1. TRN NG KHOA CH.21 2. Thng hay gp nht. n c hoc nhiu . Lin quan n cc khi U, p xe, hy myelin. Ch da vo hnh nh i khi kh phn bit cc tn thng. 3. - Di cn - p xe - X cng ri rc - ADEM - Sn no - Lao - AIDS - Lymphoma 4. - Sau x tr v ha tr - GBM - Nm - Sn - Lyme Disease - mu t bn cp trong nhu m no - nhi mu bn cp 5. - V tr thng gp ranh gii m no trng v xm 80% bn cu i no. 15% tiu no. 3% hch y 50% n c. 20% 2 . 30% trn 3 6. C khong 80% di cn no t 5 loi khi U nguyn pht. 1 phi 2 V 3 U hc t 4 U t bo thn 5 U th ng tiu ha (trc trng) 7. CLVT - Gim hoc ng t trng vng ranh gii m no trng v xm - Ph n nhu m no xung quanh - C th c chy mu - Tim thuc: ngm hnh nhn.(Ch khi U c th tng KT nu chp mun hn) 8. CHT - T1WI: ng hoc gim tn hiu.Di cn U hc t, chy mu - tng tn hiu 9. - T2WI: a dng, thng tng trung tm, tn hiu trung gian pha ngoi vi. Ph no rng xung quanh. T2* gim tn hiu trung tm nu c chy mu. - Flair: a dng, thng tng tn hiu vi vin ph no rng. 10. - DWI: thng khng hn ch khuch tn. ADC t gi tr. - T1W+C: ngm thuc mnh hnh nhn, thy r hn trn T1Wfs. Cc nt nh thng ngm c. 11. nh ngha: m khu tr trong nhu m no. - C th mt hoc 2 bn - Cc nguyn nhn do nm, k sinh trng t gp 12. - Thng tng trn lu, khu vc thy trn v thy nh - Ranh gii m no trng v xm. - Vng cp mu ca M no trc v no gia. - Tng di lu chim khong 14% - Kch thc thay i t 5 mm n vi cm - Hnh thi: Trn, nhn, ngm thuc hnh nhn. - C th c kh bn trong (him) 13. GPB chia 4 giai on: - Vim no sm (3-5 ngy), - Vim no mun ( t 4-5 ngy n 2 tun), - Hnh thnh v sm (quanh khong thi gian 2 tun), - Hnh thnh v mun (vi tun n 1 thng). 14. Hnh nh thay i theo tin trin ca p xe. 15. G vim no sm: Vng gim t trng gii hn khng r di v Hiu ng khi Tuy nhin c th bnh thng. C th c hoc khng ngm thuc sau tim. 16. CLVT: G vim no mun: - Gim t trng trung tm, ph no pha ngoi vi, hiu ng khi tng. - Ngm thuc khng u dng vin. 17. G hnh thnh v sm: Khi gim t trng, ph no mc trung bnh. Ngm thuc hnh vin. Phn su ca v thng mng nht, phn dy nht nm pha gn v no. 18. - G Hnh thnh v mun - tn thng c xu hng co li, v dy, c th hnh a thy. 19. Cng hng t T1WI - G vim no sm: vng gim tn hiu khng ng nht, gii hn khng r/ hoc ng tn hiu. - G vim no mun: gim tn hiu trung tm/ ng tn hiu/ vin mnh tng tn hiu - G hnh thi v sm:V mnh, ng tn hiu hoc tng nh so vi m no trng, trung tm tng tn hiu so vi dch no ty. - G hnh thnh v mun: tn thng c xu hng thu nh, v dy. 20. T2WI - GDVNS: tng tn hiu trn nh T2W gii hn khng r. - GVNM:Tng tn hiu vng trung tm, v gim 21. DWI - Tng tn hiu giai on vim no v p xe. - ADC gim tn hiu bn trong p xe T1W+C - G vim no sm: ngm khng u, (patchy enhancement) - G vim no mun: Ngm thuc rt mnh nhng vin ngm thuc khng u. - G hnh thnh v sm: Gii hn r, thnh mng, ngm hnh vin. - G hnh thnh v mun: p xe thu nh, c xu hng xp li, thnh dy ngm thuc mnh. 22. MRS - Hoi t trung tm c th xut hin cc nh Acetate, Lactate, Alanine, Amino acids 23. Ngm thuc giai on cp tnh Hiu ng khi thng t hn so vi kch thc ca tn thng 24. V tr tn thng c trng: Khu tr quanh tiu TM c hnh Dawson fingers. Khu tr vng b di th trai. 25. MS th khi (Tumefactive MS): L mt dng ca MS, tn thng dng khi chon ch trong nhu m Hiu ng khi thng t hn so vi kch thc ca tn thng Ngm thuc giai on cp tnh, nhng khng ngm ton b ng vin quanh 26. The open ring sign Open-ring sign y l du hiu c trng ca hy myelin, thng thy trong bnh MS. Gip phn bit GBM 27. Tn thng vim hy myelin cp tnh ca m no trng. Gp mi la tui, hay gp hn tr em. Tin s gn y b nhim vi rt Nhiu nt khu tr trong m no trng, hch y. C th biu hin l cc m ngm thuc pha ngoi vi. i khi kh phn bit MS. 28. Do nhim sn dy (tapeworm) t ln. Hnh nh c trng: kn dch km hnh u sn bn trong 29. C 4 giai on: Nang dch Nang keo ht nh Vi ha Ngm thuc hnh nhn thng thy giai on nang keo v nt ht nh. 30. Lin quan n lao mng no trong 50% cc trng hp. Chp XQ ngc c th tm thy tn thng lao nguyn pht. 31. Tn thng nhiu ngm thuc hnh nhn trn BN nhim HIV, thng c chn on:Toxoplasmosis,TB, p xe m, p xe do nm v Lymphoma. Toxoplasmosis ph bin nht trong nhim trng c hi.V tr gp hch y, ranh gii m no trng v xm. Khng i xng. C du hiu bia bn: Nt ngm thuc trung tm bn trong p xe. 32. MRS c th phn bit gia Toxoplasmosis vi Lymphoma. nh NAA v choline gn nh khng thy xut hin trong Toxo 33. Thng v tr di mng no tht, th trai Ngm thuc hnh vin BN HIV MRS tng nh choline PES: tng mnh chuyn ha 34. C th tn thng a ngm thuc hnh nhn. Kh phn bit vi tn thng U ti pht. MRS khng tng nh Choline 35. Gp trong chuyn dng ca Glioma bc thp, hoc tn thng lan rng ca GBM 36. Tin s chn thng, bnh ri lon ng mu, bnh mch mu thoi ha bt S dng cc chui xung MRI tm kim sn phm chuyn ha ca mu. 37. Nguyn nhn do vim mch mu tc nghn v do cc mu ng gy nhi mu a . Ngm thuc dng vng, ngm thuc ca hi no. Tng tn hiu mnh trn nh T1W do hoi t hi no xut hin sau 2 tun nhi mu. Ngm thuc dng vin, hnh di c th tn ti n 8 thng sau nhi mu. 38. a ngm thuc hnh nhn. Thng c vim mng no km theo. Chy mu bn trong Thng xy ra trn BN c suy gim min dch. 39. Q 1975, Lyme B cht Xon trng Borrelia burgdorgferi. Ni ban da St. RLTK B cht loi Ixodes 40. Nhiu nt tng tn hiu trn nh T2W m notrng quanh no tht ngm thuc hoc khng. Cc dy thn kinh s thng ngm thuc 41. Vim no do amip Vim no mng no.Tn thng a kh tr hoc n c, ngm thuc dng khi hnh nhn. Vim no do KST st rt: Tn thng chy mu dng cc m nh v nt hnh nhn. Nhi mu, ph no ngm thuc. Vim no do amip 42. Enhancing wall characteristics thick and nodular favours neoplasm thin and regular favours abscess incomplete ring often opened toward the cortex favours demyelination low T2 signal favours abscess restricted diffusion of enhancing wall favours GBM or demyelination Surrounding oedema extensive oedema relative to lesion size favours abscess increased perfusion favours neoplasm (metastases or primary cerebral malignancy) Nentral fluid / content restricted diffusion favours abscess Number of lesions similar sized rounded lesions at grey white matter junction favours metastases or abscesses irregular mass with adjacent secondary lesions embedded in the same region of 'oedema' favours GBM small (