![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=1738885977-IFDU6TRZVW0tv0gNDhIep6Fh3vdKM207-0-48d7b90cca762988ea565d0d085eab7c)
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=1738885977-QqHapKLTe3VxIWsTEdxyGruVujCrdHqG-0-3bf9d9eab56909a4abc245437a6d9e23)
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=1738885977-w8hbNK5chgcm92WzkN3DP7yznd4iu3eZ-0-7c5997ddcb475fd9179863d4732663df)
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=1738885977-ULBIJAlyp9xcCcfhiR3HVz6nqWvzAUJh-0-d5328e4776da285ece5606cbbc03a343)
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=1738885977-H7pUIfAhGpybEEFZQc3KaIiE0LreZjXl-0-9dc192bd90d3da64afb46ed8fb5901e9)
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=1738885977-sHKfpl2CiIq6jZO5DJ3rBAhBxLHCRBQW-0-b7d6e0de08a58fe9286a73e7ef86db0c)
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=1738885977-q2R3edDhsZqpZ85pMjTzRiH8Bl78qOys-0-a168924cbc386eadef46bcde44efcfcc)
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=1738885977-J0TQO3ykoXdu53YNmYg7MJhqqXgJgCMB-0-7c8881e6b8d8f9ddad3fc68e58a3b9ef)
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=1738885977-PS0BlBvCJQD2AqaBlLu1pN5T8JljDmip-0-1a71130278550dc1f2a0e966bee6da8e)
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=1738885977-j7CG9tgc2vDAgB10Lly8P2UGObQvQ3eV-0-0845c2c3a0e6259d3e9ac23d3020c183)
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=1738885977-PSypq98Ll2nC0tylLAOfcv3M9tUN0hjo-0-f9355b199c2d3f91876ee268e0ee3f16)
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=1738885977-5dtKcPKDjuBqU3RwCGVVNlbB4E8qN9oQ-0-05f7c1ce1dfe1ba86f2b75cf54296e18)
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=1738885977-wH8UXPv4Lw9bZMrXcA3vyeY2uPrrom4W-0-9e918316888ffc26d43e38ca3d865e18)
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=1738885977-G69ZsyS1CVk9d8MRJw14MiwUx0YbooUE-0-239bd20b619f0e098418c866edb74a5c)
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=1738885977-i7DJ7TPRgFwMjsCYKKTxg3CAF0jUKf6C-0-a878354afdf8ef34b55ce90ade2b77a6)
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=1738885977-MxdavBxp8VCOpw27K08Wl0N6zbLv1BYn-0-e901b3b18f557da9ed4df374677c6652)
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=1738885977-nMe5M2SqEoiFUzOFwE0O5gUvM5byMNwt-0-729f412a631da36faa078ba792ee317c)
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=1738885977-Fg8sPNXk56beB9KKv5o47Mr58U79RdY3-0-d40428fbd2ee8caa0606b0738a922520)
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=1738885977-cEjttqrXrlt642jNbp5Ihi4ErYiJh93F-0-be4baa10ca4c90610ac3f9be9cba535d)
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=1738885977-Yy7AmRlS1PbkAwHsduU0kOz3cK1MXUKY-0-79b87edc25f45c3222c43237d4bdb09a)
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=1738885977-k7bZiLNi4wUwcsrkwrEFzxY7E3QzUiLZ-0-638b9d0d547775dc6f3b9dab02073848)
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=1738885977-cAxv6z62j5O2kBSPLCjHuo69PYHYBTjR-0-6a7579a683c428d8fec7a8a9c5507a16)
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=1738885977-mtZX8T2g3u9MtQAWdLXeyyXVadCmApjc-0-85e4a476c410c9b947686414ab3b8ec8)
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=1738885977-SSloZ3QZTReUdYZ6DpSzVYBEgSEL6IVm-0-dffca9838404f9694b83edafc7b4719c)
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=1738885977-fW9cFl9DSWWmXs8jKgi8saUxmVj70i3d-0-f202ffda424c956a9818d3eb3568656b)
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=1738885977-qXEHYqfhgcDh57ikHwLtM0lpPvAMz6zm-0-f09e6692444b56745ae41600a1f2b5d0)
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=1738885977-tdBEM73miJA2vmwt28hjcGDhSEpcu1mp-0-508a5284b31a291449562c8e289d56c9)
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=1738885977-GNXPwITayNotdRNpfbZlO8ZShzkhUSYr-0-2abc39f89b8e7b91219b74e0b0209815)
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=1738885977-JMfvOjgBmokY0HyjHpr0QuosvRYWITKX-0-15f65c8362a8587062b6ffc2cd0bb6b3)
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=1738885977-z3FKKq7qZ6nPIAGkANpd8Rd9JdLN5wvH-0-99c950b69ef8757c09ea1a000a2aa7e7)
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=1738885977-omaw2QiFhggau5X6wrM2RwytLrPbZqLU-0-4490c23eca9d4fa49607303ac303029b)
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=1738885977-PHIVs7WGmwSS8kIXEgNdLFUY0woeoZGJ-0-f5afa8e71f091adfdbba41eb444be1bf)
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=1738885977-Fzg21PHwCZlIz4Ky1RFxT7HDLgddqmXO-0-6b249cbf9646025827470db70ff1866b)
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=1738885977-ctFASeB3dlTEVU7yJXasFJEboJ5xnuOu-0-02e1ed2cd85b7c5855dc32e28cfc7912)
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=1738885977-ftTfzrJxnE1elYYnXmHIFprJQ8UlUrr9-0-bbc26b4ce8176f3ea46092ed7acb6276)
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=1738885977-9L1eDFCYqKD7CJbyXDuDWEkQS6s5DeWo-0-0a06b8e6f8a686ca8d0db03cfff13bca)
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=1738885977-HQJ8oK70zbjQl1QjNfJmuZXSSmbX4Q6G-0-7c160313c733d35aaef9fe169c25200b)
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=1738885977-1CBlp3vVZjVNWPOvrNnZpcGpgbaX3M5K-0-80222ca37ee82a60e6a02ca5598aea1a)
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=1738885977-7xPHLcEawABXEtrGFM0iKVonGPhQPha1-0-f1811e311d8c27a8a24dd66967d418e5)
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=1738885977-bA9At4DIuYAyRj7r0Fcdh9JYkjajyvYG-0-0737287a837502bd14787ada4bd19609)
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=1738885977-BGzGOsjaQI4VuOz6bsHsUyIbFyz86atN-0-94ba9614405e2cf1fa8e3635e14426d1)
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=1738885977-7LVVl9EcrObylXq52tBQtsPJ7kHSU1FZ-0-9b228d6e3e7238338ad02b6978aadc5c)
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=1738885977-O7mktePnLJ8GJBp5qFhbz8d4elTQexBI-0-a22073eaa0e6e3f3a6e9f11dbab21847)
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=1738885977-wyhMxFVtI9L03PVk3uWhb0VSQ7xE2KVA-0-e97e247b7d0adf5b62c3fea41dea215b)
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=1738885977-NQdiSVXhL76ibQYGxIJUAcKa8XfV5iIt-0-6213701c725bb687a0115ed3b737cc6a)
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=1738885977-R0iCtVYRkdHh2qN0IAgojBrOuB7SBTQZ-0-00712f858011db4c9455bb4f5a478863)
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=1738885977-CcwoHoaaUKjg4BZiQ34LBO6iODHxH14D-0-ebcca031696a977660a8280eb75e2509)
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=1738885977-2ShcCpZ7UeXROnOcmjCDhpxZVugc7kIp-0-e9d88f47288bfe576bf3b7703ba87416)
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