Unit 5 Introduction Unit 5 8 Sagittal MRI

Unit 5 Introduction Unit 5 8 Sagittal MRI

Unit 5 Introduction Unit 5 8 Sagittal MRI Images of the Head 15 Transaxial MRI Images 15 Coronal MRI Images On campus students must draw and identify the anatomy on the linedrawings on the next three slides. Students in the degree completion course should have an understanding of basic anatomy that makes testing on the drawings unnecessary. But if you need a refresher try the drawings. The ability to visualize is important to the study of cross sectional anatomy. First page number in parenthesis is Netters 3rd edition Second page number in parenthesis is Netters 4th edition Circle of Willis Drawing Can you draw (or visualize) these anatomical structures: An exercise in cross sectional anatomy recognition of the Circle of Willis See plates 131-134 (138-141) 8 7 6

5 Rt Lt 4 10 1. Vertebral arteries 2. Common carotid arteries 3. Basilar artery 4. Anterior communicating artery 5 Anterior cerebral arteries 6. Middle cerebral arteries 7. Internal carotid arteries 8. External carotidl arteries 9. Posterior cerebral arteries 10. Posterior communicating arteries 9 3 1 2 9 Can you draw (or visualize)

these anatomical structures: An exercise in cross sectional anatomy recognition of the Venous Sinuses See plates 97-98 (103-104) Venous Sinuses Drawing 1 2 1. 2. 3. 4. 5. 6. 7. 8. 9. Superior sagittal sinus Inferior sagittal sinus Great cerebral vein (of Galen) Straight sinus Confluence of sinuses Occipital sinus

Transverse sinus Sigmoid sinus Internal jugular vein 4 3 8 5 7 6 9 Can you draw (or visualize) these anatomical structures: An exercise in cross sectional anatomy recognition of the Ventricles of the Brain 1. Frontal (anterior) horn of Lateral ventricle 2. Body (central part) of lateral ventricle 1 3. Trigone of lateral ventricle (not in Netter) 6 4. Occipital (posterior) horn of lateral ventricle 7

5. Temporal (inferior) horn of lateral ventricle 6. Interventricular foramen (of Monro) 7. Interthalamic adhesion 8. 3rd ventricle 9. Cerebral aqueduct (of Sylvius)* 10. 4th ventricle 11. Foramen of Luschka 12. Lateral recess 13. Median aperture (Foramen of Magendie) 14. Central canal of spinal cord See plate 102-103 (108-109) 2 8 3 9 4 5 10 11 12

13 Ventricular System Drawing 14 Sagittal Images 1 & 2 These sagittal sections are from right to left. The images presented here, one to seven, go to midline. Because all the anatomy seen is on the right side or in the midsagittal plane, right is not labeled and need not be labeled for testing purposes. 5 3 4 2 1 9 7 8 11 6

10 Reference 1. 2. 3. 4. 5. External jugular vein External auditory canal (or meatus) Mastoid process of the temporal bone (4) Adipose (fat) Zygomatic process of the temporal bone 6. Internal jugular vein 7. Frontal process of the zygoma (2) 8. Sulci of brain* (99)(105) 9. Gyrus of brain** 10. Convolutions of brain** 11. Facial muscles (50)(54) * The depressions in the surface of the brain (sulcus = singular) ** Raised area between the sulci (gyri = plural) *** The twisted course the gyri take Sagittal Images 1-4

Reference 1. 2. 3. 4. 5. Sagittal Images 3 & 4 2 6. Lens of eye 7. Maxillary sinus (45)(49) 8. Internal carotid artery 9. External carotid artery 10. Facial artery (65)(69) 11. Temporal horn of the lateral ventricle 12. Trigone of the lateral ventricle** 13. Occipital horn of the lateral ventricle*** * The lateral wall is seen on image 2, but the internal jugular is large, and seen in these two sections. ** Although Netter did not label the section where the body, occipital, and temporal horns converge, it is evident on sagittal images. ***The ventricles of this patient are not as prominent as are sometimes seen. 5

4 Internal jugular vein* Zygomatic bone (4) Cerebellum Vitreous humor in eyeball Lateral sulcus (Sylvian fissure) (99)(105) 3 1 12 11 6 13 7 9 10 8 3 4 3.

4. 5. 6 7. 7 2 1 8 9 18 12 10 17 15 13 11 14 16 51. Roots of teeth* (52)(56) 2.6 Internal carotid artery

Scalp Outer table of the skull Diploe layer of the skull Inner table of the skull Optic nerve (80, 81)(84,85) Reference Sagittal Images 5 & 6 8. Frontal sinus 9. Corpus callosum 10. Body of the lateral ventricle 11. Inferior nasal concha (turbinate) (33)(37) 12. Middle nasal concha (turbinate) 13. Middle nasal meatus 14. Nasopharynx (33, 59)(37, 63) 15. Soft palate 16. Oropharynx 17. Siphon of the internal carotid artery (carotid siphon)** 18. Ethmoid air cells * Of mandible. Maxilla directly above. ** Not labeled in Netter, but the siphon (the S shaped terminal portion of the internal carotid) is nicely illustrated in plate 130 (136). Sagittal Images 5 & 6 #6

Sagittal Image 7A 14 6 5 7 3 2 4 11 1 10 16 13 9 8 15

12 #7A Image 7A, 7B, & 7C are the same image, in the midsagittal plane Plate 100 (106) is an excellent correlation to this image Plate 101 (107) is also good for structures around the base Reference 1. Tongue 2. Nasal septum 3. Sphenoid sinus 4. Sphenoid bone (6) 5. Genu of the corpus callosum (100)(106) 6. Body (trunk) of the corpus callosum 7. Splenium of the corpus callosum 8. Epiglottis 9. Body of C2 10. Odontoid process (dens) 11. Anterior tubercle of C1 (15)(17) 12. Posterior tubercle of C1 13. Cerebellar tonsil (107)(113) 14. Body of the lateral ventricle* 15. Occipital lobe of the cerebrum 16. Confluence of sinuses * Just lateral to the septum pellucidum

Sagittal Image 7 Reference 2 1. 2. 3. 4. 5. 6. 1 4 10 5 6 9 8 3 Superior sagittal sinus Inferior sagittal sinus Straight sinus* Great cerebral vein (Vein of Galen)

Stalk of the pituitary gland (Hypophysis)** Chiasmatic (suprasellar) cistern*** (103) (109) 7. Spinal cord 8. Medulla oblongata**** 9. Pons 10. Cerebral peduncle * 7 Sagittal Image 7B #7B In the tentorium cerebelli (98, 100) (104,106) ** The pituitary gland is in this section, but is difficult to differentiated from the bone of the sella turcica *** Fluid filled space surrounding the stalk of the pituitary ****The medulla, pons, and midbrain (mesencephalon) make up the brain stem. See 7C for parts of the midbrain. Sagittal Image 7C 1. Thalamus

2. 3rd ventricle* 3. Optic chiasm 4. Mammillary body 5. Interpeduncular cistern 6. Prepontine cistern 7. Cerebral aqueduct (aqueduct of Sylvius) 8. Quadrigeminal plate (lamina)* 9. Pineal body (gland) 10. Quadrigeminal cistern 11. 4th ventricle 12. Cisterna magna 1 9 2 3 8 10 4 5 6 Reference 7 11

12 #7C * The (midbrain) mesencephalon is the most superior part of the brain stem. It is comprised of the cerebral peduncles (see 7B #10), the cerebral aqueduct (of of Sylvius), and the quadrigeminal plate. Sagittal Image 7 1 2 Axial Images 1 & 2 Reference Transaxial sections from base of skull to vertex of cranium. 1. 2. 3. 4. Alveolar process of the maxilla* Rt masseter muscle (57)(61) Cisterna magna

Rt & Lt vertebral arteries** (17, 130)(21,136) 4 5. Rt lobe of the cerebellum 6. Lt cerebellar tonsil 7. Medulla oblongata*** 8, Rt maxillary sinus 9. Rt ramus of the mandible 10. Internal occipital protuberance (inion) (9) 3 8 9 * Black holes are sockets are the teeth ** On exiting the vertebral foramen in the 1st cervical vertebra (image #1) the vertebral arteries turn posterior (image #3) and enter the cranium through the foramen magnum ***On image #2 the spinal cord (image 1) is in transition to the medulla. The shape of the medulla is clearly seen on image 3. 4 7 6 5

10 Axial Images 1-4 Reference 1 Axial Images 3 & 4 2 1. 2. 3. 4. 5. Rt inferior nasal concha (turbinate) (33, 43)(37,47) Nasopharynx* (59)(63) Rt & Lt vertebral arteries Inferior vermis of the cerebellum (107)(113) Rt mastoid process 6. Rt & Lt petrous portion of the temporal bone 7. Lt facial artery 8. Posterior cerebellar notch** (107)(113) * The boundary between the oropharynx and nasopharynx would be close to image 2, where the hard and soft palate can be seen. Image 1 shows a semi lunar appearance to the anterior wall of the pharynx, which is the encroachment

of the soft palate, nearing the uvula. ** Space between cerebellar hemispheres. 3 3 5 4 7 6 8 1 2 3 7 6 6 5 4 8 9

13 14 15 11 10 12 1. 2. 3. 4. 5. 6. Axial Images 5 & 6 Anterior nasal nares Reference Bony nasal septum* Coronoid process of the left mandible (4) Left vertebral artery** Rt external auditory (acoustic) meatus (canal) Head of the condylar process of the Lt mandible (Rt and Lt mandibular condyles) 7. Unidentified bright object (UBO). An MRI artifact. 8. Lt occipital lobe of the cerebrum

9. Cartilaginous nasal septum 10. Rt transverse sinus 11. Confluence of sinuses 12. 4th ventricle (102, 109)(108,115) 13. Lt middle nasal concha (turbinate) (33) 14. Rt superior nasal concha (turbinate) 15. Internal carotid arteries in carotid canals*** (8, 9, 130)(8, 9, 136) * Comprised of the vomer bone and the perpendicular plate of the ethmoid bone, both of which would be seen on this section (6) ** Seen as a streak or line on the left side, unlike the spot we have seen to this level. This is due to the left vertebral heading for midline to anastomose with the Rt vertebral to form the basilar artery. The right is doing the same, but appears differently due to asymmetry or rotation of the part. ***Enters the external carotid opening (8) turns medially and anteriorly as it runs through the canal, then turns superiorly at foramen lacerum. Axial Images 5-8 Reference 1. 2. 3. 4. 5. 6.

Axial Images 7 & 8 Sphenoid sinus* Rt cerebellopontine angle cistern Lt internal carotid artery** Superior sagittal sinus Straight sinus Pons*** 7. Pituitary gland (hypophysis) 8. Rt internal carotid artery in the cavernous sinus (98, 130, 133) (104, 136, 140) 9. Mesencephalon (midbrain) 10. Basilar artery**** 11. Occipital (posterior) horn of the Lt lateral ventricle 12. Superior vermis of the cerebellum (107)(113) * On image 5 we saw the nasopharynx in approximately this position. On image 6 the nasopharynx is replaced by the body of the sphenoid bone that makes up the floor of the sphenoid sinus. Notice the septum in the sphenoid, which is common. ** Just emerged from the canal, above foramen lacerum. ***In front of the pons and between the cerebellopontine angle cisterns is the prepontine cistern. ***It is difficult to see exactly which image the basilar first appears on, but the anastomosis occurs near the most superior part of the medulla oblongata. 1

2 6 3 5 4 7 8 12 9 10 11 1 2 9 Reference

1. Retrobulbar fat of the Lt eye (79)(83) 2. Ethmoid air cells (44, 45)(48,49) 3. Temporal horn of the Lt lateral ventricle 4. Cerebral aqueduct (aqueduct of Sylvius) (101)(107) 5. Rt ambient cistern 6. Lt internal carotid artery in the cavernous sinus 7. Chiasmatic (suprasellar) cistern 8. Interpeduncular cistern (103)(109) 9. Rt & Lt cerebral peduncles (cerebral crus)(101, 109) (107,115) 10. Straight sinus 6 7 8 5 3 4 10 12 11 17 Lt optic nerve Medial rectus muscle of the Rt eye (79)(83)

Rt & Lt mammillary bodies (101)(107) Stalk of the pituitary gland (hypophysis) Lt middle cerebral artery (132)(139) Quadrigeminal cistern Optic chiasm 15 14 13 16 11. 12. 13. 14. 15. 16. 17. Axial Images 9 & 10 Axial Images 9-12 Reference 2

1. Rt middle cerebral artery 2. Rt anterior cerebral artery 3. Choroid plexus in the trigone of the Lt lateral ventricle 4. Rt lateral sulcus (Sylvian fissure) (99)(105) 5. 3rd ventricle 6. Splenium of the corpus callosum (100, 104) (106,110) Axial Images 11 & 12 1 3 4 5 6 Reference 3 1 2 5 1 10 4

6 7 9 8 9 1. Frontal (anterior) horn of the Rt lateral ventricle 2. Rt & Lt interventricular foramen (Foramen of Monro) 3. Frontal sinus 4. Body (central part) of the Rt lateral ventricle 5. Genu of the corpus callosum 6. Inferior sagittal sinus* 7. Superior sagittal sinus 8. Falx cerebri** (97)(103) 9. Longitudinal fissure 10. Septum pellucidum * Close to the level of the splenium of the corpus callosum is the anastomosis of the straight sinus and inferior sagittal sinus **Reflection of dura mater In the longitudinal fissure

Axial Images 13-15 1 Reference Coronal sections from anterior to posterior 2 1. 2. 3. 4. 3 4 6 Superior sagittal sinus Rt optic foramen Superior, middle, & inferior nasal concha (turbinates) (44)(48) Tongue 5. Frontal (anterior) horn of the left lateral ventricle 6. Genu of the corpus callosum 7. Lt temporal lobe of the cerebrum

5 7 Coronal Images 2 & 3 Coronal Images 2-5 Reference Coronal Images 4 & 5 1. Inferior sagittal sinus 2. Lt lateral sulcus (Sylvian fissure) 3. Rt & Lt internal carotid arteries 4. 5. 6 7. 1 2 Septum pellucidum 3rd ventricle Optic chiasm Throat (nasopharynx and oropharynx) 3

4 6 5 7 Reference Coronal Images 6 & 7 1. Chiasmatic (suprasellar) cistern 2. Body (central part) of the Lt lateral ventricle 1 3. 3rd ventricle 4. Rt & Lt interventricular foramen (Foramen of Monro)(102 bottom) (108 bottom) 5. Interpeduncular cistern 6. C2-C3 intervertebral disk space 4 5 2 4 3 6

Coronal Images 6-9 Reference 1. 2. 3. 4. 5. 6. 7. 8. 9. Odontoid process of C2 (dens) Rt & Lt vertebral arteries Rt atlantoaxial articulation (joint) Lt atlantooccipital articulation (joint) Choroid plexus in the body (central part) of the Lt lateral ventricle Choroid plexus in the temporal horn of the Lt lateral ventricle Body of the corpus callosum* Rt external auditory (acoustic) meatus (canal) Pons 5 4 1

3 * Close to the splenium of the corpus callosum, but note that the communication between the right and left cerebral hemispheres persists through image 10 and 11. 2 7 6 Coronal Images 8 & 9 8 9 Reference 1 1. Falx cerebri* 2. Spinal cord 3. Choroid plexus in the 3rd ventricle 4. Rt superior colliculus* (colliculi = plural) (108 & 109 top) (114 & 115 top) 5. Cerebral aqueduct (aqueduct of Sylvius) 6. 4th ventricle 7. Tentorium cerebelli

8. Inferior sagittal sinus 2 8 7 3 4 5 6 Coronal Images 10 & 11 Coronal Images 10-13 Reference Coronal Images 12 & 13 1. Choroid plexus 2. 4th ventricle 3. Splenium of the corpus callosum 3 1 2

4 Longitudinal fissure* 5. Straight sinus * Behind the corpus callosum 4 5 Reference 3 1. Rt cerebellar hemisphere 2. Occipital (posterior) horn of the lateral ventricles 3. Superior sagittal sinus 1 2 Coronal Images 14-16 Coronal Images 14-16

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