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四、脑室与脑池疾病鉴别诊断
1.第四脑室区常见肿瘤的鉴别诊断
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image104.jpeg?sign=1739283451-zInKJwBVCyltPaPJUd4Tj4yYXfJzFV7X-0-38fc8859fd3cb06f564e0872b70b826f)
图1-4-1 室管膜瘤MRI表现
第四脑室扩大,其内可见不规则混杂信号肿物影,以长T2信号为主(→);增强扫描病灶明显不均匀强化(),并可见多发囊变区
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image105.jpeg?sign=1739283451-rFy0wBrWm8M5eUvSRLXeuqFva5vEuh4T-0-0fb467abb3e737b936f70a5a914c256f)
图1-4-2 髓母细胞瘤MRI表现
小脑蚓部可见实性占位(→),呈稍长T1、稍长T2信号,病变与右侧小脑半球及小脑蚓部分界不清。增强扫描病变明显强化。邻近脑干受压,幕上脑室扩张
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image107.jpeg?sign=1739283451-dvyt7svHffHActNVRkdLedWNnt7gY3rl-0-103323b941c0366fbd11e699d39b215d)
图1-4-3 脉络丛乳头状瘤MRI表现
第四脑室内可见类圆形囊实性肿物影,实性部分为分叶状,呈等T1、等T2信号影(→),囊性部分呈长T1、长T2信号影();增强后可见实性病灶明显强化
2.侧脑室区常见肿瘤的鉴别诊断
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image110.jpeg?sign=1739283451-nm1bZ5tSMLUoLkGYErnnqcUu6Wa55PAm-0-b63a661f2e2acc985641ed4177ff91b1)
图1-4-4 室管膜瘤MRI表现
左侧侧脑室前角可见不规则团块状混杂信号肿物影(→),T1WI其内散在斑片状高信号改变(),提示合并出血,T2WI其内信号混杂,囊实性改变,肿瘤跨越脑室前角向脑内蔓延,瘤周可见水肿带,增强扫描肿瘤不均匀花环样强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image111.jpeg?sign=1739283451-bTtCqAmb1LwQi1QSyDW1IGHEFlujLBSt-0-1d8a28ee37e782016e2ba85408d711c9)
图1-4-5 脑膜瘤MRI表现
左侧侧脑室三角区见椭圆形稍长T1、长T2信号肿块影(→),T2WI信号略不均,其内低信号为钙化所致,边界较清晰。增强扫描显示肿块影较均匀明显强化,肿块与侧脑室壁分界清
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image112.jpeg?sign=1739283451-DkN5wGu5KNxtc3O5PHsJf7KNWLr52NPb-0-7d68c1cb7eeab4dc3de3b283a7b2151f)
图1-4-6 室管膜下巨细胞星形细胞瘤MRI表现
左侧侧脑室前角孟氏孔附近可见长类圆形等T1、稍高T2信号肿块影(→),其内信号不均,T2WI低信号为合并钙化();侧脑室前角扩大,脑室旁间质性水肿形成。病灶旁亦可见小结节。增强扫描显示病灶明显强化,邻近小结节亦强化明显
3.第三脑室区常见肿瘤的鉴别诊断
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image114.jpeg?sign=1739283451-ni5XMOgAmo1ieIgdI4ECClAErrI120aj-0-f2788b557bdcd09e9a07f716e46bed7b)
图1-4-7 室管膜瘤MRI表现
第三脑室扩张,其内可见等T1、长T2信号肿块影(→),其内散在沙粒样短T2信号灶,提示合并钙化。增强扫描肿瘤不均匀强化,其内可见斑点状未强化区
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image116.jpeg?sign=1739283451-R7F2w6sHUWO56Md0aCCN6KbnETJlwB89-0-faff34c2dacf9f689dd4f063b9c01844)
图1-4-8 胶样囊肿MRI表现
第三脑室轻度扩张,其内可见椭圆形短T1高信号灶,T2WI呈稍低信号改变(→)。FLAIR呈稍长信号,边界清晰()
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image117.jpeg?sign=1739283451-jx434JE6hDt5BtlVPdlV5nxWZuTLpgI3-0-d9d0fb5e5870f26699365d0d31e02faa)
图1-4-9 松果体细胞瘤MRI表现
松果体区见一不规则肿块影(→),边界不清,其内信号不均,以稍长T1、稍长T2信号为主,肿块向前累及第三脑室后部。双侧侧脑室增宽。矢状位FLAIR显示松果体区病变明显强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image118.jpeg?sign=1739283451-iLeHw896O7BRc4nCl9gdqyfpocJmMgpm-0-bac0ed850c05a1e902a3b5c886740b4f)
图1-4-10 毛细胞型星形细胞瘤MRI表现
鞍上区椭圆形肿物影(→),其内信号不均,以长T2信号为主,第三脑室前部受压,后部扩张;增强扫描病灶明显强化,其内可见点状未强化区