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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=1738959666-jqP8Fu9EmXRF6tvHVXomU4lrW8RjlwH3-0-861d993106ba03d212b4e01560087751)
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=1738959666-eE0LxzgoFoYUv1HJueF1uvV3icrx3pFz-0-c077b57b377d64e1d599a952a05654e4)
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=1738959666-JSeu4f6dP3H8F7FzanLqayFd7D8Y8vhS-0-4e5e06a8d8e7dbb6045272747f9450ef)
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=1738959666-SP0LBi3AMoR4pq5WO4ONch9JjhFTS5Rk-0-9bb5f485105265e2457278a0cb9c5f03)
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=1738959666-YcZpi5O7UoVoT5oTtihm3X2VPKqNlGOq-0-e62ee6c3a6f9a5ebfae9ce6f6f37b96e)
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=1738959666-zih3GBPBAe2NYmw4xznbgo2KbA5EpJF6-0-7e424fe9b964bc0ca2ab3a3ce919ff46)
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=1738959666-RvXETgxz0eQp0Z5PD5k6GzkNQxDnUO3i-0-35a9bff3c6ec34aa5cb5bbe98acd4f13)
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=1738959666-jJeCxrjfBIwsBWVVL4e5W0apo1jtmApf-0-fb1da53afd5c3e1ac2db8910131b7639)
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=1738959666-jY7jwSvvdcGGVlcAuVCcOK8s5TT8CluD-0-990f34bf41bd9d49e9121cee6448edf8)
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=1738959666-FHp0ibdKcRaFKv9ENZ252FK9s55dHIJC-0-44163e1b9dce4fe45eeba9d71cd7ae18)
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