第二章 中枢神经系统
一、目的与要求
1.了解颅脑和脊髓的检查方法；
2.熟悉颅脑和脊髓的X线、CT和MRI正常解剖；
3.掌握颅脑和脊髓的基本病变的影像学表现，尤其CT、MRI表现；
4.掌握常见颅内肿瘤、脑血管疾病、外伤、常见感染性疾病的影像学表现；
5.熟悉脊髓疾病的影像学表现。
二、教学内容
第一节 检查方法
1．颅脑
（1）X线检查：平片、血管造影；
（2）CT检查：平扫、增强、CTA以及CT灌注扫描；
（3）MRI检查：侧重常规序列的讲解，简单介绍功能成像。
2．脊髓
（1）X线平片：常规正侧位；
（2）脊髓造影：了解适应症；
（3）CT检查：平扫、增强以及脊髓造影CT（CTM）；
（4）MRI检查：侧重常规序列的讲解，简单介绍MR脊髓成像（MRM）。
第二节 正常影像解剖
1．头颅平片的正常表现和变异，侧重讲述颅缝、囟门、颅壁压迹、蝶鞍的表现；
2．颅脑CT、MRI横断面正常表现；
3．脊髓CT、MRI正常表现。
第三节 基本病变的影像学表现
1．颅脑
（1）平片：侧重讲解颅内压增高、颅内肿瘤定位征象；
（2）CT和MRI：分别讲解颅内病变的病灶显示、强化表现、脑水肿、占位效应、
脑积水和脑萎缩的表现；
2. 椎管内肿瘤
简单介绍X线平片和脊髓造影的表现。
第四节 颅内肿瘤
1．神经胶质瘤：熟悉星形细胞瘤、少突胶质细胞瘤和髓母细胞瘤的临床和病理表现，掌握其CT和MRI征象。
2．脑膜瘤：熟悉其临床和病理表现，掌握CT和MRI征象。
3．垂体腺瘤：了解其分类和临床表现，掌握微腺瘤和大腺瘤的CT和MRI特点。
4．颅咽管瘤：熟悉其好发部位、病理特点以及CT、MRI诊断依据。
5．生殖细胞瘤：熟悉其好发部位、病理特点以及CT、MRI诊断依据。
6．听神经瘤：熟悉其病理改变，掌握CT和MRI表现，了解桥小脑角占位的鉴别诊断。
7．血管母细胞瘤：了解其病理特点，熟悉CT和MRI表现。
8．脑转移瘤：熟悉其临床和病理表现，掌握CT和MRI特点。
第五节 脑血管疾病
1．脑梗死：结合动脉性脑梗死后的病理生理改变，重点掌握常规CT和MRI表现；熟悉腔隙性脑梗死和出血性脑梗死的CT和MRI诊断要点。
2．脑出血：结合脑出血不同时期的病理改变，着重讲述常规CT和MRI表现；
3．结合病例，熟悉蛛网膜下腔出血、动静脉畸形、动脉瘤的CT、MRI、DSA的表现。
第六节 颅脑外伤
1.硬膜外血肿：了解本病的发生机理、病理改变，掌握其CT和MRI表现。
2.硬膜下血肿：了解本病的发生机理、病理改变，掌握其CT和MRI表现。
3.脑挫裂伤：了解本病的发生机理、病理改变，掌握其CT和MRI表现。
4.弥漫性轴索损伤：自学。
第七节 颅内感染性疾病
1.化脓性脑脓肿：了解发病机制、病理表现，掌握其CT、MRI典型表现。
2.颅内结核：熟悉CT、MRI表现。
3.病毒性脑炎：自学内容。
4.脑囊虫病：自学内容。
第八节 脱髓鞘疾病
本节简单介绍多发性硬化的影像学表现。
第九节 颅脑先天性畸形及发育障碍
本节为自学内容。
第十节 脊髓疾病
结合病例，介绍常见的脊髓内肿瘤（室管膜瘤、星形细胞瘤）、髓外硬膜下肿瘤（神经鞘瘤、神经纤维瘤、脊膜瘤）的CT和MRI表现。
脊髓损伤、脊髓空洞症为自学内容。
三、实验内容与要求
通过示教片了解中枢神经系统的平片、造影检查、CT和MRI检查方法；
通过示教片熟悉颅脑和脊髓平片、CT和MRI正常影像；熟悉颅脑和脊髓异常表现；
通过示教片掌握神经胶质瘤、脑膜瘤、垂体腺瘤、听神经瘤、脑转移瘤、脑梗死、脑出血、颅脑外伤、化脓性脑脓肿、脊髓内肿瘤、髓外硬膜下肿瘤的影像学表现。
熟悉颅咽管瘤、生殖细胞瘤、血管母细胞瘤、蛛网膜下隙出血、动静脉畸形、动脉瘤、颅内结核、脊髓空洞症的影像学表现。
四、教学时数分配
理论课学时分配
|
章 节 |
理 论 课 内 容 |
学 时 |
|
第二章第一节
第二节 |
检查方法
颅脑正常影像表现
脊髓正常影像表现 |
1 |
|
第二章第三节 |
颅脑基本病变的影像学表现
椎管内肿瘤的基本影像学表现 |
1 |
|
第二章第四节 |
颅内肿瘤：侧重讲解神经胶质瘤、脑膜瘤、垂体腺瘤、听神经瘤、脑转移瘤；
简单介绍颅咽管瘤、生殖细胞瘤、血管母细胞瘤 |
1
1 |
|
第二章第五节 |
脑血管疾病：重点讲解脑梗死、脑出血；
简单介绍蛛网膜下隙出血、动静脉畸形、动脉瘤 |
1
1 |
|
第二章第六节 |
颅脑外伤：重点讲解硬膜外血肿、硬膜下血肿和脑挫裂伤 |
1 |
|
第二章第七节 |
颅内感染性疾病：重点讲授化脓性脑脓肿，简单介绍颅内结核、病毒性脑炎 |
1 |
|
第二章第八节
第二章第十节 |
脱髓鞘疾病：简单介绍分类和多发性硬化
脊髓疾病：重点讲解椎管内肿瘤 |
1 |
|
总 学 时 |
9 |
实验课学时分配
|
序 号 |
实 习 课 内 容 |
实 验 类 型 |
学 时 |
|
1 |
读片内容：颅脑、脊髓正常表现：基本病变；颅内肿瘤的影像学表现 |
演示性实验 |
2 |
|
2 |
读片内容：脑血管疾病、脑外伤、脑感染性疾病以及脱髓鞘疾病；椎管内肿瘤 |
演示性实验 |
2 |
|
总 学 时 |
4 |
思考题
1．颅内压增高的X线诊断？
2．星形细胞瘤的组织学分级和CT、MRI表现？
3．脑膜瘤的CT和MRI诊断要点？
4．垂体大腺瘤的MRI表现？
5．常见的桥小脑角区肿瘤的CT和MRI鉴别诊断？
6．缺血性脑梗死的CT和MRI表现？
7．不同时期脑出血的MRI信号特点？
8．硬膜外血肿和硬膜下血肿的CT鉴别诊断？
Chapter 2 Central nervous system
一、Requirement
1.Comprehend examination methods for brain and spinal cord.
2.Conversant with normal anatomy appearance of brain and spinal cord in x-ray, CT and MRI.
3.Master image appearance of basic disease in brain and spinal cord, especially CT and MRI ones.
4.Master image appearance of common intracranial tumors, cerebrovascular disease, trauma and common infective disease.
5.Conversant with image appearance of spinal disease.
二、 Teaching Content
Section 1 Examination method
1.Brain
（1） x-ray: plain film and angiography(comprehend)
（2） CT: all examination technique(comprehend)
（3） MRI: emphasize on conventional sequence and simply present functional MRI
2.Spine
（1）X-ray plain film：posterior-anterior and lateral position is routine.
（2）Spinal myelography
（3）CT：plain scan, contrast scan and CT myelography(CTM)；
（4）MRI：emphasize on conventional sequence and simply present MR myelography.
Section 2 Normal imaging anatomy
1. Normal appearance and variance in skull plain film ,emphasis on cranial suture, fontanelles, impression of cranial bone and sella turcica
2. CT and MRI sectional anatomy of brain
3. Normal appearance of spinal cord in CT and MRI
Section 3 Image appearance of basic disease
1.Brain
（1）Plain film: location symptom of increased intracranial pressure and brain tumors
（2）CT and MRI：displaying lesions, enhancement appearance, cranial edema, common mass effect, hydrocephalus and brain atrophy.
2.Intraspinal tumors
Comprehend image appearance of x-ray film and myelography.
Section 4 Intracranial tumors
1.Gliomas：Master main manifestation of astrocytoma, oligodendroglioma and medulloblastoma in CT and MRI after be familiar with their clinic and pathologic findings.
2.Meningioma：Master main sign in CT and MRI after be familiar with their clinic and pathologic findings.
3.Pituitary adenoma：First comprehend its class and clinic findings and then master main characteristics in CT and MRI.
4.Craniopharynioma：Be familiar with its common position, pathologic characteristics and diagnosis points in CT and MRI.
5.Germinoma：Be familiar with its common position, pathologic character and diagnosis points in CT and MRI.
6.Acoustic neurinoma：Be familiar with its pathologic characteristics,master CT and MRI manifestation, and then comprehend differentiating diagnosis of tumors in cerebral-pontinal angle area.
7.Hemangioblastoma：Comprehend its pathologic character and know well CT and MRI findings.
8.Metastatic tumors：Be familiar with its clinic and pathologic findings and master its CT and MRI character.
Section 5 Cerebrovascular disease
1.Cerebral infarction: Combining physiologic pathology of cerebral ischemia resulting from thrombosis of cerebral artery, emphase on conventional image appearance, and then know well diagnostic points of lacunar infarction and hemorrhagic infarction in CT and MRI scans.
2.Cerebral hemorrhage: Combining pathological variation in different periods, emphase on image appearance of CT and MRI.
3.Combining cases, introduce characteristics about subarachnoid space hemorrhage, arteriovenous malformation and intracranial aneurysm in CT MRI and DSA.
Section 6 Injury of skull and brain
Combining pathogenisis with pathology, introduce image appearance especially the CT scans of epidural hematoma, subdural hematoma and contusion and laceration of brain.
Section 7 Intracranial infective disease
1．Cerebral abscess：Master typical image appearance of in CT and MRI
2．Cranial tuberculosis： Be familiar with CT and MRI manifestation.
Section 8 Demyelinating disease
Introduce simply the imaging appearance of multiple sclerosis.
Section 9 Cranial congenital malformation
Self-culture.
Section 10 Spinal cord disease
Combining cases, introduce characteristics about ependymatoma, astrocytoma, neurinoma, neurofibroma and meningioma in CT and MRI.
三、 Experiment Content and Requirement
Understanding imaging methods by reading film.
Understanding the normal manifestations and basic abnormal findings of brain and spine in plain film, CT and MRI by reading film.
Mastering the imaging findings of glioma, meningioma, pituitary adenoma, acoustic neurinoma, metastatic tumors, infarction, hemorrhage, trauma, abscess, intraspinal tumors and subedrual tumors by reading film.
Being familiar with craniopharynioma, germinoma, hemangioblastoma, sudarachnoid hemorrhage, aterio-venous malformation, aneurysm, tuberculosis and syringomyelia by reading film.
四、 Course plan
Theory lesson
|
Chapter |
Contents |
Time |
|
Two -One
- Two |
Imaging methods
Normal imaging anatomy of brain and spine |
1 |
|
Two - Three |
Basal abnormal appearance of brain and spine |
1 |
|
Two - Four |
Cranial tumors: glioma, meningioma, pituitary adenoma, acoustic neurinoma, metastatic tumors |
2 |
|
Two - Five |
cerebrovascular diseases: cerebral infarction, hemorrhage |
2 |
|
Two - Six |
Brain trauma: epidural hematoma, subdural hematoma, laceration and contusion of brain |
1 |
|
Two - Seven |
Cranial infective diseases: brain abscess |
1 |
|
Two - Eight
- Ten |
Demyelinating diseases: Multiple sclerosis
Spinal diseases |
1 |
|
All together |
9 |
Experiment lesson
|
Number |
Contents |
Category |
Time |
|
1 |
Reading films contents: Normal imaging anatomy and basal abnormal appearance of brain and spine, cranial tumors |
Demonstrating |
2 |
|
2 |
Reading films contents: cerebrovascular diseases, brain trauma, Cranial infective diseases, Demyelinating diseases and Spinal diseases |
Demonstrating |
2 |
|
All together |
4 |
Questions
1．What is the location symptom of increased intracranial pressure in X-ray plain film?
2．What is the histological classification and CT and MRI appearance of astrocytoma?
3．What is the diagnostic point of meningioma in CT and MRI?
4．What is the MRI findings if pituitary adenoma?
5．What is the differentiating diagnosis of common tumors in cerebral-pontinal angle area?
6．What is the typical manifestation of ischemia infarction in CT and MRI?
7．Combining pathological variation in different periods, present MRI intensity characteristics?
8．Differentiating diagnosis between epidural and subdural hematoma in CT?
第三章 头颈部
一、目的与要求
1．了解眼、鼻与鼻窦、咽部、喉部、耳、口腔颌面部以及颈部的常规检查技术；
2．了解眼、鼻与鼻窦、咽部、喉部、耳、口腔颌面部以及颈部的正常解剖；
3．熟悉眼、鼻与鼻窦、咽部、喉部、耳、口腔颌面部以及颈部常见疾病的影像学表现，如眼眶异物、鼻窦炎、鼻咽癌、喉癌、中耳乳突炎、颈淋巴结肿大、甲状腺肿瘤。
二、教学内容
此章节的讲授可根据课时实际安排灵活掌握，以了解和自学为主，不做硬性统一安排。
Chapter 3 Head and neck
1．Requirement
（1）Comprehend conventional examination technique of eyes, nose, nasal sinus, pharynx, larynx, ear, oromaxillary part and neck;
（2）Comprehend normal anatomy of eyes, nose, nasal sinus, pharynx, larynx, ear, oromaxillary part and neck;
（3）Familiar with image appearance of common disease in eyes, nose, nasal sinus, pharynx, larynx, ear, oromaxillary part and neck, such as ocular foreign body, nasal sinusitis, nasopharyngeal carcinoma, laryngeal cancer, otomastoiditis, enlargement of cervical lymph nodes and thyroid tumors.
1.Content
No compulsory arrangement for this chapter, flexible schedule is allowable according to active teaching.