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三、脑血管疾病及感染性疾病的鉴别诊断
1.脑脓肿分期的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image63.jpeg?sign=1739496377-cGd7RkpImCFjQ0LPQhFa0O490DHkSkOp-0-0a5848dadd638c8a46056326d824eb03)
图1-3-1 脑炎期脑脓肿
CT平扫可见双侧脑室旁、基底节区斑片状低密度改变,边界模糊,双侧脑沟内可见条带状高密度出血灶(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image64.jpeg?sign=1739496377-pY02i6xWxGdt8i9ry5218eua2PRFtewQ-0-239449e8cc2a83ce8e53c3098e5bada6)
图1-3-2 化脓期脑脓肿
CT增强扫描可见右额叶大片状低密度水肿带(→),其内可见环形轻微强化灶,强化囊壁不完整,边界模糊、不清
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image65.jpeg?sign=1739496377-jbuK7LAR9psLZDaAXWc0X2NirSax0pRD-0-b5ac7ba57649ec8856066a209da1fec7)
图1-3-3 包膜形成期脑脓肿
脑实质内可见多发指套状低密度水肿带(→),增强扫描其内可见多个薄壁环形强化灶(→),病灶囊壁清晰,边缘光滑
2.血管性脑白质病变与多发性硬化的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image67.jpeg?sign=1739496377-9IFo6wiketmDOGAGEJWZKIFDyMaHgxDa-0-1240812e5ca13636d8e04418c46f9d47)
图1-3-4 血管性脑白质病变 (脑白质疏松症)
CT平扫显示脑室前后角周围白质内 片状低密度灶(→),边界模糊, 右侧脑室前角旁斑点状低密度灶 提示同时合并腔隙性脑梗死
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image68.jpeg?sign=1739496377-QEaXS9Jx0lUEnuotWrC5jDmcJ4aS0aR1-0-315da4e5a9a319b01e291870c3820993)
图1-3-5 多发性硬化
CT平扫显示双侧脑室前后角 旁见多发斑点状低密度灶(→)
3.脑感染性疾病的鉴别诊断
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image70.jpeg?sign=1739496377-diSaNeYcTxtYOOD8YAeHurH6G09xMvLa-0-13f759e8218a8aa3e7753cbbc1b5633b)
图1-3-6 脑脓肿
CT增强扫描显示左额叶斑片状低密度灶(→),薄壁环形强化
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image71.jpeg?sign=1739496377-xIK90jc0l6qajg21vgFDc0EW3zsZTuHY-0-0d44a5f5674f61bc136c78959efbb480)
图1-3-7 脑结核
(A)可见脑室扩大,右顶叶厚壁环形高密度灶(→),灶周斑片状水肿带围绕;(B)显示囊壁明显强化(→),邻近脑膜强化明显
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image72.jpeg?sign=1739496377-meUlUDQnQweKTiv7NhogoFYXTKXa5AWg-0-fb01b9a62e83ff1ffa813860cab8ff47)
图1-3-8 病毒性脑炎
CT平扫显示左颞叶斑片状低密度影(→),边界模糊
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image73.jpeg?sign=1739496377-SmNasal0N7uYE1WfwgHP2JEQhzWKg9vp-0-88bc840e55fc61a29637bab6a6403cc2)
图1-3-9 脑囊虫病(急性期)
(A)可见左顶叶斑片状低密度水肿带,其内可见稍高密度环形影,环内点状高密度灶代表头节(→);(B)显示囊壁及其内头节明显强化(→)
![](https://epubservercos.yuewen.com/6D40E4/14262446004375506/epubprivate/OEBPS/Images/image74.jpeg?sign=1739496377-7cq9xvnvwflgy49HHUnijdhgh7SvHBlO-0-4671b0b9f5fed160aaed6a1b53961b3c)
图1-3-10 脑棘球蚴病
CT增强扫描显示双侧顶叶多发圆形或类圆形低密度囊性病变(→),囊内可见子囊,未见强化