脑内环形强化病变鉴别诊断 PPT
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➢ Establishing a correct diagnosis is necessary to quickly start the appropriate treatment.
➢ This is a real challenge for the radiologist, as it frequently requires a multidisciplinary approach.
➢ Ring enhancing lesions on MRI have a long list of differentials ranging from infectious processes to necrotic neoplasm.
➢ Although radiographic differentiation of the cause of the intracranial abnormality is difficult and often nonspecific, certain clues may help differentiate the etiology of the infection.
概述
➢中枢神经系统感染性疾病是一种新出现的健康问题，若 治疗不充分将预后不良
➢建立一个正确的诊断是必要的，以便迅速开展适当的治 疗
➢这对放射科医生来说是一个真正的挑战，由于其经常需 要联合多学科知识
➢在MRI上，环形强化病变有种类繁多，从感染性病变到 坏死肿瘤
➢虽然影像学鉴别颅内异常的病因是困难的，往往也是非 特异性的，但某些线索可能有助于鉴别感染的病因
➢ Thinner near the ventricles because of the relatively poor vascularity.
由于血供应较差，病变邻近脑室侧 较薄
“DAUGHTER” ABSCESS（子脓肿）
The thin wall may predispose to daughter abscesses or intraventricular rupture if located adjacent to the ventricular margin. 如果薄壁位于脑室边缘，则易产生子脓肿或脑室内破裂
✓ However, restricted diffusion is not pathognomonic (metastases, subacute hematomas…)（弥散受限不具有特征性， 如转移瘤，亚急性血肿…）
PYOGENIC ABSCESS WALL 化脓性脓肿壁
➢ Hyperintensity on T1WI against the hypointense background of necrotic cavity and surrounding edema. （T1WI在坏死脓腔和周围水肿低信号背 景下表现为高信号）
CASE 1
Most likely diagnosis？ A)Pyogenic abscess（化脓 性脓肿） B)Tuberculoma（结核瘤） C)Fungal abscess（真菌性 脓肿） D)Toxoplasmosis（弓形虫）
PYOGENIC ABSCESS CAVITY （化脓性脓肿腔）
脑内环形强化病变鉴别诊断 PPT
Introduction(前言)
➢ Central nervous system (CNS) infections are an emerging health problem with poor prognosis if treatment is not adequate.
PYOGENIC ABSCESS WALL “DUAL RIM SIGN” 化脓性脓肿壁“双环征”
➢ Best appreciated on SWI. (also onT2WI and FLAIR)在SWI上显示最佳（同样 在T2WI及FLAIR也可显示）
Hale Waihona Puke 大家学习辛苦了，还是要坚持继续保持安静
PYOGENIC ABSCESS WALL 化脓性脓肿壁
➢ Usually a continuous smooth thin rim. 脓肿壁通常是薄而连续光滑的环
➢ Neoplasms usually have a more nodular and irregular appearance. 肿瘤通常伴有结节状和不规则的外 观
✓ Marked and homogeneous restricted diffusion（均匀弥散受限） – High concentration of protein, bacteria and cellular debris（高浓度蛋白、细菌、细胞 碎片 ）
✓ DWI is regarded as the best sequence for differentiation of ring-enhancing pyogenic abscess from necrotic tumor（DWI被认为是 鉴别环化强化病变化脓性脓肿与坏死肿瘤 的最佳序列）
– Paramagnetic effect of free radicals generated by macrophages. （巨噬细胞产生自由基的顺磁 效应） ➢ Hypointensity on T2WI（T2W低信号） – Free radicals and collagenous fibrous capsule.（自 由基及胶原纤维囊）
➢ But it is not a specific finding and not always so smooth… 但这点并不是特异征象，也不总是 那么光滑……
PYOGENIC ABSCESS WALL 化脓性脓肿壁
➢ Thicker near the cortex because of the rich vascularization of the grey matter. 由于灰质的血供丰富，病变邻近 皮层侧变厚
➢ This is a real challenge for the radiologist, as it frequently requires a multidisciplinary approach.
➢ Ring enhancing lesions on MRI have a long list of differentials ranging from infectious processes to necrotic neoplasm.
➢ Although radiographic differentiation of the cause of the intracranial abnormality is difficult and often nonspecific, certain clues may help differentiate the etiology of the infection.
概述
➢中枢神经系统感染性疾病是一种新出现的健康问题，若 治疗不充分将预后不良
➢建立一个正确的诊断是必要的，以便迅速开展适当的治 疗
➢这对放射科医生来说是一个真正的挑战，由于其经常需 要联合多学科知识
➢在MRI上，环形强化病变有种类繁多，从感染性病变到 坏死肿瘤
➢虽然影像学鉴别颅内异常的病因是困难的，往往也是非 特异性的，但某些线索可能有助于鉴别感染的病因
➢ Thinner near the ventricles because of the relatively poor vascularity.
由于血供应较差，病变邻近脑室侧 较薄
“DAUGHTER” ABSCESS（子脓肿）
The thin wall may predispose to daughter abscesses or intraventricular rupture if located adjacent to the ventricular margin. 如果薄壁位于脑室边缘，则易产生子脓肿或脑室内破裂
✓ However, restricted diffusion is not pathognomonic (metastases, subacute hematomas…)（弥散受限不具有特征性， 如转移瘤，亚急性血肿…）
PYOGENIC ABSCESS WALL 化脓性脓肿壁
➢ Hyperintensity on T1WI against the hypointense background of necrotic cavity and surrounding edema. （T1WI在坏死脓腔和周围水肿低信号背 景下表现为高信号）
CASE 1
Most likely diagnosis？ A)Pyogenic abscess（化脓 性脓肿） B)Tuberculoma（结核瘤） C)Fungal abscess（真菌性 脓肿） D)Toxoplasmosis（弓形虫）
PYOGENIC ABSCESS CAVITY （化脓性脓肿腔）
脑内环形强化病变鉴别诊断 PPT
Introduction(前言)
➢ Central nervous system (CNS) infections are an emerging health problem with poor prognosis if treatment is not adequate.
PYOGENIC ABSCESS WALL “DUAL RIM SIGN” 化脓性脓肿壁“双环征”
➢ Best appreciated on SWI. (also onT2WI and FLAIR)在SWI上显示最佳（同样 在T2WI及FLAIR也可显示）
Hale Waihona Puke 大家学习辛苦了，还是要坚持继续保持安静
PYOGENIC ABSCESS WALL 化脓性脓肿壁
➢ Usually a continuous smooth thin rim. 脓肿壁通常是薄而连续光滑的环
➢ Neoplasms usually have a more nodular and irregular appearance. 肿瘤通常伴有结节状和不规则的外 观
✓ Marked and homogeneous restricted diffusion（均匀弥散受限） – High concentration of protein, bacteria and cellular debris（高浓度蛋白、细菌、细胞 碎片 ）
✓ DWI is regarded as the best sequence for differentiation of ring-enhancing pyogenic abscess from necrotic tumor（DWI被认为是 鉴别环化强化病变化脓性脓肿与坏死肿瘤 的最佳序列）
– Paramagnetic effect of free radicals generated by macrophages. （巨噬细胞产生自由基的顺磁 效应） ➢ Hypointensity on T2WI（T2W低信号） – Free radicals and collagenous fibrous capsule.（自 由基及胶原纤维囊）
➢ But it is not a specific finding and not always so smooth… 但这点并不是特异征象，也不总是 那么光滑……
PYOGENIC ABSCESS WALL 化脓性脓肿壁
➢ Thicker near the cortex because of the rich vascularization of the grey matter. 由于灰质的血供丰富，病变邻近 皮层侧变厚