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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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