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五、脑膜及颅骨疾病鉴别诊断
1.脑膜疾病的鉴别诊断
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image120.jpeg?sign=1739349123-SPCbmaG1W3nLWGlZL6eZWtFW76kdynKS-0-14e7f5aa1931e3976c2b0d4e66bfdf2d)
图1-5-1 化脓性脑膜炎MRI表现
双侧半卵圆区脑沟、脑裂模糊、消失(→),FLAIR呈条带状高信号改变;DWI信号增高,提示水分子弥散受限,T1WI增强扫描脑沟内多发脑回状强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image122.jpeg?sign=1739349123-CuV6pzfUGaXWyRSsMsm7bOhUxPuMrsPR-0-4b2786fd18146c2832be45d393418ee2)
图1-5-2 病毒性脑膜炎MRI表现
双侧岛叶、右侧颞叶脑沟、脑裂模糊,呈云絮状稍长T2信号改变,边界模糊,双侧丘脑、尾状核头、壳核亦受累(→);FLAIR信号增高、病灶显示清晰;DWI未见弥散受限高信号改变
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image123.jpeg?sign=1739349123-7LrGdvEZPIlA0wVLz46e2mZ9co3hA3hQ-0-52c78dc54ecec5bf7b9d378f9e5af8b7)
图1-5-3 结核性脑膜炎MRI表现
脑桥基底部、脚间池及鞍上池见团块状混杂信号影(→),以长T2信号为主,其内散在斑片状T2WI低信号灶,FLAIR呈等及稍低信号(→);T1WI增强扫描显示软脑膜强化,病灶呈不均匀强化,部分呈花环样强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image124.jpeg?sign=1739349123-r6xtgjGEqyhVJdH5MoLkmNoH4jQ1Bbdy-0-d716a7730c8a2c97bd70b97a6d685818)
图1-5-4 脑膜转移瘤MRI表现
T2WI可见小脑脑沟增宽,FLAIR脑沟内脑回样高信号改变,增强扫描沿软脑膜分布的多发结节样、线样强化(→)
2.颅骨常见疾病的鉴别诊断
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image126.jpeg?sign=1739349123-dyGTaskMrsaHSXOX9m8qyy0iEXvBzdAR-0-74329c5bc457e46f37f0d040547b233a)
图1-5-5 骨髓瘤MRI表现
左侧额骨巨大软组织肿块影(→),T1WI、T2WI稍低于骨髓信号,肿块向颅内及颅外蔓延,额叶皮质扣压改变,增强扫描明显强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image127.jpeg?sign=1739349123-4zp0vccX8YoRN5KsP5OjQJCCMCxw9iee-0-01a5fb75c1a3f82e90c3c6afddef67d0)
图1-5-6 血管瘤MRI表现
右侧额骨内可见梭形软组织肿块影,呈长T1、长T2信号改变(→),边界清晰,局部骨质膨胀,增强扫描明显强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image129.jpeg?sign=1739349123-bsJtPK4PHg9lsQPnAVgCVxPe9dBB3xP1-0-68e0c4789879acea60aa4ddf068451e2)
图1-5-7 转移瘤MRI表现
肺癌患者,左侧枕骨骨质破坏,见混杂稍长T1、稍短T2肿块影,小脑实质轻度受压改变,增强病灶明显强化,病理证实为颅骨转移
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image130.jpeg?sign=1739349123-NBT8iSP4PtHCmlJi4TVJSWj7cJjOZPvG-0-922d8c7c25f19b8fd5f6bb55587fcef6)
图1-5-8 嗜酸性肉芽肿MRI表现
左侧顶骨局部骨质破坏及不规则软组织肿块影,增强扫描周边明显强化(→),中央坏死区未见强化,邻近脑膜亦可见强化
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image131.jpeg?sign=1739349123-EB2RGo4oBUWPPXqLmzE8jZH5YuolNrc5-0-c7ea9bf34a209e5aa1d398482f793c10)
图1-5-9 颅骨骨纤维异常增殖症MRI表现
右侧额骨见类圆形等T1、短T2信号团块影(→),边界清楚,向颅内外膨隆;增强扫描呈不均匀斑片状强化()
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image132.jpeg?sign=1739349123-hS6KO7yMhChobSvswYPQzo7LahF6vxui-0-3e54d4f196c8824cba0f3eaf0e7949aa)
图1-5-10 畸形性骨炎MRI表现
颅骨弥漫性不均匀增厚,T1WI呈高低信号混杂改变,T2WI弥漫性信号减低(→)
![](https://epubservercos.yuewen.com/ACF619/14262447305041006/epubprivate/OEBPS/Images/image133.jpeg?sign=1739349123-1Z99UIWR1j8vZRud7kg2MaJYBO0c44MW-0-22bacb57772da0a0d24ce8877aff7a29)
图1-5-11 颅骨表皮样囊肿MRI表现
额骨正中板障内可见梭形T1低、T2高信号灶(→),边界清晰,T1较脑脊液信号稍高,T2较脑脊液信号稍低,相应骨质膨隆向外突出