![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=1739249105-bmYCCTy9p7W28SiLndLG2aAo541B2a5j-0-685470fceb304d593c3c9d6546a13274)
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=1739249105-eyyrj0WvFN9EzwdM2pzUG5JidLGCbYvs-0-cd67b65d4a6164923888967171cbc1bb)
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=1739249105-6X1FoHsXpe7jLpropwWkLjYYRsh6Msyj-0-fd76cca5e549c92410f87866134e66db)
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=1739249105-K4uYQbfDn7aJjwDywuDQAFsF87TKhjPG-0-04cdbbcfdd82e7a1b5df1300371148bf)
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=1739249105-uTJiTECWEWUeA4WuNH4cN3e5irs4Mhrx-0-d9f5c5d6848493e4d48f00b29ed98577)
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=1739249105-OvQtQOtE8PANjFDbTD6vl83uP3OEFMIc-0-73714916de5c4498f7ff68962f4ac921)
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=1739249105-y0CQt5yVgbEzQjcKWL3KjrZXZQkEFMgF-0-a619eb1b40a0f6b6a6e181904cf0b161)
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=1739249105-f0dbE3qH3L41wwnIQXx7DzqFSel04buf-0-6de4f7ef5f6f7dece5ee77c491aa1e2a)
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=1739249105-ybmJTSq0SiJ61nLnNq7VlCyy91ydX4AF-0-1efa7e799f137ed7aee3f64f8839723f)
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=1739249105-1oAy823GPCIsylTMwn3gWdJqYpYwAweH-0-f8dc78959419626ca05771820c732804)
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=1739249105-IyV4mHdlzvf2zN2ssI1RGHVCo7ivXxRb-0-c670cc58998fa55155e1401275961d11)
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=1739249105-JJevsPR8rxSXTiPurvMXe0kZjVLNy4uu-0-faf2ddb86f9d04a88209a8cd88d8b3fa)
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=1739249105-05WRG0eeLmFJheXQ24zmwjAhjIUKeSn5-0-02b0c011f00fe251e63b616427a615f3)
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=1739249105-Q3aJhMqC3KA87OmdqfsJ2W0fTedmrtKH-0-c0aea854f31c18b9869200180eea53d1)
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=1739249105-PoNilAnPtId4dN8XrhtIh5Fsk4KXTS7B-0-c00aaac7faa8b542c40a1e21e67d47f6)
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=1739249105-PldQIWBZ7reBI18ommSGrBpn1nNHUoz5-0-1fdb4ec39dae55ec680006786d415eb5)
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=1739249105-BncgYphP2vMWTO0S9R8lPjakNrfvgtmo-0-f1a51495f39693b226152d47ea15758f)
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=1739249105-4mnlPCpQY4IEGimw8n7esZnwdZI52ODD-0-670574768f6a17bc44948946443cd0e0)
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=1739249105-bxH93spN0tkI3eKMRuHHBOt0iwpY5u4w-0-05d8a458bb2121ed01bf2ce9e82e91bd)
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=1739249105-Ax76kByr8DNxrVAwIB1EqXMxt3NKKXCP-0-86fad4e803ec28ac5c5bf9bd8a37413e)
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=1739249105-xJXBIF0Yg038rqyl8vpjfUp7AyScCpiR-0-4f18e4da290643af6b5fd376f26d7ff2)
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=1739249105-rAptZcxsIG3brb4syQZOTrGqVuM6jBGK-0-9bca899f92fbe08c3f725bb4ceae6057)
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=1739249105-uj9IGIH9yljFZecqcWR2bS7qz6Cl1BcD-0-de82fd5ec9f1f267d55a144837ecfb55)
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=1739249105-eL9DdIZ9EhkQhujOGHvonb6MHKr8aXEZ-0-aa46c949ff4fa59a4eda5d06af4e136a)
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=1739249105-Z9s0D8JPsSqgjbDFEULPoVcsdBP3ULlT-0-3f8feb9b7303d52c9ebb8c74df14a3b2)
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=1739249105-MDLejZlI3IS5Kt2CwXAEkRCBtl4hgf6P-0-6a6c0438f2e3625f458471f052982632)
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=1739249105-XQ2QCztNiOChUtI7xNzDoNc0hK62JJV3-0-8b4a16f1fceb05bffc6a12dc6513a7d1)
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=1739249105-JN6hBJFP69NPJgPHX6CuomXJEq3iePn0-0-b60ae5633064df8b5f099ccfc5d8f687)
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=1739249105-th89FLK9WDelLo6fOJN4EogXA9PbYrLg-0-cc6098d85058b07d62e2691f8ffe7cf5)
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=1739249105-RoB4wdHP0XHyRpxkUWV3gmmQMza1nZuG-0-2f698f920c2869b404a99eac20550325)
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=1739249105-dgTKX6DCptAOZRlAn2UJmHcSfcri8ahv-0-103f09ff31b70df78741dec7406f41f6)
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=1739249105-56LP1eyMbF0HdOf5gKbGNbkNBagNmVX9-0-951e345b792314229ff127f8b4863333)
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=1739249105-F7HkFlve34sHidqewJ0Y51KcI7wjMoIK-0-6533ea6c0795f5f18d7ba36c179881aa)
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=1739249105-mfjT0bdZFiBc8QkIdZbIhhSrbyfxqR2g-0-404c3d6adb3904a647e18e544aef79de)
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=1739249105-j4h0i7iwXGHAK6dRCehzLzAI6CtcjRFk-0-f8dd0aad1dd2bfb6d80db87918b60af0)
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=1739249105-eI8IvY6DWJmEEliEgC65SreqkSkf9SR3-0-500ce1038e40e179480ccc7780d729c1)
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=1739249105-77nRR9CglNNGWrYQr7DFC8DlDiWnspc1-0-06a036797012918c987c98f1527c9be5)
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=1739249105-ZiOK4w2eh69JN7NH1YO9anyUmPRjfSkL-0-8ee5ab886ed7ebcaaeb72ceb4074b20e)
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=1739249105-89N17UTGig4UHYeyh43s60EcEufVdaxM-0-5f43ebaf767d14bfddd7a9947178d9b1)
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=1739249105-96yJPcoGbgxyUZU65HEwZPNcOlV8TIiq-0-52da401101a2c4128a7c88e9f42f7525)
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=1739249105-pM0z015BimPTOUgeIEDZHOsVMHhv0EET-0-de1663cc65f12f4323a72eb509e7a8b6)
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=1739249105-pZClLFahJj5kSHtv7NhzlCoc5vUWJmhE-0-1bdf1e9e33e853dc9be9b1947526e263)
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=1739249105-bFeIwJaZmUxfsxgT88Yen2JkXz3HZG8k-0-046b2ccab829df222de7a6f7b23b059a)
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=1739249105-R1uR6yXwvep17OWmrWi9DugOrifi3FPM-0-ac0f574155f793ac483116df9b99e376)
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=1739249105-3zyFhDdx8HmDhxjB5jGFE3oNttlDOrmR-0-476bd67902e904e674319bffc53ae47a)
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=1739249105-s44SZvWBhcPClnyQUjidH9HvrP4pfZmQ-0-d0be179d48f4b65fc7dd01f37616d0d1)
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=1739249105-XgYU2mbob5CVfeusAXJ0lSMuLvxhdx73-0-97a80d90e634b87c8c525acf3aaf59f4)
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=1739249105-76d5v1JY87IZyvY5ewCKjdFYNe971gZF-0-ec18b78aa12ecff86d45c5e98dd0ec58)
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