cross sectional anatomy by CT and intro to CT procedures ... · Cross Sectional Anatomy –...

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CT Procedures and Anatomy

Cross Sectional Anatomy – Overview&

Slide # 12009

CT imaging Procedures - Introduction

Carolyn Kaut Roth, RT (R)(MR)(CT)(M)(CV) FSMRTCEO, Imaging Education Associates

www.imaginged.com [email protected]

Overview Cross-Sectional Anatomy• Head & Neck

– Brain– Vasculature

• Spine– Cervical– Thoracic– Lumbar

B dCT MR

Slide # 22009

• Body– Chest– Abdomen– Pelvis– Vasculature

• Musculoskeletal – Upper extremities– Lower extremities

Images Images

HeadCT Images

MRI Images

Midline Sagittal T1WI

Para Sagittal

Midline Sagittal reformat

Para Sagittal reformat

Slide # 32009

Axial PDWI

Coronal T2WI

Axial

Coronal Direct or reformat

Cranial Bones & Brain Lobes

Cranial Bones

ParietalFrontal

OccipitalTemporal

Brain Lobes

ParientalOccipitalFrontal

Slide # 42009

Frontal

Temporal

The 5th lobe of the brain is known as the InsulaIt is located “inside” the Sylvian (Lateral) Fissure

Brain Anatomy: Mid-Sagittal

Axial CT Image

Frontal lobe

Temporal lobe Occipital lobe

Parietal lobe

Parietal lobe

Frontal lobe

Sylvian fissure(Insula located within)Occipital lobe

The red line (box) indicates the approximate location of the midline

Frontal bone

Parietal lobeParietal bone

Occipital boneBrain Specimen

Slide # 52009

MRI Image

Frontal lobe Occipital lobe

Midline Sagittal

ppsagittal slice

Cerebellum

Parietal lobe

Frontal lobe

Occipital lobe

Cerebellum

Midline SagittalCT Image

What separates the lobes?

Sylvian Fissure or Lateral Fissure…Separates the Frontal lobe from the parietal lobeInside is the 5th lobe of the brain, the “Insula” & the MCA

Tentorium… separates cerebrum from cerebellum

Longitudinal Fissure… Right and Left lobes

(inside is the Falx Cerebri)

Slide # 62009

Sylvian Fissure

TentoriumTentorium

Longitudinal Fissure

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Midline Sagittal Parasagittal

Sagittal Plane

Slide # 72009

Sagittal Axial Coronal

Midline SagittalParasagittal

Gray Matter

Gray Matter

White Matter

White Matter

Brain Anatomy: Gray & White Matter

Brain specimin

Slide # 82009

CT Image MRI ImageMidline Sagittal Midline Sagittal

Corpus Callosum (body)

Corpus Callosum

(genu)

Corpus Callosum (splenium)

Corpus Callosum

(genu)

Corpus Callosum (body)

Brain Anatomy: Corpus Callosum

Corpus Callosum (splenium)

Slide # 92009


Hint‐ the Corpus callosum is the only white matter structure to cross midlineHint‐ white matter is made up of myelin

Fractional Anisopetry

Slide # 102009

Cerebral peduncles Pons

Brain Anatomy: Brain Stem

Cerebral pedunclesPonsMedullaSpinal Cord

Slide # 112009

CT ImageMidline Sagittal

PonsMedullaSpinal Cord

Hint‐ we know that we are in the midline when we see the spinal cord

MRI ImageMidline Sagittal

Spinal Cord

Anterior horn Lateral ventricle

ThalamusThird ventricleOptic chiasmPituitary stalk

Anterior horn lateral ventricleThalamusThird ventricle

Brain Anatomy: Midline Structures

Slide # 122009


Pituitary stalkPituitary gland

Clivus

Sella turcica

Clivus

Hint‐ we know that we are in the midline when we see the pituitary and sella Turcica

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Brain Anatomy: Para-Sagittal

Parietal lobe

Occipital lobe

Sulcigyri

Maxillary SinusTeeth

MRI Imagepara Sagittal

ParietalFrontalTemporal

OccipitalCerebellum

Slide # 132009

Frontal lobeCerebellum

Temporal Lobe

Sylvian (lateral) fissureMCA flow throughThe Insula is inside

CT Imagepara Sagittal

Coronal Plane

coronal slice more anterior

Slide # 142009


coronal slice more posterior

coronal slice very posterior

Coronal Facial Bone Anatomy Christi galliCribriform plateOrbital roofNasal conchae

Maxilla

MaxillaMandibleFracture

Slide # 152009

Coronal Oblique CT

Coronal CT reformatted image of Trauma

Frontal boneNasal boneMaxilla

Temporal boneZygoma

• Lateral & AP Scout120 kv, 80 ma, 50 fov

• Axial120 kv, 220 ma, 28cm fov512 x 512 matrix1-3 mm to frontal sinus-straight- floor of maxillary sinus perpendicular to table- gantry straight 9 mm to top of heador Soft tissue windows

High Resolution Brain Protocol

Slide # 162009

or5mm / 5mm through fossa8 -9mm entire head125 W 55 L Head

• Coronal120 kv, 220 ma, 16-20cm fov512 x 512 matrix3 mm to frontal sinusangled perpendicular to mandible250 W 30 L (soft tissue)2000 W 350 L (bone)

Bone windows

Soft tissue windows

Parietal lobe

Longitudinal fssure

Pituitary gland (w/tumor)

Pit stalk (infundibulum)

Coronal Through Pituitary Gland

Do you see the seagull?

Optic chiasmPituitary stalk

Slide # 172009

Pit stalk (infundibulum)

Optic chiasm

Lateral ventricles

Septum pellucidum

Temporal lobes

Coronal CT Coronal MR

Brain Anatomy Coronal Posterior

This red line indicates the location of the coronal slice This red line indicates the location of

the coronal slice

Slide # 182009

Coronal CT image Coronal MR image

Cisterna Ambiens w/Pineal glandCerebral aqueductTentorium4th ventricleCerebellum

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Imaging PlanesAxial – SLICE # 1

Angled with base of skull

Axial Slice locations5 4 3 2 1

Axial – SLICE # 2

Slide # 192009

g

Axial – SLICE # 4Axial – SLICE # 3 Axial – SLICE # 5

Axial Slice Locations

Slide # 202009

Brain Anatomy: Axial Superior

Frontal lobe

Superior sagittal sinus

LongitudinalWhite matter

Gray matter ribbons

This red line indicates the location of the axial slice


Anterior

Slide # 212009

Parietal lobeSulcigyri

falx cerebri-enhanced on

CT image

Superior sagittal sinus

Longitudinal fissure

Cortical bone

Subcutaneus fat

Sulci & Gyri

Axial CT image Superior location Axial MR image Superior locationPosterior

Brain Anatomy: Axial @ Ventricles

Axial proton density weighted MR image

Gray matter

White matter

Anterior Horns of the Lateral Ventricles

Septum pellucidum

Slide # 222009

Axial CT image Axial T1 weighted MR image

Just because the structure is gray, does not automatically make it gray matter!

Chroriod Plexus

Posterior Horns of the Lateral Ventricles

Caudate nucleus

Lentiform nucleusPutamen & globus pallidus

Internal capsule

Thalamus

Brain Anatomy: Axial Basil Ganglia

Axial T1 weighted MR image

Caudate Nucleus

External Capsule

Lentiform Nucleus

Internal Capsule

Slide # 232009

External capsuleClaustrumExtreme capsule

Axial CT image Axial PD weighted MR image

Just because the structure is white, does not automatically make it white matter!

Thalamus

White Matter Tracts

Slide # 242009

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Brain Anatomy: Axial Orbits CerebellumAt the level of the vermis

Frontal sinusOrbit

Nasal conchae

Shenoid sinus



Slide # 252009

Basilar ArteryPons

4th ventricleMastiod air cellsCerebellum

Temporal Lobe

Axial CT image

Axial MR image

Brain Anatomy: Axial Orbits

LensGlobe of the eyeOptic nerve

Slide # 262009

Optic nerveLateral rectus muscle

Rt. Medial rectus muscleLt. Medial rectus muscle

Temporal lobe

Axial CT image Axial MR image

Brain Anatomy: IAC’s



Temporal Lobe

Slide # 272009

Axial MR image

Temporal LobeTemporal boneIACMastoid Air Cells7th & 8th cranial nerves

Axial CT image

Brain Anatomy: IAC’s



Temporal LobeTemporal bone

Slide # 282009

Axial MR image

Temporal boneIACMastoid Air CellsCocleaSemicircular canals

Axial CT image

Axial Brain Anatomy: Midbrain

CerebellumAt the level of the vermis

Frontal LobeFalx Cerebri

Sylvian Fissure

This red line indicates the approximate location of the axial slice

This red line indicates the approximate location of the axial slice

MCA

Slide # 292009

Temporal lobe

Cerebral pedunclesRed nucleus

Cerebral AcqueductVermis

Cerebellum

Occipital Lobe


occlusion

Overview Cross-Sectional Anatomy

• Head

– Anterior Circulation

– Posterior Circulation

COW (circle of Willis)

Slide # 302009

– COW (circle of Willis)

• Neck

– Carotid Arteries

– Vertebral Arteries

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Cerebral Vasculature

Slide # 312009

Circle of Willis - CTA

Slide # 322009

Axial

Sagittal Coronal

Superior

Cerebral Circulation – Coronal (COW)

Slide # 332009Coronal CTA

Right Left

Inferior

Left (Anterior & Middle) Artery – Coronal

Left (ACA ) Anterior Cerebral Artery Left (MCA )

Middle Cerebral Artery

(ACOM )

Slide # 342009

AP angiogram ‐ Left Internal Carotid (Anterior and Middle Circulation)

Coronal CTA Image

(ICA ) Internal Carotid Artery

(ACOM ) Anterior Communicating Artery

AP image

(ACA ) Anterior Cerebral Artery

(MCA ) Middle Cerebral Artery (ACOM ) Anterior

Communicating Artery

Right & Left (Anterior & Middle) Artery – Coronal

Slide # 352009

g

AP image


Coronal image

AP image(PCA ) Posterior Cerebral Artery

Right & Left Vertebral Arteries & Basilar Artery –Coronal

Slide # 362009

Basilar Artery

Vertebral Artery

Coronal imageAP image

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Intra-Cerebral Circulation - COW

AP image


(MCA ) Middle Cerebral Artery (ACOM ) Anterior


(PCA ) Posterior Cerebral Artery

Slide # 372009 AP image


Basilar Artery

Vertebral Artery

Coronal CTA Image

Superior

Cerebral Circulation – Coronal (COW)


(MCA ) Middle Cerebral Artery



Slide # 382009Coronal CTA

Right Left

Inferior


Basilar Artery

Vertebral Artery

Cerebral Circulation – Sagittal (COW)Superior

Slide # 392009Sagittal CTA

Anterior Posterior

Inferior

Anterior & Middle Cerebral Arteries – Sagittal

d ddl l




Internal carotid (Anterior and

Slide # 402009

Anterior and Middle circulationLateral DSA

Sagittal CTALateral Radiograph

Middle circulation)Lateral angiogram

Left (ICA ) Internal Carotid

Artery

Right (ICA ) Internal Carotid Artery

(PCOM ) Posterior Communicating Artery

Posterior Cerebral Arteries - Sagittal

Sagittal CTA

Vertebral Artery

Basilar Artery

(PCA) Posterior Cerebral Artery

Slide # 412009

Posterior cerebral circulationLateral DSA

Lateral Radiograph

Cerebral Circulation – Sagittal




Vertebral Artery

Basilar Artery

(PCA) Posterior Cerebral Artery

Slide # 422009

Anterior and Middle circulationLateral DSA

Posterior cerebral circulationLateral DSALateral Radiograph

Sagittal CTA


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Cerebral Circulation – Sagittal (COW) Superior


(MCA ) Middle Cerebral Artery (PCOM )

Posterior Communicating Artery

(PCA ) Posterior b l

Slide # 432009Sagittal CTA

Anterior

Inferior


Basilar Artery

Vertebral Artery

Posterior

Cerebral Artery

Superior

Cerebral Circulation – Axial (COW)

Slide # 442009Axial CTA

Right Left

Inferior

Anterior

Cerebral Circulation - Axial (Circle of Willis)

(PCOM ) Posterior




(ACOM ) Anterior Communicating

Artery


Right Left

Posterior



Basilar Artery

Intra-Cerebral Circulation – Axial COW

Right Left

Anterior





Anterior



Basilar Artery

Slide # 462009

Left

Anterior

Left

Anterior Cerebral Arteries (right & left)Anterior





Artery


Right Left

Posterior

Axial COWAnterior cerebral arteries

–

Axial CTA

Right Left

Anterior

Posterior





Slide # 482009

Left

Anterior

Left

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Posterior Cerebral Arteries (right & left)


Anterior


Right Left

Posterior

Artery


Basilar Artery

Axial CTA

Right Left

Posterior



Basilar Artery

Anterior Axial COWPosterior cerebral arteries

–

Slide # 502009

Anterior

Cerebral Circulation - Axial (Circle of Willis)

(PCOM ) Posterior





Artery


Right Left

Posterior



Basilar Artery

CTACTA--Rapid Brain ProtocolRapid Brain Protocol\\CTACTA--Rapid Brain ProtocolRapid Brain Protocol\\• AP & Lateral Scout

– 120 kv, 80 ma, 50 fov• Axial

120 kv, 420 ma512 x 512 matrix, 24cm fov.675 mm through COW

then9mm through entire head -straight- floor of maxillary sinus perpendicular to table

Slide # 522009

sinus perpendicular to table-gantry 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 reconstructedto a field of 128mm fromabove the cow to c2

Circle of Willis - CTA

Slide # 532009

Axial

Sagittal Coronal

Head Veins

Slide # 542009

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• Head




Slide # 552009


• Neck



Neck Vasculature

Slide # 562009

Carotid Arteries – Sagittal(ICA ) Internal Carotid Artery

(ECA ) External Carotid Artery

Slide # 572009

Sagittal Neck Sagittal Neck

Right and Left CCA - common carotid arteries

Vertebral Arteries – Sagittal

Basilar Artery


Slide # 582009

Sagittal Neck

Vertebral Artery

Sagittal Neck

Carotid Arteries – Sagittal(ICA ) Internal Carotid Artery

(ECA ) External Carotid Artery

Basilar Artery


Slide # 592009

Sagittal Neck

Right and Left CCA - common carotid arteries

Sagittal Neck

Vertebral Artery

Carotid Arteries – Sagittal

Slide # 602009

Sagittal Neck Sagittal Neck

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• Head




Slide # 612009


• Neck



Protocol for Neck• AP & Lat scout

120 kv, 80 ma, 50cm FOV• Axial

120 kv 280 ma5/5 mm, 23 cm FOV512 x 512 matrix

• Scan frontal sinus to carina-include mandible

Slide # 622009

• 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)

Scan Planning

Slide # 632009

• AP & Lateral Scout– 120 kv, 80 ma, 50 cm FOV

• Axial120 kv, 420 ma512 x 512 matrix, 24cm FOV1 mm from the arch to abovethe frontal sinuses-straight- floor of maxillary sinus perpendicular to table- gantry

CTA‐Rapid Neck Protocol

Slide # 642009

perpendicular to table 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 reconstructedto a field of 128mm

Axial

CT Images

Median LineMid-sagittal Plane

Parasagittal Planes

Imaging Planes

Axial

MRI Images

Frontal orCoronal Plane

TransverseOr AxialPlane

Slide # 652009

Sagittal Reformat

Coronal Reformat

Sagittal

Coronal


C2C2

C3C3

C4C4

SliceSlicelocationlocation

Image Comparison in the C-spine

Slide # 662009

Lateral radiograph Sagittal CT Sagittal T1 MRI

C5C5

C6C6

C7C7

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Spinal Anatomy Brachial Plexus & Lumbar Plexus

CORONAL MRI

Brachial plexusCervical vertebrae

Fracture

Slide # 672009 CORONAL MRI

SAGITTAL MRICORONAL CT

Lumbar vertebraeLumbar plexusSacral plexus

Sacrum

pinal Anatomy Vertebral bodies & Intervertebral disks

C1C2C3

Slide # 682009 SAGITTAL MRI

SAGITTAL CT

Spinal cordIntervertebral DiskAnulus (dark)Nucleus pulposis (bright)Conus medularisL4L5S1

Laryngeal Cartilages

Imaging Planes – C Spine & Neck

Anterior arch c1The dens

Slide # 692009

Larynx

Cervical vertebraPedicleDorsal and ventral nerve rootsSpinal cordLaminaSpinous process

Spinal muscles

Axial CT imageAxial MR image

Neck CT - Laryngocele

Slide # 702009

Internal LaryngoceleCauses stridor

“C-spine”

C 1Dens (C2)

Vertebral bodyPedicleLaminaforamina

CT AXIAL

MRI AXIAL

Slide # 712009

Dens (C2)C‐7

LordosisVert bopdiesDiskCordesophagustracheaSpinal muscles

Epidural fat (bright)CSF (Cerebro spinal fluid)(dark)

SAGITTAL MRISAGITTAL CT

“Arnold Chiari Malformation”

Cerebellar TonsilsSyrinx

Slide # 722009

SAGITTAL MRI

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Apical Herniation: Ehlers-Danlos syndrome

Slide # 732009

Sagittal T-spine Anatomy

T1 (1st thoracic vertebrae)T 12 (12th thoracic vertebrae)

Spinal CordVertebral bodies(curvature = kyphosis)

CT AXIALMRI AXIAL

Approximate location for sagittal reformat

Approximate location for sagittal

T1

T2

T3

T4

T1T2T3

T4

T5

T6

T7

Ligamentum flavum

Slide # 742009

( yp )Intervertebral DiskSpinus processConusCauda equinaCSF around the nerves

SAGITTAL MRISagittal Reformatted

CT

Posterior longitudinal ligament(along the posterior vertebral bodies from C1 –sacrum)

Anterior longitudinal ligament(along the anterior vertebral bodies from C1 –sacrum)

T5

T6

T7

T8

T9

T10

T11

T12

L4

L5

S1

L1

L2

L3

T8

T9

T10

T11

T12

Thoracic Spine

AortaVertebral bodyLung


Approximate location for axial

Approximate location for

axial

Slide # 752009

Lung Costo‐vertebral joint

Pedicle

Rib

Spinal canalSpinal cordCSF (cerebrospinal fluid)Transverse processLaminaSpinus processLigamentum flavumErector spinae muscles

MRI AXIALCT AXIAL

Lumbar Spine

L 1L 5Vert bodieslordosis

CT AXIAL MRI AXIAL

Vertebral bodyPedicleLaminaFacet joints

Slide # 762009

lordosis

Disk

Ligamentum flavumPosterior longitudinal ligament


TMJ TMJ

Anatomy Musculoskeletal System

Slide # 772009

Median Line

Mid-sagittal Plane

Parasagittal Planes

Axial

Mid FrontalCoronal Plane

TransversePlane

Imaging Planes - TMJ

Slide # 782009

Sagittal

Coronal

MRI Images


CT Images

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Localizer for sagittal oblique sections Localizer for coronal oblique sections

Overview musculoskeletal Anatomy - TMJ

Slide # 792009

Sagittal Oblique TMJ Coronal Oblique TMJ

Temporal boneFossa(meniscus within)Mandibular

condyleMandible

Shoulder radiograph

Corocoid vs coronoid… “There’s a sea (C) between two Nations”

Slide # 802009

CoroNoid CoroCoid CoroNoidSagittal reformatted CT Lateral radiography (Elbow)

Shoulder radiograph

TMJ 3D CT reformatted image

Shoulder CT

Sagittal MR Elbow


Shoulder

Shoulder

Slide # 812009

• Shoulder– Scapula

• Spine of the scapula• Coracoid process

The lumps and bumps of the shoulder

Slide # 822009

p• Acromion process

– Clavicle– Humerus

• Head of the humerus• Greater tubercle• Lesster tubercle Reformatted CT Image shoulder

Surgical Fixation

AC Joint

Clavicle

Ribs

Slide # 832009

Median LineMidline Sagittal Plane

Parasagittal Planes



Axial

The sagittal oblique plane is acquired along this f

Overview musculoskeletal Anatomy - Shoulder

Slide # 842009

Sagittal

Coronal obliqueThe 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

dotted red line, parallel to the glenoid fossa

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Reformatted CT Image

TrapeziusDeltoid

Structures of the rotator cuff …(SITS)

Axial Shoulder CT

Spine of the scapula

Slide # 852009

Axial MR Image Coronal oblique MR Image

DeltoidRC (S.I.T.S.)Supraspinatus Infraspinatus Teres Minor Subscapularis

Supraspinatus tendon.Infraspinatus tendonTeres minor tendonSubscapularis tendonBicepts muscle


Shoulder Structures

Sagittal Oblique Shoulder

Deltoid


Slide # 862009

Axial MR Image

TrapeziusDeltoid

Supraspinatus tendonRotator cuff

Glenoid fossa Glenoid labrum

Coronal oblique MR Image

AcromionA/C joint(acromio‐clavicular joint)ClavicleHumeral HeadHumerusCorocoid process


Bony Structures of the shoulder

Sagittal Oblique Shoulder


Slide # 872009

Axial MR Image Coronal oblique MR Image

AcromionRotator cuffHumeral HeadGlenoid fossaGlenoid rimScapulaHumerus


Elbow

Elbow

Slide # 882009

HumerusOlecranon processJoint spaceTrochleaCapetellumCoronoid processUlna

Bones of the Elbow Joint

Slide # 892009

Axial MR Image

HumerusOlecranon fossaCapetellumHumero‐radial jointCapetellum

TrochleaHumero‐ulnar jointRadio‐ulnar joint

“Cap on Head”(Capetellum on the head of the radius)


Sagittal Oblique Elbow

Tricepts musclesBicepts MusclesExtensor tendons

Brachoiadialis muscle

Muscles, Tendons & Ligaments of the Elbow Joint

Slide # 902009

Axial MR ImageSagittal Oblique Elbow


Tricepts musclesUlnar collateral ligamentBrachoiadialis muscle

Radial collateral ligament

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WristWrist

Slide # 912009

NavicularLunateTriquetruim

Never Lower Tillie’s Pants…Grandmother Might Come Home

Overview musculoskeletal Anatomy – Wrist

Slide # 922009

TriquetruimPisiformGreater MutlangularLesser MultangularCapatateHammate

Coronal reformatted CT

Coronal MRI


ScaphoidLunateTriquetruim

Some Lovers Try Positions….That They Can’t Handle

Slide # 932009

Coronal reformatted CTCoronal MRI

TrapeziumTrapezoidCapetateHammate

TriquetruimPisiformTrapeziumTrapezoidCapetateHammateAneurysm Raidal arteruUlnar artery

TrapeziumTrapezoidCapetateHammateHook of the

HammateTFCC (triangulo-fibrocartilege complex)


Slide # 942009

fibrocartilege complex)Carpal TunnellFlexor tendonsMedian Nerve

Axial MRI

Coronal MRI

Distal RadiusDistal UlnaRadio‐ulnar joint

Wrist Pathology

Aneurysm

Slide # 952009

Fracture

Handshake

Slide # 962009

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Slide # 972009

HipHip

AcetabulimIlium

IshiumPubis

Bony anatomy of the HIP

Femoral HeadFemoral Neck

Greater TrocanterLesser trocanter

Femoral Shaft

Slide # 982009

Obturator foramen

Reformatted CT Image Hip

Femoral Shaft

BONE METS

Compressed vertebral body

Met to the pelvic

Slide # 992009

Reformatted Coronal CT Image pelvis

Reformatted Sagittal CT Image Spine

bone

IlumIliac arteries

Psoas MusclesObturator foramen

Gleuteal Muscles


Hips & Pelvis

Slide # 1002009

Obturator Internus musclesObturator Externus

Coronal CT

Mass

Axial pelvis CT

Femoral HeadFemoral Neck Greater Trocanter

Lesser trocanterFemoral Shaft

Structures of the HIP

(ASIS) Ilium Acetabulim

Obturator foramen Ishium Pubis

Slide # 1012009

Reformatted CT Image Hip

Coronal MRI of the Hips

Ilium Acetabulim Glenoid LabrumFemoral Neck Femur

Obturator Internus musclesObturator Externus

NAVELNerve, Artery, Vein, Empty space, Lymph node

Psoas MuscleIliacus MuscleGleuteus MaximusGleuteus minimusQuadracepts MuscleHamstrings

Slide # 1022009

Coronal MRI of the Hips

Axial MRI of the Hips

NerveArteryVeinEmpty spaceLymph nodesQuadracepts Muscle Gleuteus MaximusRectum

bladder

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Slide # 1032009

KneeKnee

Bones of the Knee

Coronal knee MRI Axial knee

Condyle

ndyleeal plateauial spine

Slide # 1042009

FemurPatellaPatello‐femoral jointKnee JointTibiaFibula

Sagittal knee MRI


Anterior cruciate ligament (ACL)

Posterior cruciate ligament (PCL)

Quadracepts musclesFemurHamstrings muscles

Quadcepts tendonMid sagittal slice (MRI)

Lower Extremity Anatomy

Axial pelvis CT

Axial femur CT

Slide # 1052009 Coronal

reformatted CTPara sagittal slice (MRI)

Patello- Femoral JointPatellar ligament

Locations of the lateral collateral ligaments

Femoral coldylesMeniscus ([posterior horn, lateral meniscus)Patella

TibiaFibula

Mid sagittal slice (MRI) Axial femur CT

Axial femur CT

Axial knee CT

Muscles of the Knee

Hamstring musclesQuadracepts TendonAttaches the quatracepts musclesGastrocnemius muscles

Slide # 1062009

Para Sagittal knee MRI

Quatracepts musclesHamstring Muscles

Axial Femur MRI Axial CT

Meniscus and other structures of the knee

Anterior horn of the meniscus

Posterior horn of the

Lateral aspect of the patello‐femoral jointLateral retinaculum

Medial retinaculum

Slide # 1072009

Para Sagittal knee MRI

Coronal knee MRI

Posterior horn of the meniscus

Axial knee MRI

Medial collateral ligament Medial meniscusLateral collateral ligament

Lateral meniscus

Lower Leg FractureLower Leg FractureLower Leg FractureLower Leg Fracture

Fracture

Fracture

Slide # 1082009

AP Scout

Lat Scout

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Slide # 1092009

Foot and ankle Foot and ankle

Come… (calcaneus)To … (talus)Cuba (cuboid)Next… NavicularCh i t (3 if !)

TibiaFibula

Foot & ankle bones - Come To Cuba Next Christmas

Slide # 1102009

Christmas … (3 cuneiforms!)

TibiaFibula

Mortise jointMedial collateral ligamentsLateral collateral ligaments

Ankle Ligaments and Tendons

Tibio‐talar joint

Slide # 1112009

Posterior longitudinal ligamenAchilles tendon

Review, Peripheral Vascular Anatomy

Abdominal Aorta(AAA- abdominal aortic aneurysm)

Iliac Arteries

Femoral Arteries

Slide # 1122009 Coronal reformatted CTACoronal MRA

Popliteal Arteries

Trifurcation…(anterior tibial)

(posterior Tibial)(Pernoeus Brevis)


Hand Vasculature

Slide # 1132009

• View Images• Scroll Through• Window / Level• Magnification• Post Processing

What Do We Do With All The Images?

Basic Tasks

Slide # 114

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Axial

CT Images


Parasagittal Planes

Imaging Planes

Axial

MRI Images



Slide # 1152009

Sagittal Reformat

Coronal Reformat

Sagittal

Coronal


Chest Coronal, Heart & Lungs

Heart

CTA

MRA

Slide # 1162009

Lungs

Enhanced Coronal CT Coronal MRI

Chest Coronal, Vasculature

CTA

MRA

Slide # 1172009

Pulmonary ArteriesPulmonary Veins

Enhanced Coronal CTCoronal MRI

Chest Coronal, Lungs & Airway

Upper Lobe of the right lungUpper Lobe of the left lung

Bronchi ‐ carina

Middle lobe of the right lung*remember there is no

Slide # 1182009

middle left because of the heart!

Lower lobe of the right lungLower lobe of the left lung

Diaphragm

Coronal CTCoronal MRI

Chest Coronal Muscles of the Chest

Trapezius

Latissimus

Pectoralis musclesHeart Muscle

Axial CTAxial MRI

Slide # 1192009

Intercostal Muscles

Diaphragm

Coronal CT Coronal MRI

Sagittal Chest – “Candy Cane Shot”

Aortic Arch

Ascending AortaDescending Aorta

Slide # 1202009

Heart

Sagittal CT

Sagittal MRI

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Axial chest

Axial slice #1Axial slice #2Axial slice #3

Axial slice #1Axial slice #2Axial slice #3

Axial slice #1Axial slice #1

Pectoralis MuscleAortic ArchLatissimus MuscleSpine (vertebral body)

Slide # 1212009

Axial slice #2

Axial slice #3

Axial slice #2

Axial slice #3

Spine (vertebral body)Ascending AortaPulmonary arteriesPulmonary veinsDescending AortaHeart

• AP Scout120 kv, 60 ma, 50 cm FOV

• Axial120 kv 180 ma

Basic “Vanilla” Thorax Protocol

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120 kv, 180 ma, 36 cm FOV (fit anatomy)512 x 512 matrixgenerally 5mm1500 W & 500 L(lung windows)450 W & 30 L (mediastinal windows)30 sec (or less) breath-hold

can be modified

Lung Nodule ‐MDCT

Slide # 1232009

Evaluation of Stent Placement

Slide # 1242009

MDCT evaluation of airway stent after chemical injury

3D rendering of normal lung

Heart

Slide # 1252009

Heart anatomy

Heart flowIVC & SVC (Inferior & Superior vena cava)RA (right atrium)TriRvP valve

CTA CORONALMRI CORONAL

Slide # 1262009

P valvePaLungsPvLaBiLvAortic valveAorta – coronaryarch

CT AXIAL MRI AXIAL

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Heart Anatomy

Heart flowSVC (superior vena cava)RA (right atrium)Tri cuspid valveRvP valve


Slide # 1272009

P valvePaLungsPvLaBiLvAortic valveAorta – coronaryarch

CT AXIAL MRI AXIAL

Heart flowIVC & SVC (Inferior & Superior vena cava)RA (right atrium)Tri cuspid valveRV (right ventricle)P valve

CTA CORONALMRI CORONALHeart Anatomy

Slide # 1282009

P valvePaLungsP‐S vLaBiLvAortic valveAorta – coronaryarch

CT AXIAL MRI AXIAL

Heart flowIVC & SVC (Inferior & Superior vena cava)RA (right atrium)Tri cuspid valveRV (right ventricle)Pulmonary valve


Slide # 1292009

Pulmonary valvePA (Pulmonary artery)LungsPvLaBiLvAortic valveAorta – coronaryarch

CT AXIAL MRI AXIAL



Slide # 1302009

Pulmonary valvePA (Pulmonary artery)LungsPV (pulmonary veins)LABiLVAortic valveAorta – coronaryArch

CT AXIAL MRI AXIAL

Heart anatomy



Slide # 1312009

Pulmonary valvePA (Pulmonary artery)LungsPV (pulmonary veins)LA (Left Atrium)BiLVAortic valveAorta – coronaryArch

CT AXIAL MRI AXIAL

Heart anatomy



Slide # 1322009

Pulmonary valvePA (Pulmonary artery)LungsPV (pulmonary veins)LA (Left Atrium)Bi cuspid valveLVAortic valveAorta – coronaryArch

CT AXIAL MRI AXIAL

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Heart anatomy



Slide # 1332009

Pulmonary valvePA (Pulmonary artery)LungsPV (pulmonary veins)LA (Left Atrium)Bi cuspid valveLV (Left Ventricle)Aortic valveAorta – coronaryArch

CT AXIAL MRI AXIAL

Heart anatomy



Slide # 1342009

Pulmonary valvePA (Pulmonary artery)LungsPV (pulmonary veins)LA (Left Atrium)Bi cuspid valveLV (Left Ventricle)Aortic valveAorta – coronaryArch

CT AXIAL MRI AXIAL

Heart and Pulmonary Arteries

Slide # 1352009

Aortic Arch – the “ A, B, C’s”

Ascending aortaCoronariesBrachiocephalic (aka Innominate)

right common carotidright subclavian

right vertebralLeft common carotid

Slide # 1362009

Left SubclavianLeft vertebral

CTA CORONAL

MRA CORONAL





Slide # 1372009


CTA CORONAL

MRA CORONAL





Slide # 1382009


CTA CORONAL

MRA CORONAL

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Slide # 1392009


CTA CORONAL

MRA CORONAL

• Calcium is an indicator for a disease artery (CAD)

• Calcification in the coronary artery reveals

Coronary Calcifications

Slide # 1402009

the condition of coronary arteriosclerosis

• Leads to heart attacks

Grossly calcified left coronary artery

Situs Inversus

Slide # 1412009

Cross Sectional Abdomen

Slide # 1422009

Abdomen Images

Slide # 1432009


Parasagittal Planes

Imaging PlanesFrontal orCoronal Plane


Slide # 1442009Axial

CT Images

Sagittal reformat

Coronal reformat


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Parasagittal Planes



Imaging Planes

Slide # 1452009Axial

CT Images

SagittalCoronal


Coronal Abdomen

Kidneys

Adrenals

Spleen

Approximate Slice location


Slide # 1462009

p

Liver

Psoas Muscles

Gleuteus Muscles

Coronal CT image

Coronal MR image

StomachLiver

Liver Mass

Spleen

Coronal Abdomen



Spleen

Slide # 1472009

BowelSmall BowelStructures of the Small bowelDuodenumJejunemIleum


body anatomy Slide 2b

StomachStructures of the stomach:Lesser curvatureFundusPylorusGreater curvature

Lesser curvatureSpleen

Coronal Abdomen



Liver

umor

Slide # 1482009

Small BowelStructures of the Small bowelDuodenumJejunemIleum

Large bowel (colon)Ascending colonTransverse colonDescending colonSigmoid colon


Axial Abdomen



Liver

Diaphragm Diaphragm

Slide # 1492009

Spleen

Stomach

Aorta

Vertebralbody


Axial Abdomen



Liver

Spleen

Slide # 1502009

Spleen

Stomach

Aorta

Vena cava

Vertebralbody


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Axial Abdomen



Liver

Spleen

Slide # 1512009

Spleen

Pancreas

Kidneys


Axial Abdomen

Approximate Slice location Approximate Slice

location

Rectus abdominus muscles

Liver

Gall bladder

Slide # 1522009

Pancreas

Kidneys


Sagittal AbdomenApproximate Slice location


Thoracic Spine

LiverPancreasLumbar SpineAorta

Slide # 1532009

Aorta

Bowel

Sacrum

Coccyx

Bladder

Symphysis PubisSagittal CT image Sagittal MR image

Sagittal Abdomen

Slide # 1542009

• AP Scout80 kv 120 ma50 cm FOV

• Axial120 kv, 220 ma,

Basic “Vanilla” Abdomen & Pelvis Protocol

Slide # 1552009

, ,36 fov (fit anatomy)512 x 5125mm – 8 mm500 W & 50 L30 sec breath-hold

can be modified

Renal Calculus (Stones)

• No oral contrast• No IV contrast• Run to the bladder

For ureters

Slice #1

Slide # 1562009

Slice #2

Slice #3

Slice #4

Slice #1

Slice #2

Slice #3

Slice #4

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Non‐Contrast PathologyTrauma

Slide # 1572009

3D Reconstruction of Kidney Fracture

• AP Scout• Axial

120 kv, 220 ma, 36 fov (fit anatomy)512 x 512generally 5mm500 W & 50 L30 sec breath-hold

Basic “Vanilla” Abdomen & Pelvis Protocolwith sprinkles

Slide # 1582009

30 sec breath-holdcan be modified

• Post contrastIV- Contrast if 100 cc’snon-ionic 300 mg/ml

2 cc/sec for 20g angiocathdelay scan 60-70 secondsOral –gastrografin 30 per 1 liter waterBarium (dilute for CT) 32 oz

“C”=Celiacgastrichepaticsplenic

Abdominal Vasculature“See Spot Run In..”

(“C” not see) Celiac, SMA, Renals (right & Left), IMA

Slide # 1592009

Coronal CTA Image Coronal MRA image

Arises the aorta at the level of

L1

Provides blood supply to the stomach,

spleen and liver

SMAsuperior mesenteric artery

Arises anteriorly



Slide # 1602009


from the aorta at the level of L2‐3

Provides blood supply to the stomach, small bowel and part of the colon

Renal arteriesrightleft



Slide # 1612009


Arises Bilaterally and posteriorly from the aorta at the level of L3‐4

Provides blood supply to the right & left kidney

IMAInfereriorMesentericArtery

Arises anteriorly & i f i l f



Slide # 1622009


& inferiorly from the aorta at the level of L 4‐5

Provides blood supply to the inferior colon, sigmoid and rectum

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(AAA)AbdominalAortic Aneurysm



Slide # 1632009


AbdominalAorta

Iliac arteries

Peripheral Vasculature “Run-off’s

Abdominal Aorta

Iliac arteries(at the level of the Ileum)

Femoral ArteriesSuperficial femoral & common

femoral(at the level of the Femur)

Slide # 1642009


Popliteal Arteries(at the level of the Knee)

Trifurcation(Lower Leg)

*Anterior Tibeal*Posterior Tibealis*Peroneus Brevis

(at the level of the Foot)Dorsalis Pedis

Medial Malalear

Abdominal Vasculature

Slide # 1652009

Review Vasculature…Almost ALL Arteries:

– Carry oxygenated blood away from the heart

– Carry oxyhemaglobin blood to organsAlmost ALL Veins:

– Carry deoxygenated blood to the heart– Carry deoxyhemaglobin away from

Abdominal Veins

Portal veinSplenic vein

Left renal vein(SMV)Superior mesenteric Vein

(IVC)Inferior vena cava

Slide # 1662009

y y g yorgans

Exceptions: – Portal vein-

• Carries deoxyhemaglobin to the liver– Pulmonary veins-

• Carries deoxyhemaglobin to the lungs– Pulmonary arteries-

• Carries oxyhemaglobin to the heart Coronal abdominal venogram

Vein

(IVC)Inferior vena cava

Right iliacvein

Biliary ducts

Cystic ductPancreatic duct

Hepatic ducts

Slide # 1672009

body anatomy Slide 7

MRCPMR cholangiopancreatography

Coronal

Gall bladder

Common bile duct

Pancreatic duct

Biliary System

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APPENDICITIS

• INFLAMATION OF THE APPENDIX

Slide # 1692009

APPENDIX

• TYPICALLY APPEARS

PUS/AIR FILLED

CROHNS DISEASE

REGIONAL ILEITIS

Slide # 1702009

• REGIONAL ILEITIS

• ETILOGY

DIVERTICULITIS

• INFLAMED

Slide # 1712009

DIVERTICULUM

• CT PRESENTATION

Female Pelvis Anatomy

Uterus

FundusJunctional Zone

Sagittal ultrasound image

FundusEndometrium

Approximate Slice locations

Slide # 1722009

body anatomy Slide 8a

Endometrium

Cervix

VaginaBladder Symphysis pubis

Sagittal Reformatted CT Sagittal MRI (T2 image)


UterusJunctional ZoneEndometrium

OvaryFallopian tube

Bl dd


Slide # 1732009

Bladder

MusclesGleuteal MusclesIleumAcetabulum

Obturator internus musclesObturator extermus muscles

Coronal Reformatted CT

Coronal MRI (T2 image)


Rectus abdominus muscles

Uterusendometrium

Gleuteal muscles

rectum


MR #1MR #2

CT #1CT #2


Slide # 1742009

Bladder

Ovary Femoral head

Obturator Internus muscles

CervixVagina

Axial CT #1

Axial CT #2

Axial MR #1

Axial MR #2

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Male Pelvis Anatomy



Slide # 1752009

Coronal Reformatted CT

Coronal Oblique MRI (T2 image)High resolution (small FOV)

Psoas MusclesBladder

Prostate (base)Seminal vessiclesVas defferens

UrethraApex of the Prostate

Pubic bone

Male Pelvis Anatomy



Symphysis Pubis

NAVEL

Slide # 1762009

Axial MR High resolution (small FOV)

Symphysis Pubis

Prostate Central glandPeripheral zone

(normal)Peripheral zone

(cancer)

Neuro vascular bundle

Rectum

Axial CT

Obtuaturator Internus Muscles

Gleuteal Muscles

Male Pelvis Anatomy


Seminal vessiclesUrinary Bladder

Slide # 1772009

Sagittal Reformatted CT

Sagittal MRI (T2 image)High resolution (small FOV)

y

Prostate BasePeripheral zone

Prostate Apex

Rectum

Rectus abdominus Muscles

Symphysis Pubis

• AP Scout80 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

b difi d

Basic Pelvis Protocol

Slide # 1782009

can be modifiedIf contrast• Post contrast

-Contrast if 100 cc’snon-ionic 300 mg/ml

3 cc/sec for 20g angiocathdelay scan 25-30 seconds min post injection- to peak enhancement

Male Pelvis

Slide # 1792009

Male and Female Pelvis

Slide # 1802009

cross sectional anatomy by CT and intro to CT procedures ... · Cross Sectional Anatomy –...

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Transcript of cross sectional anatomy by CT and intro to CT procedures ... · Cross Sectional Anatomy –...