分析脑实质内表皮样囊肿（IEC）的影像特征及误判原因，为临床诊疗提供借鉴。

回顾性选取南方医科大学珠江医院神经外科自2015年1月至2025年4月经手术病理证实的8例IEC患者为研究对象，基于术前影像学资料，系统分析临床特征、影像表现、诊断结果及误判原因。

8例患者中，病变位于额叶、颞叶及小脑各2例，枕叶、脑干各1例；7例累及皮质或皮质下区，1例累及脑干后部浅表区域。1例为不规则形实性，CT以钙化密度为主，MRI以T1WI高信号、T2WI稍低信号为主；7例为囊性病变，CT呈低或稍低密度，MRI呈T1WI低或稍低信号、T2WI高信号，伴内部片絮状影（1例呈漩涡状改变），其中5例伴脑实质局部虫蚀样破坏。6例MRI检查者FLAIR信号不均匀减低，2例DWI无弥散受限，1例DTI灶周白质纤维束受压移位及部分中断，1例颅内散在脂滴，3例增强扫描无强化。术前定位诊断不准确4例，定性诊断误判3例。

IEC罕见且影像表现复杂多样，术前容易误判，综合临床与多模态影像特征分析，可提高术前诊断准确率、减少误判，为后续治疗策略提供关键决策信息。

To analyze the imaging characteristics and causes of misdiagnosis in intraparenchymal epidermoid cysts (IEC), providing reference for clinical diagnosis and treatment.

Eight patients with IEC confirmed by surgical pathology in Neurosurgery Department of Zhujiang Hospital of Southern Medical University from January 2015 to April 2025 were selected retrospectively. Based on preoperative imaging data, the clinical characteristics, imaging manifestations, diagnosis results and causes of miscarriage of justice were systematically analyzed.

Among the 8 cases, the lesions were located in the frontal lobe, temporal lobe, and cerebellum in 2 cases each, and in the occipital lobe and brainstem in 1 case each; 7 cases involved the cortex or subcortical area, and 1 case involved the superficial area behind the brainstem. One case had irregular solid shape, with CT showing mainly calcified density and MRI showing mainly high signal on T1WI and slightly low signal on T2WI; 7 cases were cystic, with CT showing hypodense or slightly hypodense, MRI showing hypo- or slightly hypointense on T1WI and hyperintense signals on T2WI, accompanied by internal flocculent shadows (one case showed vortex like changes), of which 5 cases were associated with local moth-eaten parenchymal destruction. Six cases of MRI examination showed uneven FLAIR signal reduction, 2 cases had no diffusion restriction on DWI, 1 case had white matter fiber bundle displacement and partial interruption around DTI lesion, 1 case had scattered lipid droplets in the skull, and 3 cases showed no enhancement in the enhanced scan. Preoperative diagnosis revealed inaccurate localization in 4 cases and incorrect characterization in 3 cases.

IECs are extremely rare and exhibit complex imaging features, leading to frequent misdiagnosis. Comprehensive analysis integrating clinical presentation and multimodal imaging characteristics can improve preoperative diagnostic accuracy, reduce misdiagnosis, and provide crucial information for treatment strategies.