胼胝体病变的影像学诊断课件整理.ppt

1、The First Affiliated Hospital Zhejiang Chinese Medical University.1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.2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 2023-1-22

2、.3胼胝体解剖学概述 胼胝体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The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.4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胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.5膝向下弯曲变簿称嘴

3、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胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.6 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胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.7 血供血供 胼胝体前4/5供血：大脑前动脉

4、前交通动脉 胼周动脉 胼胝体后1/5供血：大脑后动脉 后脉络膜动脉胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.8 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-胼胝体胼胝体解剖学概述The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.9 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-胼胝体背侧胼胝体解剖学概

5、述The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.10 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 胼胝体发育不良The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.11 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

6、半球间裂增宽胼胝体发育不良The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.12胼胝体发育不良侧脑室平行分离，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 2023-1-22.13胼胝体发育不良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 C

7、hinese Medical University 2023-1-22.14胼胝体发育不良 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 2023-1-22.15胼胝体发育不良 The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.16胼胝体发育不良 仅膝部存在仅膝部存在The First Affiliated Hospital

8、Zhejiang Chinese Medical University 2023-1-22.17胼胝体发育不良 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 2023-1-22.18胼胝体发育不良 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 2023-1

9、-22.19胼胝体发育不良 影像学表现影像学表现 -胼胝体发育不良合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 2023-1-22.20胼胝体发育不良 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 2023-1-22.21胼胝体变性 概念：又称原发性胼胝体变性

10、 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 也常累及附近白质和脑桥中央The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.22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 The First Affiliated Hospital Zhejiang Chinese Medic

11、al University 2023-1-22.23胼胝体变性 影像学特征：CT表现：多位于胼胝体压部、体部和(或)膝部；大片对称性低密度影；增强扫描无强化The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.24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The First Affiliated Hospit

12、al Zhejiang Chinese Medical University 2023-1-22.25胼胝体变性T1WIT1WI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 2023-1-22.26胼胝体变性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

13、 2023-1-22.27胼胝体变性胼胝体囊变和萎缩胼胝体囊变和萎缩The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.28胼胝体变性横断面：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 C

14、hinese Medical University 2023-1-22.29胼胝体变性横断面：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 2023-1-22.30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The First

15、Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.31胼胝体变性肿瘤样脱髓鞘病变DWI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 2023-1-22.32胼胝体出血 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 Zh

16、ejiang Chinese Medical University 2023-1-22.33胼胝体出血 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 2023-1-22.34胼胝体出血胼胝体动静脉畸形胼胝体动静脉畸形The First Affiliated Hospital Zhejiang Chinese Medical University 2023-

17、1-22.35胼胝体出血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 Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.36胼胝体出血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 2023-1-22.37胼胝体出血男男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

18、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、FLAIRFLAIR高信号高信号The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.38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The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1

19、-22.39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The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.40胼胝体梗死 急性梗死患者，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 2023-1-22.41胼胝体梗死

20、胼胝体压部梗死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 2023-1-22.42胼胝体梗死 急性梗死DWI: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 U

21、niversity 2023-1-22.43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The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.44胼胝体肿瘤 良性：胼胝体脂肪瘤The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.45胼胝体肿瘤 良性：胼胝体发育不良 合并脂肪瘤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

22、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 2023-1-22.46胼胝体肿瘤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 2023-1-22.47胼胝体肿瘤 恶性：胶质瘤The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.48胼胝体肿

23、瘤 恶性：胶质瘤The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.49胼胝体肿瘤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 2023-1-22.50胼胝体肿瘤多形性恶性胶质瘤多形性恶性胶质瘤The First Aff

24、iliated Hospital Zhejiang Chinese Medical University 2023-1-22.51胼胝体肿瘤淋巴瘤The First Affiliated Hospital Zhejiang Chinese Medical University 2023-1-22.52胼胝体肿瘤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 2023-1-22.53胼胝体肿瘤肺癌胼胝体转移瘤肺癌胼胝体转移瘤The First Affiliated Hospital Zhejiang Chinese Medical University.54