Cross Sectional Anatomy
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2/27/2009 Overview Cross-Sectional Anatomy • Head & Neck – Brain – Vasculature CT Procedures and Anatomy • Spine Cross Sectional Anatomy – Overview & CT imaging Procedures - Introduction Carolyn Kaut Roth, RT (R)(MR)(CT)(M)(CV) FSMRT CEO, Imaging Education Associates candi@imaginged.com www.imaginged.com 2009 – Cervical – Thoracic – Lumbar CT Images • Body B d – Chest – Abdomen – Pelvis – Vasculature • Musculoskeletal – Upper extremities – Lower extremities 2009 Slide # 1 Head MR Images Slide # 2 Cranial Bones & Brain Lobes CT Images MRI Images Brain Lobes Cranial Bones Midline Sagittal T1WI Midline Sagittal reformat Parietal Frontal Para Sagittal Pariental Occipital Frontal Occipital Temporal Para Sagittal reformat Temporal Axial PDWI Axial The 5th lobe of the brain is known as the Insula It is located “inside” the Sylvian (Lateral) Fissure Coronal T2WI Coronal Direct or reformat 2009 2009 Slide # 3 Brain Anatomy: Mid-Sagittal What separates the lobes? Parietal lobe Frontal lobe Frontal bone Temporal lobe Parietal lobe Parietal bone Occipital lobe Occipital bone Tentorium… separates cerebrum from cerebellum Occipital lobe Frontal lobe Sylvian fissure (Insula located within) Sylvian Fissure or Lateral Fissure… Separates the Frontal lobe from the parietal lobe Inside is the 5th lobe of the brain, the “Insula” & the MCA Brain Specimen Axial CT Image The red line (box) indicates the pp location of the midline approximate sagittal slice Parietal lobe Frontal lobe Parietal lobe Occipital lobe Longitudinal Fissure… Right and Left lobes (inside is the Falx Cerebri) Longitudinal Fissure Occipital lobe Frontal lobe Slide # 4 Sylvian Fissure Cerebellum Cerebellum Midline Sagittal Midline Sagittal CT Image MRI Image Tentorium Tentorium 2009 Slide # 5 2009 Slide # 6 1 2/27/2009 Brain Anatomy: Gray & White Matter Sagittal Plane Midline Sagittal Parasagittal Brain specimin White Matter White Matter Gray Matter Parasagittal Midline Sagittal Midline Sagittal Sagittal 2009 Gray Matter Axial Coronal 2009 Slide # 7 Brain Anatomy: Corpus Callosum Corpus Corpus Corpus Callosum Callosum Callosum (genu) (body) (splenium) Midline Sagittal Midline Sagittal CT Image MRI Image Slide # 8 Fractional Anisopetry Corpus Corpus Corpus Callosum Callosum Callosum (genu) (body) (splenium) Midline Sagittal CT Image MRI Image Hint‐ the Corpus callosum is the only white matter structure to cross midline Hint‐ white matter is made up of myelin 2009 2009 Slide # 9 Brain Anatomy: Brain Stem Slide # 10 Brain Anatomy: Midline Structures Cerebral peduncles Pons Medulla Spinal Cord Spinal Cord Cerebral peduncles Pons Medulla Spinal Cord Anterior horn Lateral ventricle Thalamus Third ventricle Optic chiasm Anterior horn lateral ventricle Thalamus Third ventricle Sella turcica Pituitary stalk Pituitary stalk Pituitary gland Clivus Clivus Midline Sagittal Midline Sagittal Midline Sagittal CT Image Hint‐ we know that we are in the midline when we see the spinal cord 2009 Slide # 11 Midline Sagittal CT Image MRI Image MRI Image Hint‐ we know that we are in the midline when we see the pituitary and sella Turcica 2009 Slide # 12 2 2/27/2009 Brain Anatomy: Para-Sagittal Parietal Frontal Temporal Occipital Cerebellum Coronal Plane Maxillary Sinus Teeth Sulci gyri Parietal lobe para Sagittal MRI Image coronal slice more anterior Occipital lobe Sylvian (lateral) fissure MCA flow through The Insula is inside coronal slice more posterior Frontal lobe Cerebellum Temporal Lobe Sagittal Axial Coronal para Sagittal 2009 CT Image Slide # 13 Slide # 14 High Resolution Brain Protocol Coronal Facial Bone Anatomy Christi galli Cribriform plate Orbital roof Nasal conchae • • Maxilla Maxilla Mandible Fracture Frontal bone Nasal bone Maxilla • Temporal bone Zygoma Coronal CT reformatted image of Trauma Coronal Oblique CT 2009 coronal slice very posterior 2009 Lateral & AP Scout 120 kv, 80 ma, 50 fov Axial 120 kv, 220 ma, 28cm fov 512 x 512 matrix 1-3 mm to frontal sinus -straight- floor of maxillary sinus perpendicular to table- gantry straight 9 mm to top of head or 5mm / 5mm through fossa 8 -9mm entire head 125 W 55 L Head Coronal 120 kv, 220 ma, 16-20cm fov 512 x 512 matrix 3 mm to frontal sinus angled perpendicular to mandible 250 W 30 L (soft tissue) 2000 W 350 L (bone) 2009 Slide # 15 Slide # 16 Soft tissue windows Bone windows Brain Anatomy Coronal Posterior Coronal Through Pituitary Gland Optic chiasm Pituitary stalk This red line indicates the location of the coronal slice Do you see the seagull? Parietal lobe Longitudinal fssure Pituitary gland (w/tumor) Pit stalk (infundibulum) Pit stalk (infundibulum) Optic chiasm Lateral ventricles Septum pellucidum Temporal lobes Coronal CT 2009 Cisterna Ambiens w/Pineal gland Cerebral aqueduct Tentorium 4th ventricle Cerebellum Coronal MR Slide # 17 This red line indicates the location of the coronal slice Coronal MR image Coronal CT image 2009 Slide # 18 3 2/27/2009 Imaging Planes Axial Slice Locations Axial Slice locations 5 4 3 2 1 Axial – SLICE # 1 Axial – SLICE # 2 Axial – SLICE # 4 Axial – SLICE # 5 Angled with base of skull g Axial – SLICE # 3 2009 2009 Slide # 19 Brain Anatomy: Axial Superior Slide # 20 Brain Anatomy: Axial @ Ventricles This red line indicates the location of the axial slice This red line indicates the location of the axial slice White matter Gray matter ribbons Superior sagittal sinus Anterior Anterior Horns of the Lateral Ventricles Frontal lobe White matter Septum pellucidum Longitudinal fissure falx cerebrienhanced on CT image Superior sagittal sinus 2009 Axial MR image Superior location Axial CT image Brain Anatomy: Axial Basil Ganglia Axial T1 weighted MR image Just because the structure is gray, does not automatically make it gray matter! 2009 Slide # 21 Slide # 22 White Matter Tracts Axial T1 weighted MR image Caudate nucleus Caudate Nucleus Posterior Horns of the Lateral Ventricles Subcutaneus fat Posterior Axial CT image Superior location Chroriod Plexus Sulci gyri Cortical bone Parietal lobe Sulci & Gyri Axial proton density weighted MR image Gray matter Lentiform nucleus External Capsule Putamen & globus pallidus Internal capsule Lentiform Nucleus Thalamus Internal Capsule Thalamus External capsule Claustrum Extreme capsule Axial CT image Axial PD weighted MR image Just because the structure is white, does not automatically make it white matter! 2009 Slide # 23 2009 Slide # 24 4 2/27/2009 Brain Anatomy: Axial Orbits Brain Anatomy: Axial Orbits This red line indicates the location of the axial slice Cerebellum At the level of the vermis This red line indicates the location of the axial slice Frontal sinus Orbit Nasal conchae Lens Globe of the eye Optic nerve Optic nerve Lateral rectus muscle Rt. Medial rectus muscle Lt. Medial rectus muscle Temporal lobe Shenoid sinus Temporal Lobe Basilar Artery Pons 4th ventricle Mastiod air cells Cerebellum Axial MR image 2009 Axial CT image Axial CT image Axial MR image 2009 Slide # 25 Brain Anatomy: IAC’s Slide # 26 Brain Anatomy: IAC’s This red line indicates the location of the axial slice This red line indicates the location of the axial slice This red line indicates the location of the axial slice This red line indicates the location of the axial slice Temporal Lobe Temporal bone Temporal bone IAC Mastoid Air Cells Coclea Semicircular canals Temporal Lobe Temporal bone IAC Mastoid Air Cells 7th & 8th cranial nerves Axial CT image Axial CT image Axial MR image Axial MR image 2009 2009 Slide # 27 Axial Brain Anatomy: Midbrain Overview Cross-Sectional Anatomy This red line indicates the approximate location of the axial slice This red line indicates the approximate location of the axial slice Cerebellum At the level of the vermis Frontal Lobe Falx Cerebri • Head – Anterior Circulation – Posterior Circulation Sylvian Fissure MCA occlusion Slide # 28 – COW (circle of Willis) Temporal lobe • Neck Cerebral peduncles Red nucleus Cerebral Acqueduct Vermis Cerebellum – Carotid Arteries Occipital Lobe Axial CT image 2009 – Vertebral Arteries Axial MR image Slide # 29 2009 Slide # 30 5 2/27/2009 Cerebral Vasculature Circle of Willis - CTA Sagittal 2009 2009 Slide # 31 Coronal Slide # 32 Axial Cerebral Circulation – Coronal (COW) Left (Anterior & Middle) Artery – Coronal Superior Right Left Left (ACA ) Anterior Left (MCA ) Cerebral Artery Middle Cerebral Artery (ACOM ) (ACOM ) Anterior Communicating (ICA ) Artery Internal Carotid Artery Coronal CTA Image AP angiogram ‐ Left Internal Carotid (Anterior and Middle Circulation) Coronal CTA 2009 2009 Inferior Slide # 33 Right & Left (Anterior & Middle) Artery – Coronal Slide # 34 Right & Left Vertebral Arteries & Basilar Artery – Coronal (ACA ) Anterior Cerebral Artery (MCA ) Middle (ACOM ) Anterior Cerebral Artery Communicating Artery (PCA ) Posterior Cerebral Artery AP image AP image g Basilar Artery (ICA ) Internal Carotid Artery Coronal image 2009 Vertebral Artery Coronal image AP image AP image Slide # 35 2009 Slide # 36 6 2/27/2009 Cerebral Circulation – Coronal (COW) Intra-Cerebral Circulation - COW Superior (ACA ) Anterior Cerebral Artery (MCA ) Middle (ACOM ) Anterior Cerebral Artery Communicating Artery (ACA ) Anterior Cerebral Artery (PCA ) Posterior Cerebral Artery (PCA ) Posterior Cerebral Artery AP image (MCA ) Middle Cerebral Artery (ACOM ) Anterior Communicating Artery Basilar Artery (ICA ) Internal Carotid Artery Right (ICA ) Internal Carotid Artery Left Basilar Artery Vertebral Artery Coronal CTA Image 2009 Vertebral Artery AP image Coronal CTA 2009 Slide # 37 Cerebral Circulation – Sagittal (COW) Superior Slide # 38 Inferior Anterior & Middle Cerebral Arteries – Sagittal (ACA ) Anterior Cerebral Artery (MCA ) Middle Cerebral Artery (ICA ) Internal Carotid Artery Anterior Sagittal CTA 2009 Posterior Inferior 2009 Slide # 39 Internal carotid (Anterior and Middle circulation) Lateral angiogram Anterior and Middle circulation d ddl l Lateral DSA Right (ICA ) Internal Carotid Artery (PCOM ) Posterior Communicating Artery Left (ICA ) Internal Carotid Artery Sagittal CTA Posterior Cerebral Arteries - Sagittal (PCA) Posterior Cerebral Artery SlideLateral Radiograph # 40 Cerebral Circulation – Sagittal (PCA) Posterior Cerebral Artery (ACA ) Anterior Cerebral Artery (MCA ) Middle Cerebral Artery Basilar Artery Vertebral Artery Basilar Artery (ICA ) Internal Carotid Artery Vertebral Artery Sagittal CTA Anterior and Middle circulation Lateral DSA Lateral Radiograph Posterior cerebral circulation Lateral DSA 2009 Lateral Radiograph Slide # 41 Posterior cerebral circulation Lateral DSA (PCOM ) Posterior Communicating Artery 2009 Sagittal CTA Slide # 42 7 2/27/2009 Cerebral Circulation – Sagittal (COW) (ACA ) Anterior Cerebral Artery Cerebral Circulation – Axial (COW) Superior Superior (MCA ) Middle Cerebral Artery (PCOM ) Posterior Communicating Artery (PCA ) Posterior Cerebral Artery b l Anterior Posterior Right Left Basilar Artery (ICA ) Internal Carotid Artery Vertebral Artery Sagittal CTA 2009 Axial CTA 2009 Inferior Slide # 43 Cerebral Circulation - Axial (Circle of Willis) Anterior Slide # 44 Anterior (ACOM ) Anterior Communicating Artery (ACA ) Anterior Cerebral Artery (ACOM ) Anterior Communicating Artery Inferior (ACA ) Anterior Cerebral Artery Intra-Cerebral Circulation – Axial COW (MCA ) Middle Cerebral Artery (ICA ) Internal Carotid Artery (MCA ) Middle Cerebral Artery Right Basilar Artery (PCA ) Posterior Cerebral Artery (PCOM ) Posterior Communicating Artery Left (ICA ) Internal Carotid Artery (PCOM ) Posterior Communicating Basilar Artery Artery Right (PCA ) Posterior Cerebral Artery Anterior Left Left Left Axial CTA 2009 2009 Posterior Slide # 45 Anterior Cerebral Arteries (right & left) Anterior (ACOM ) Anterior Communicating Artery Slide # 46 Anterior (ACOM ) Anterior Communicating Artery Axial COW (ACA ) Anterior Cerebral Artery Anterior cerebral arteries (ACA ) Anterior Cerebral Artery – (ICA ) Internal Carotid Artery (MCA ) Middle Cerebral Artery (MCA ) Middle Left Cerebral Artery Right (ICA ) Internal Carotid Artery Posterior Axial CTA Anterior Right Left Left Left Axial CTA 2009 Posterior Slide # 47 2009 Slide # 48 8 2/27/2009 Posterior Cerebral Arteries (right & left) Anterior Axial COW Posterior cerebral arteries Anterior – (PCOM ) Posterior Communicating Artery Right (PCOM ) Posterior Communicating Artery (PCA ) Posterior Cerebral Artery Axial CTA Basilar Artery Left Posterior Basilar Artery Right Left (PCA ) Posterior Cerebral Artery Axial CTA 2009 2009 Posterior Slide # 49 Cerebral Circulation - Axial (Circle of Willis) Anterior (ACA ) Anterior Cerebral Artery (ACOM ) Anterior Communicating Artery (ICA ) Internal Carotid Artery (PCOM ) Posterior Communicating Basilar Artery Artery Right Left (PCA ) Posterior Cerebral Artery Axial CTA 2009 Circle of Willis - CTA 2009 – 120 kv, 80 ma, 50 fov Axial 120 kv, 420 ma 512 x 512 matrix, 24cm fov .675 mm through COW then 9mm through entire head -straight- floor of maxillary sinus perpendicular to table tablegantry straight -Contrast if 100 -120cc’s non-ionic 350 mg/ml - 3 cc/sec for 20g angiocath -delay scan 15-20 sec post injection -usually reconstructed to a field of 128mm from above the cow to c2 2009 Posterior Slide # 51 Sagittal CTA-Rapid Brain Protocol CTA\• AP & Lateral Scout • (MCA ) Middle Cerebral Artery Slide # 50 Slide # 52 Head Veins Coronal Slide # 53 Axial 2009 Slide # 54 9 2/27/2009 Overview Cross-Sectional Anatomy Neck Vasculature • Head – Anterior Circulation – Posterior Circulation – COW (circle of Willis) • Neck – Carotid Arteries – Vertebral Arteries 2009 2009 Slide # 55 Carotid Arteries – Sagittal Slide # 56 Vertebral Arteries – Sagittal (ICA ) Internal Carotid Artery Basilar Artery (PCA ) Posterior Cerebral Artery (ECA ) External Carotid Artery Right and Left CCA - common carotid arteries Vertebral Artery Sagittal Neck 2009 Sagittal Neck Sagittal Neck 2009 Slide # 57 Carotid Arteries – Sagittal Sagittal Neck Slide # 58 Carotid Arteries – Sagittal (ICA ) Internal Carotid Artery Basilar Artery (PCA ) Posterior Cerebral Artery (ECA ) External Carotid Artery Right and Left CCA - common carotid arteries Vertebral Artery Sagittal Neck 2009 Slide # 59 Sagittal Neck Sagittal Neck 2009 Sagittal Neck Slide # 60 10 2/27/2009 Overview Cross-Sectional Anatomy Protocol for Neck • AP & Lat scout 120 kv, 80 ma, 50cm FOV • Axial 120 kv 280 ma 5/5 mm, 23 cm FOV 512 x 512 matrix • Scan frontal sinus to carinainclude mandible • Contrast 100 cc’s non-ionic 240-300 mg/ml -2 cc/sec for 20g cath -delay scan 70 second post injection -250 W 30 L (soft tissue) -2000 W 350 L (bone) • Head – Anterior Circulation – Posterior Circulation – COW (circle of Willis) • Neck – Carotid Arteries – Vertebral Arteries 2009 2009 Slide # 61 CTA‐Rapid Neck Protocol Scan Planning • • 2009 CT Images AP & Lateral Scout – 120 kv, 80 ma, 50 cm FOV Axial 120 kv, 420 ma 512 x 512 matrix, 24cm FOV 1 mm from the arch to above the frontal sinuses -straight- floor of maxillary sinus perpendicular to tabletable gantry straight -Contrast if 100 -120cc’s non-ionic 300-350 mg/ml - 3 cc/sec for 20g angiocath -delay scan 15-20 sec post injection -usually reconstructed to a field of 128mm 2009 Slide # 63 Imaging Planes Slide # 62 Slide # 64 Image Comparison in the C-spine Median Line Mid-sagittal Plane Parasagittal Planes Transverse Or Axial Plane Slice location Frontal or Coronal Plane MRI Images C2 C3 Axial Axial C4 C5 Coronal Coronal Reformat C6 C7 Sagittal Sagittal Reformat Lateral radiograph Sagittal 2009 Axial Slide # 65 Sagittal CT Sagittal T1 MRI Coronal 2009 Slide # 66 11 2/27/2009 Spinal Anatomy Brachial Plexus & Lumbar Plexus pinal Anatomy Vertebral bodies & Intervertebral disks C1 C2 C3 Fracture Brachial plexus Cervical vertebrae CORONAL MRI Spinal cord Intervertebral Disk Anulus (dark) Nucleus pulposis (bright) Conus medularis L4 L5 S1 Lumbar vertebrae Lumbar plexus Sacral plexus Sacrum SAGITTAL MRI CORONAL CT CORONAL MRI 2009 Slide # 67 2009 SAGITTAL CT Imaging Planes – C Spine & Neck Slide # 68 SAGITTAL MRI Neck CT - Laryngocele Anterior arch c1 The dens Laryngeal Cartilages Larynx Cervical vertebra Pedicle Dorsal and ventral nerve roots Spinal cord Lamina Spinous process Internal Laryngocele Causes stridor Spinal muscles Axial MR image Axial CT image 2009 2009 Slide # 69 “C-spine” Slide # 70 “Arnold Chiari Malformation” Vertebral body Pedicle Lamina foramina Cerebellar Tonsils Syrinx MRI AXIAL CT AXIAL C 1 Dens (C2) Dens (C2) C‐7 Lordosis Vert bopdies Disk Cord esophagus trachea Spinal muscles SAGITTAL MRI Epidural fat (bright) CSF (Cerebro spinal fluid)(dark) 2009 SAGITTAL CT Slide # 71 2009 SAGITTAL MRI Slide # 72 12 2/27/2009 Apical Herniation: Ehlers-Danlos syndrome Sagittal T-spine Anatomy Approximate location for sagittal Approximate location for sagittal reformat CT AXIAL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 2009 2009Reformatted Sagittal CT Slide # 73 MRI AXIAL T1 (1st thoracic vertebrae) T 12 (12th thoracic vertebrae) Spinal Cord Vertebral bodies ((curvature = kyphosis) yp ) Intervertebral Disk Spinus process Conus Cauda equina CSF around the nerves T1 T2 T3 T7 T8 T9 T10 T11 T12 L1 Posterior longitudinal ligament (along the posterior vertebral bodies from C1 – sacrum) Anterior longitudinal ligament (along the anterior vertebral bodies from C1 – sacrum) Slide # 74 L3 L4 L5 S1 SAGITTAL MRI Vertebral body Pedicle Lamina Facet joints Approximate location for axial CT AXIAL SAGITTAL CT SAGITTAL MRI MRI AXIAL L 1 L 5 Vert bodies lordosis Aorta Vertebral body Lung Lung Costo‐vertebral joint Disk Pedicle Ligamentum flavum Posterior longitudinal ligament Rib CT AXIAL L2 Lumbar Spine Thoracic Spine Approximate location for axial 2009 Ligamentum flavum T4 T5 T6 Spinal canal Spinal cord CSF (cerebrospinal fluid) Transverse process Lamina Spinus process Ligamentum flavum Erector spinae muscles MRI AXIAL 2009 Slide # 75 SAGITTAL MRI Slide # 76 SAGITTAL CT Imaging Planes - TMJ Anatomy Musculoskeletal System Median Line TMJ Mid-sagittal Plane TMJ Mid Frontal Coronal Plane Parasagittal Planes Axial Transverse Plane Coronal Sagittal CT Images 2009 Slide # 77 MRI Images 2009 Sagittal Slide # 78 Axial Coronal 13 2/27/2009 Overview musculoskeletal Anatomy - TMJ Localizer for sagittal oblique sections Corocoid vs coronoid… “There’s a sea (C) between two Nations” Localizer for coronal oblique sections Shoulder radiograph Temporal bone Fossa (meniscus within) Mandibular condyle Mandible Shoulder CT Sagittal reformatted CT Sagittal Oblique TMJ 2009 Sagittal MR Elbow TMJ 3D CT reformatted image Coronal Oblique TMJ CoroNoid 2009 Slide # 79 CoroCoid Lateral radiography (Elbow) CoroNoid Slide # 80 The lumps and bumps of the shoulder Anatomy Musculoskeletal System Shoulder Shoulder • Shoulder – Scapula • Spine of the scapula process • Coracoid p • Acromion process – Clavicle – Humerus • Head of the humerus • Greater tubercle • Lesster tubercle 2009 2009 Slide # 81 Surgical Fixation Reformatted CT Image shoulder Slide # 82 Overview musculoskeletal Anatomy - Shoulder Median Line Midline Sagittal Plane Parasagittal Planes AC Joint Frontal or Coronal Plane Transverse Or Axial Plane Clavicle Axial Ribs The sagittal oblique plane is acquired along this dotted red line, parallel to the glenoid fossa f Sagittal The coronal oblique plane is acquired along this dotted red line on the axial shoulder image. Parallel to the supraspinatus muscle & tendon or perpendicular to the glenoid fossa 2009 Slide # 83 2009 Coronal oblique Slide # 84 14 2/27/2009 Structures of the rotator cuff …(SITS) Spine of the scapula Shoulder Structures Deltoid Spine of the scapula Supraspinatus tendon. Infraspinatus tendon Teres minor tendon Subscapularis tendon Bicepts muscle Reformatted CT Image Axial Shoulder CT Trapezius Deltoid RC (S.I.T.S.) Supraspinatus Infraspinatus Teres Minor Subscapularis Axial MR Image 2009 Trapezius Deltoid Supraspinatus tendon Rotator cuff Glenoid fossa Glenoid labrum Coronal oblique MR Image Axial MR Image 2009 Slide # 85 Bony Structures of the shoulder Acromion A/C joint (acromio‐clavicular joint) Clavicle Humeral Head Humerus Corocoid process Reformatted CT Image Sagittal Oblique Shoulder Coronal oblique MR Image Slide # 86 Anatomy Musculoskeletal System Spine of the scapula Elbow Reformatted CT Image Sagittal Oblique Shoulder Elbow Acromion Rotator cuff Humeral Head Glenoid fossa Glenoid rim Scapula Humerus Coronal oblique MR Image Axial MR Image 2009 2009 Slide # 87 Bones of the Elbow Joint Muscles, Tendons & Ligaments of the Elbow Joint Humerus Olecranon process Joint space Trochlea Capetellum Coronoid process Ulna Sagittal Oblique Elbow Humerus Olecranon fossa Capetellum Humero‐radial joint Capetellum Coronal oblique MR Image “Cap on Head” 2009 (Capetellum on the head of the radius) Slide # 89 Slide # 88 Tricepts muscles Bicepts Muscles Extensor tendons Brachoiadialis muscle Axial MR Image Trochlea Humero‐ulnar joint Radio‐ulnar joint Axial MR Image Sagittal Oblique Elbow Tricepts muscles Ulnar collateral ligament Brachoiadialis muscle Radial collateral ligament 2009 Coronal oblique MR Image Slide # 90 15 2/27/2009 Overview musculoskeletal Anatomy – Wrist Anatomy Musculoskeletal System Never Lower Tillie’s Pants…Grandmother Might Come Home Navicular Lunate Triquetruim Pisiform Greater Mutlangular Lesser Multangular Capatate Hammate Wrist Wrist Coronal MRI Coronal reformatted CT 2009 2009 Slide # 91 Overview musculoskeletal Anatomy – Wrist Slide # 92 Overview musculoskeletal Anatomy – Wrist Some Lovers Try Positions….That They Can’t Handle Scaphoid Lunate Triquetruim Pisiform fibrocartilege complex) Coronal reformatted CT 2009 Carpal Tunnell Flexor tendons Median Nerve Trapezium Trapezoid Capetate Hammate Trapezium Trapezoid Capetate Hammate Aneurysm Raidal arteru Ulnar artery Trapezium Trapezoid Capetate Hammate Hook of the Hammate TFCC (triangulo- Coronal MRI Distal Radius Distal Ulna Radio‐ulnar joint Coronal MRI Axial MRI 2009 Slide # 93 Wrist Pathology Slide # 94 Handshake Aneurysm Fracture 2009 Slide # 95 2009 Slide # 96 16 2/27/2009 Bony anatomy of the HIP Anatomy Musculoskeletal System Acetabulim Ilium Ishium Pubis Femoral Head Femoral Neck Greater Trocanter Lesser trocanter Femoral Shaft Hip Hip Obturator foramen Reformatted CT Image Hip 2009 2009 Slide # 97 BONE METS Slide # 98 Hips & Pelvis Ilum Iliac arteries Psoas Muscles Obturator foramen Compressed vertebral body Gleuteal Muscles Coronal reformatted CT Met to the pelvic bone Reformatted Sagittal CT Image Spine Reformatted Coronal CT Image pelvis 2009 Mass Axial pelvis CT Obturator Internus muscles Obturator Externus 2009 Slide # 99 Femoral Head Femoral Neck Greater Trocanter Lesser trocanter Femoral Shaft Structures of the HIP (ASIS) Ilium Acetabulim Obturator foramen Ishium Pubis Coronal CT Slide # 100 NAVEL Nerve, Artery, Vein, Empty space, Lymph node Psoas Muscle Iliacus Muscle Gleuteus Maximus Gleuteus minimus Quadracepts Muscle Hamstrings Reformatted CT Image Hip Coronal MRI of the Hips Ilium Acetabulim Glenoid Labrum Femoral Neck Femur bladder Obturator Internus muscles Obturator Externus Coronal MRI of the Hips 2009 Slide # 101 2009 Axial MRI of the Hips Nerve Artery Vein Empty space Lymph nodes Quadracepts Muscle Gleuteus Maximus Slide #Rectum 102 17 2/27/2009 Anatomy Musculoskeletal System Bones of the Knee Condyle ndyle eal plateau ial spine Coronal knee MRI Axial knee Femur Patella Patello‐femoral joint Knee Joint Tibia Fibula Knee Knee Coronal reformatted CT 2009 Sagittal knee MRI 2009 Slide # 103 Slide # 104 Muscles of the Knee Lower Extremity Anatomy Anterior cruciate ligament (ACL) Axial pelvis CT Posterior cruciate ligament (PCL) Hamstring muscles Quadracepts Tendon Attaches the quatracepts muscles Gastrocnemius muscles Quadracepts muscles Femur Hamstrings muscles Quadcepts tendon Axial femur CT Mid sagittal slice (MRI) Patello- Femoral Joint Patellar ligament Para Sagittal knee MRI Locations of the lateral collateral ligaments Quatracepts muscles Hamstring Muscles Axial femur CT Femoral coldyles Meniscus ([posterior horn, lateral meniscus) Patella Axial knee CT Para2009sagittal slice (MRI)Tibia Fibula Coronal Slide # 105 reformatted CT Meniscus and other structures of the knee Lateral aspect of the patello‐femoral joint Lateral retinaculum Axial Femur MRI 2009 Lower Leg Fracture Medial retinaculum Fracture Anterior horn of the meniscus Fracture Posterior horn of the Posterior horn of the meniscus Para Sagittal knee MRI Axial CT Slide # 106 AP Scout Axial knee MRI Medial collateral ligament Medial meniscus Lateral collateral ligament Lateral meniscus Lat Scout 2009 Slide knee # 107 MRI Coronal 2009 Slide # 108 18 2/27/2009 Anatomy Musculoskeletal System Foot & ankle bones - Come To Cuba Next Christmas Tibia Fibula Come… (calcaneus) To … (talus) Cuba (cuboid) Next… Navicular Ch i t Christmas … (3 cuneiforms!) if !) Foot and ankle 2009 Foot and ankle 2009 Slide # 109 Slide # 110 Review, Peripheral Vascular Anatomy Ankle Ligaments and Tendons Tibia Fibula Abdominal Aorta (AAA- abdominal aortic aneurysm) Mortise joint Medial collateral ligaments Lateral collateral ligaments Iliac Arteries Femoral Arteries Tibio‐talar joint Posterior longitudinal ligamen Achilles tendon Popliteal Arteries Trifurcation… (anterior tibial) (posterior Tibial) (Pernoeus Brevis) 2009 Slide # 111 Coronal MRA 2009 Coronal reformatted CTA Slide # 112 Coronal reformatted CT What Do We Do With All The Images? Hand Vasculature • • • • • View Images Scroll Through Window / Level Magnification Post Processing Basic Tasks 2009 Slide # 113 Slide # 114 19 2/27/2009 Imaging Planes CT Images Median Line Mid-sagittal Plane Frontal or Coronal Plane Chest Coronal, Heart & Lungs MRI Images Parasagittal Planes Transverse Or Axial Plane MRA Axial Axial CTA Heart Coronal Coronal Reformat Lungs Sagittal Reformat 2009 Sagittal Enhanced Coronal CT Coronal MRI 2009 Sagittal Slide # 115Axial Coronal Chest Coronal, Vasculature Slide # 116 Chest Coronal, Lungs & Airway Upper Lobe of the right lung Upper Lobe of the left lung MRA CTA Bronchi ‐ carina Middle lobe of the right lung *remember there is no middle left because of the heart! Pulmonary Arteries Pulmonary Veins Lower lobe of the right lung Lower lobe of the left lung Diaphragm Coronal MRI Coronal CT Enhanced Coronal CT 2009 Coronal MRI Slide # 117 Chest Coronal Muscles of the Chest 2009 Slide # 118 Sagittal Chest – “Candy Cane Shot” Pectoralis muscles Heart Muscle Aortic Arch Axial MRI Axial CT Ascending Aorta Descending Aorta Trapezius Latissimus Heart Intercostal Muscles Sagittal MRI Diaphragm Coronal MRI Coronal CT 2009 Slide # 119 Sagittal CT 2009 Slide # 120 20 2/27/2009 Axial chest Axial slice #1 Axial slice #2 Axial slice #3 Axial slice #1 Axial slice #2 Axial slice #3 Axial slice #1 Axial slice #2 2009 Axial slice #3 Pectoralis Muscle Aortic Arch Latissimus Muscle Spine (vertebral body) Ascending Aorta Pulmonary arteries Pulmonary veins Descending Aorta Heart Slide # 121 Lung Nodule ‐ MDCT Axial slice #1 Axial slice #2 Axial slice #3 Basic “Vanilla” Thorax Protocol • AP Scout 120 kv, 60 ma, 50 cm FOV • Axial 120 kv kv, 180 ma ma, 36 cm FOV (fit anatomy) 512 x 512 matrix generally 5mm 1500 W & 500 L(lung windows) 450 W & 30 L (mediastinal windows) 30 sec (or less) breath-hold can be modified 2009 Evaluation of Stent Placement 3D rendering of normal lung 2009 Slide # 122 Slide # 123 2009 Heart anatomy Heart MDCT evaluation of airway stent after chemical injury Slide # 124 CTA CORONAL Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri Rv P valve P valve Pa Lungs Pv La Bi Lv Aortic valve Aorta – coronary CT AXIAL arch 2009 Slide # 125 2009 MRI CORONAL MRI AXIAL Slide # 126 21 2/27/2009 Heart Anatomy Heart flow SVC (superior vena cava) RA (right atrium) Tri cuspid valve Rv P valve P valve Pa Lungs Pv La Bi Lv Aortic valve Aorta – coronary arch 2009 Heart Anatomy Heart Anatomy CTA CORONAL CT AXIAL Heart anatomy CTA CORONAL CTA CORONAL Slide # 131 Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri cuspid valve RV (right ventricle) P valve P valve Pa Lungs P‐S v La Bi Lv Aortic valve Aorta – coronary CT AXIAL arch 2009 MRI CORONAL MRI AXIAL Heart Anatomy MRI CORONAL MRI AXIAL Heart anatomy CTA CORONAL MRI AXIAL MRI CORONAL MRI AXIAL Slide # 130 CTA CORONAL Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri cuspid valve RV (right ventricle) Pulmonary valve Pulmonary valve PA (Pulmonary artery) Lungs PV (pulmonary veins) LA (Left Atrium) Bi cuspid valve LV Aortic valve Aorta – coronary CT AXIAL Arch 2009 MRI CORONAL Slide # 128 Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri cuspid valve RV (right ventricle) Pulmonary valve Pulmonary valve PA (Pulmonary artery) Lungs PV (pulmonary veins) LA Bi LV Aortic valve CT AXIAL Aorta – coronary Arch 2009 Slide # 129 Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri cuspid valve RV (right ventricle) Pulmonary valve Pulmonary valve PA (Pulmonary artery) Lungs PV (pulmonary veins) LA (Left Atrium) Bi LV Aortic valve Aorta – coronary CT AXIAL Arch 2009 MRI AXIAL Slide # 127 Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri cuspid valve RV (right ventricle) Pulmonary valve Pulmonary valve PA (Pulmonary artery) Lungs Pv La Bi Lv Aortic valve CT AXIAL Aorta – coronary arch 2009 MRI CORONAL CTA CORONAL MRI CORONAL MRI AXIAL Slide # 132 22 2/27/2009 Heart anatomy CTA CORONAL Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri cuspid valve RV (right ventricle) Pulmonary valve Pulmonary valve PA (Pulmonary artery) Lungs PV (pulmonary veins) LA (Left Atrium) Bi cuspid valve LV (Left Ventricle) Aortic valve Aorta – coronary CT AXIAL Arch 2009 MRI CORONAL MRI AXIAL Heart anatomy Heart flow IVC & SVC (Inferior & Superior vena cava) RA (right atrium) Tri cuspid valve RV (right ventricle) Pulmonary valve Pulmonary valve PA (Pulmonary artery) Lungs PV (pulmonary veins) LA (Left Atrium) Bi cuspid valve LV (Left Ventricle) Aortic valve Aorta – coronary CT AXIAL Arch 2009 Slide # 133 CTA CORONAL MRI CORONAL MRI AXIAL Slide # 134 Aortic Arch – the “ A, B, C’s” Heart and Pulmonary Arteries Ascending aorta Coronaries Brachiocephalic (aka Innominate) right common carotid right subclavian right vertebral Left common carotid Left Subclavian Left vertebral MRA CORONAL CTA CORONAL 2009 2009 Slide # 135 Aortic Arch – the “ A, B, C’s” Slide # 136 Aortic Arch – the “ A, B, C’s” Ascending aorta Coronaries Brachiocephalic (aka Innominate) right common carotid right subclavian right vertebral Left common carotid Ascending aorta Coronaries Brachiocephalic (aka Innominate) right common carotid right subclavian right vertebral Left common carotid Left Subclavian Left vertebral Left Subclavian Left vertebral MRA CORONAL MRA CORONAL CTA CORONAL 2009 Slide # 137 CTA CORONAL 2009 Slide # 138 23 2/27/2009 Aortic Arch – the “ A, B, C’s” Coronary Calcifications Ascending aorta Coronaries Brachiocephalic (aka Innominate) right common carotid right subclavian right vertebral Left common carotid Left Subclavian Left vertebral MRA CORONAL • Calcium is an indicator for a disease artery (CAD) • Calcification in the coronary artery reveals the condition of coronary arteriosclerosis • Leads to heart attacks Grossly calcified left coronary artery CTA CORONAL 2009 Slide # 139 Situs Inversus 2009 2009 Slide # 140 Cross Sectional Abdomen Slide # 141 2009 Slide # 142 Frontal or Coronal Plane Median Line Mid-sagittal Plane Imaging Planes Abdomen Images Parasagittal Planes Transverse Or Axial Plane Sagittal Axial Coronal CT Images 2009 Slide # 143 Axial 2009 Coronal reformat Sagittal reformatSlide # 144 24 2/27/2009 Frontal or Coronal Plane Median Line Mid-sagittal Plane Imaging Planes Coronal Abdomen Parasagittal Planes Approximate Slice location Approximate Slice location Transverse Or Axial Plane Kidneys Adrenals Spleen p Sagittal Axial Coronal Liver CT Images Psoas Muscles Gleuteus Muscles Coronal MR image Axial 2009 Coronal Coronal CT image Sagittal 2009 Slide # 145 Coronal Abdomen Coronal Abdomen Approximate Slice location Approximate Slice location Approximate Slice location Spleen Liver Slide # 146 Liver Spleen Spleen Stomach umor Liver Mass Coronal CT image Coronal MR image Slide # 147 Coronal CT image 2009 body anatomy Slide 2b Axial Abdomen Large bowel (colon) Ascending colon Transverse colon Descending colon Slide # 148 Sigmoid colon Coronal MR image Axial Abdomen Diaphragm Diaphragm Approximate Slice location Approximate Slice location Liver Spleen Spleen Stomach Stomach Aorta Aorta Vena cava Vertebral body Axial MR image Axial CT image Slide # 149 Approximate Slice location Approximate Slice location Liver 2009 Lesser curvature Small Bowel Structures of the Small bowel Duodenum Jejunem Ileum Bowel Small Bowel Structures of the Small bowel Duodenum Jejunem Ileum 2009 Approximate Slice location Stomach Structures of the stomach: Lesser curvature Fundus Pylorus Greater curvature Axial CT image 2009 Vertebral body Axial MR image Slide # 150 25 2/27/2009 Axial Abdomen Axial Abdomen Approximate Slice location Approximate Slice location Approximate Slice location Rectus abdominus muscles Approximate Slice location Liver Liver Gall bladder Spleen Pancreas Pancreas Kidneys Kidneys Axial MR image Axial CT image Axial MR image Axial CT image 2009 2009 Slide # 151 Sagittal Abdomen Slide # 152 Sagittal Abdomen Approximate Slice location Approximate Slice location Thoracic Spine Liver Pancreas Lumbar Spine Aorta Bowel Sacrum Coccyx Bladder Sagittal CT image 2009 Symphysis Pubis Sagittal MR image 2009 Slide # 153 Basic “Vanilla” Abdomen & Pelvis Protocol Slide # 154 Renal Calculus (Stones) • No oral contrast • No IV contrast • Run to the bladder • AP Scout 80 kv 120 ma 50 cm FOV For ureters • Axial 120 kv,, 220 ma,, 36 fov (fit anatomy) 512 x 512 5mm – 8 mm 500 W & 50 L 30 sec breath-hold can be modified Slice #1 Slice #1 Slice #2 Slice #2 Slice #3 Slice #3 Slice #4 Slice #4 2009 Slide # 155 2009 Slide # 156 26 2/27/2009 Basic “Vanilla” Abdomen & Pelvis Protocol with sprinkles Non‐Contrast Pathology Trauma • AP Scout • Axial 120 kv, 220 ma, 36 fov (fit anatomy) 512 x 512 generally 5mm 500 W & 50 L 30 sec breath-hold can be modified • Post contrast IV- Contrast if 100 cc’s non-ionic 300 mg/ml 2 cc/sec for 20g angiocath delay scan 60-70 seconds Oral – gastrografin 30 per 1 liter water Barium (dilute for CT) 32 oz 3D Reconstruction of Kidney Fracture 2009 2009 Slide # 157 Slide # 158 Abdominal Vasculature “See Spot Run In..” Abdominal Vasculature “See Spot Run In..” (“C” not see) Celiac, SMA, Renals (right & Left), IMA (“C” not see) Celiac, SMA, Renals (right & Left), IMA SMA superior mesenteric artery “C”=Celiac gastric hepatic splenic Arises anteriorly from the aorta at the level of L2‐3 Arises the aorta at the level of L1 Provides blood supply to the stomach, small bowel and part of the colon Provides blood supply to the stomach, spleen and liver Coronal CTA Image 2009 Coronal MRA image Coronal CTA Image 2009 Slide # 159 Coronal MRA image Slide # 160 Abdominal Vasculature “See Spot Run In..” Abdominal Vasculature “See Spot Run In..” (“C” not see) Celiac, SMA, Renals (right & Left), IMA (“C” not see) Celiac, SMA, Renals (right & Left), IMA IMA Infererior Mesenteric Artery Renal arteries right left Arises anteriorly &i f i l f & inferiorly from the aorta at the level of L 4‐5 Arises Bilaterally and posteriorly from the aorta at the level of L3‐4 Provides blood supply to the inferior colon, sigmoid and rectum Provides blood supply to the right & left kidney Coronal CTA Image 2009 Coronal MRA image Slide # 161 Coronal CTA Image 2009 Coronal MRA image Slide # 162 27 2/27/2009 Peripheral Vasculature “Run-off’s Abdominal Vasculature “See Spot Run In..” Abdominal Aorta (“C” not see) Celiac, SMA, Renals (right & Left), IMA Iliac arteries (at the level of the Ileum) Femoral Arteries Superficial femoral & common femoral (at the level of the Femur) (AAA) Abdominal Aortic Aneurysm Abdominal Aorta Popliteal Arteries (at the level of the Knee) Iliac arteries Trifurcation (Lower Leg) *Anterior Tibeal *Posterior Tibealis *Peroneus Brevis Coronal CTA Image Coronal CTA Image 2009 Coronal MRA image 2009 Slide # 163 Coronal MRA image (at the level of the Foot) Dorsalis Pedis Medial Malalear Slide # 164 Abdominal Veins Abdominal Vasculature (IVC) Inferior vena cava Review Vasculature… Almost ALL Arteries: Portal vein Splenic vein – Carry oxygenated blood away from the heart – Carry oxyhemaglobin blood to organs Left renal vein (SMV) Superior mesenteric Vein Almost ALL Veins: – Carry deoxygenated blood to the heart – Carry y deoxyhemaglobin y g away y from organs Exceptions: (IVC) Inferior vena cava – Portal vein• Carries deoxyhemaglobin to the liver – Pulmonary veins- Right iliac vein • Carries deoxyhemaglobin to the lungs – Pulmonary arteries• Carries oxyhemaglobin to the heart 2009 2009 Slide # 165 Biliary ducts Coronal abdominal venogram Slide # 166 Biliary System Hepatic ducts Cystic duct Pancreatic duct Pancreatic duct Common bile duct Gall bladder MRCP MR cholangiopancreatography Coronal 2009 Slide # 167 2009 body anatomy Slide 7 Slide # 168 28 2/27/2009 CROHNS DISEASE APPENDICITIS • INFLAMATION OF THE APPENDIX • REGIONAL ILEITIS REGIONAL ILEITIS • ETILOGY • TYPICALLY APPEARS PUS/AIR FILLED 2009 2009 Slide # 169 Slide # 170 Female Pelvis Anatomy DIVERTICULITIS Fundus Endometrium Approximate Slice locations Sagittal ultrasound image Uterus Fundus Junctional Zone Endometrium • INFLAMED DIVERTICULUM Cervix • CT PRESENTATION Vagina Bladder Symphysis pubis Sagittal Reformatted CT 2009 2009 Slide # 171 Sagittal MRI (T2 image) Slide # 172 body anatomy Slide 8a Female Pelvis Anatomy Female Pelvis Anatomy Approximate Slice locations CT #1 CT #2 Approximate Slice locations Uterus Junctional Zone Endometrium Approximate Slice locations MR #1 MR #2 Rectus abdominus muscles Uterus endometrium Gleuteal muscles Ovary Fallopian tube rectum Bl dd Bladder Axial CT #1 Coronal Reformatted CT Muscles Gleuteal Muscles Ileum Acetabulum Ovary Femoral head Obturator Internus muscles Coronal MRI (T2 image) Cervix Vagina Obturator internus muscles Obturator extermus muscles 2009 Slide # 173 Axial MR #1 Bladder 2009 Axial CT #2 Axial MR #2 Slide # 174 29 2/27/2009 Male Pelvis Anatomy Male Pelvis Anatomy Approximate Slice locations Approximate Slice locations Approximate Slice locations Approximate Slice locations NAVEL Symphysis Pubis Symphysis Pubis Psoas Muscles Bladder Prostate Central gland Peripheral zone (normal) Peripheral zone (cancer) Prostate (base) Seminal vessicles Vas defferens Urethra Apex of the Prostate Pubic bone Coronal Reformatted CT 2009 Axial CT Coronal Oblique MRI (T2 image) High resolution (small FOV) Obtuaturator Internus Muscles 2009 Slide # 175 Rectum Axial MR High resolution (small FOV) Slide # 176 Basic Pelvis Protocol Male Pelvis Anatomy • AP Scout 80 kv 120 ma • Axial -120 kv, 220 ma, -36 fov (fit anatomy) -512 x 512 -generally 5mm -500 W & 50 L -30 sec breath-hold can be b modified difi d If contrast Approximate Slice locations Seminal vessicles Urinary Bladder y Prostate Base Peripheral zone • Prostate Apex Rectum Sagittal Reformatted CT Neuro vascular bundle Gleuteal Muscles Rectus abdominus Muscles Sagittal MRI (T2 image) High resolution (small FOV) Post contrast -Contrast if 100 cc’s non-ionic 300 mg/ml 3 cc/sec for 20g angiocath delay scan 25-30 seconds min post injection- to peak enhancement Symphysis Pubis 2009 Slide # 177 Male Pelvis 2009 2009 Slide # 178 Male and Female Pelvis Slide # 179 2009 Slide # 180 30
