉芽肿MRI表现
左侧顶骨局部骨质破坏及不规则软组织肿块影,增强扫描周边明显强化(→),中央坏死区未见强化,邻近脑膜亦可见强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image131.jpeg?sign=1738894143-m7KYEdObViddgPJ3Alp0b0P7jIwSAKxw-0-d29cad6f0d8ccae42ba88321d7c01332)
图1-5-9 颅骨骨纤维异常增殖症MRI表现
右侧额骨见类圆形等T1、短T2信号团块影(→),边界清楚,向颅内外膨隆;增强扫描呈不均匀斑片状强化()
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image132.jpeg?sign=1738894143-po41pdfGAhKfRFupkI8JFOnqjzxeAtUN-0-0f14738fb57442dd61bdde6bac6847f6)
图1-5-10 畸形性骨炎MRI表现
颅骨弥漫性不均匀增厚,T1WI呈高低信号混杂改变,T2WI弥漫性信号减低(→)
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image133.jpeg?sign=1738894143-q2JMeRS0FVuHjijYcrSOxmoDK2PvA8gs-0-fa9043fe2606b87c6e509b4600385d9b)
图1-5-11 颅骨表皮样囊肿MRI表现
额骨正中板障内可见梭形T1低、T2高信号灶(→),边界清晰,T1较脑脊液信号稍高,T2较脑脊液信号稍低,相应骨质膨隆向外突出