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9.1 CNS Imaging

Slide # 1

Part I Sectional Anatomy Overview

of the Brain & Spine

Carolyn Kaut Roth, RT (R)(MR)(CT)(M)(CV) FSMRT

CEO, Imaging Education Associates

www.imaginged.com candi@imaginged.com

Slide # 2

Part I

• Planes of the Brain & Spine

• Sectional Anatomy of the Brain

• Sectional Anatomy of the Spine

Outline

Slide # 3

Upon completion of this course, the

attendee should…

1. Learn about planes of the brain & spine

2. Learn sectional anatomy of the brain

3. Learn sectional anatomy of the spine

Part I

Objectives

Slide # 4

Axial PDWI

Midline Sagittal T1WI

Coronal T2WI

Para Sagittal

Sagittal Axial Coronal

MRI Images

Imaging Planes for CT & MR Images

Mid-sagittal Plane

Coronal Plane

Transverse

Or Axial Plane

Parasagittal

Planes

Scott Roth

Axial

Midline Sagittal

reformat

Coronal Direct or reformat

Para Sagittal

reformat

CT Images

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Slide # 5

Cranial Bones & Brain Lobes

Cranial Bones

Parietal

Frontal

Occipital

Temporal

Brain Lobes

Pariental

Occipital

Frontal

Temporal

The 5th lobe of the brain is known as the Insula

It is located “inside” the Sylvian (Lateral) Fissure

Slide # 6

Brain Anatomy: Mid-Sagittal

Axial CT Image

MRI Image

Frontal lobe

Temporal lobe Occipital lobe

Parietal lobe

Parietal lobe

Frontal

lobe Occipital lobe

Frontal lobe

Sylvian fissure

(Insula located within)

Occipital lobe

Midline Sagittal

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

Frontal bone

Parietal lobe

Parietal bone

Occipital bone

Cerebellum

Parietal lobe

Frontal

lobe

Occipital

lobe

Cerebellum

Midline Sagittal

CT Image

Brain Specimen

Slide # 7

What separates the lobes?

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

Sylvian Fissure

Tentorium…

separates

cerebrum from

cerebellum

Tentorium Tentorium

Longitudinal Fissure…

Right and Left lobes

(inside is the Falx Cerebri)

Longitudinal Fissure

Slide # 8

Ventricles as landmarks?

The red lines indicate the approximate location of the sagittal slice

Ventricles make up the

“Face” within the brain

Anterior Horns Lateral

Ventricles

3rd vent

4th ventricle

Posterior Horns of the Lat. Vents

Anterior Horns Lateral

Ventricles Choroid plexus

3rd vent

Posterior Horns of the Lateral

Ventricles

Axial T1W MR image Axial CT image

Sagittal T1W MR image Axial T1W MR image

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Slide # 9

Subdural hematoma Midline shift

Hydrocephalus Hydrocephalus

Axial CT Axial CT Axial T2W MR images

Ventricular Pathology

SDH

shift

The red lines indicate the approximate location of the axial slice

Slide # 10

Anterior Horns Lateral

Ventricles

Upper slice

Lower slice 3rd vent

4thventricle

Axial CT images

Sagittal MR images

What flows into what? Anterior Horns Lateral

Ventricles Interventricular

foramen 3rd vent

Choriod Plexus

Posterior

Horns

4th ventricle

Axial T2 weighted

MR images

Slide # 11

Choroid plexus Anterior horns of the lateral ventricles

Posterior horns of the lateral ventricles

Interventricluar foramen Between lateral ventricles & 3rd ventricle

3rd vetricle Lateral walls, made up of the thalamus

Cerebral Aquiduct

(aka Aquiduct of Sylvius) Between 3rd vent & 4th vent

4th ventricle Located anterior to cerebellum

Aquiducts to the cerebellum & cord Aquiduct of Magende

Aquiduct of Lushka

Anterior horns

of the lateral

ventricles

Choroid plexus

Choroid plexus

Posterior horns

of the lateral

ventricles

Axial MR image

Axial CT image

Brain Anatomy: CSF Flow

Anterior horns

of the lateral

ventricles

Interventricular foramen

3rd ventricle

Posterior horns

of the lateral

ventricles

Slide # 12

Anterior horns of

the lateral

ventricles

Invterventricular foramen

3rd ventricle

Posterior horns

of the lateral

ventricles

Ventricluar System - A closer look…Slice #1

Axial T2W MR Image

Slice location #1

Slice #1

Sagittal T1W MR Image

The red lines indicate the approximate location of the sagittal slice

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Slide # 13

Sagittal MR Image

Epithalamus

pineal gland

Cerebral Peduncles

(Midbrain)

Cerebral Acqueduct

Corpora Quadragemina

Cisterna Ambiens

Cerebellum (Vermis)

4th Ventricle

Axial MR Image

Slice location #2

Slice #1

Slice #2

Ventricluar System - A closer look…Slice #2

Slide # 14

Sagittal MR Image

4th Ventricle

Axial MR Image

Slice location #3

Slice #1

Slice #2

Slice #3

Ventricluar System - A closer look…Slice #3

Slide # 15

Choroid plexus

Anterior horns of the lateral ventricles

Posterior horns of the lateral ventricles

Interventricluar foramen

Between lateral vents & 3rd vent

3rd vetricle

Lateral walls made up of the thalamus

Cerebral aquiduct (aka aquiduct of Sylvius)

Between 3rd vent & 4th vent

4th ventricle

Located in the cerebellum

Aquiducts to the cerebellum & cord

Aquiduct of Megende

Aquiduce of Lushka

Anterior horn of the lateral ventricle

3rd ventricle

Cerebral Aqueduct

Midbrain

4th ventricle

Pons

Medulla Oblongata

CSF surrounding spinal cord

Spinal cord

Axial MR image

Axial CT image

4th ventricle

Brain Anatomy: CSF Flow

Slide # 16

Anterior

Cerebral

Arteries

Anterior Communicating Artery

Posterior Communicating Artery

Middle Cerebral Artery

Posterior Cerebral Artery

Brain Anatomy: Circle of Willis

Axial MRA image

Axial CTA image

Anterior

Posterior

Anterior

Posterior

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Slide # 17

Middle Cerebral Artery

Marco Essig, MD, PhD, Associate Professor Director of MRI and MRS, Department of Radiology German Cancer Research Center, Heidelberg, Germany

Courtesy: University of Leuven, Belgium

Middle Cerebral Artery

Lacunar branches

Slide # 18

Brain Anatomy: Venous Flow

Superior sagittal sinus Inferior sagittal sinus Vein of galen

Straight sinus Confluence of sinuses Transverse Sinus Sigmoid sinus

Internal jugular vein

Superior sagittal sinus

Superior sagittal sinus

Axial MR image

Axial CT image Coronal MR image

Superior Sagittal Sinus

Straight Sinus

Transverse

Sinus

Venogram

Straight sinus Confluence of sinuses

Superior sagittal sinus

Coronal CT image

Slide # 19

CT Image MRI Image

Midline Sagittal Midline Sagittal

Gray

Matter

Gray

Matter White

Matter

White

Matter

Brain Anatomy: Gray & White Matter

Brain specimin

Slide # 20

CT Image MRI Image

Midline Sagittal Midline Sagittal

Corpus

Callosum

(body)

Corpus Callosum

(genu)

Corpus Callosum (splenium)

Corpus Callosum

(genu)

Corpus

Callosum

(body)

Hint- the Corpus callosum is the only white matter structure to cross midline Hint- white matter is made up of myelin

Brain Anatomy: Corpus Callosum

Corpus Callosum (splenium)

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Slide # 21

CT Image

Midline Sagittal

Cerebral peduncles Pons Medulla Spinal Cord

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

Brain Anatomy: Brain Stem

MRI Image Midline Sagittal

Cerebral peduncles Pons Medulla Spinal Cord

Slide # 22

CT Image MRI Image

Midline Sagittal Midline Sagittal

Anterior horn Lateral ventricle

Thalamus Third ventricle

Optic chiasm Pituitary stalk

Pituitary gland

Clivus

Sella turcica Clivus

Anterior horn lateral ventricle Thalamus Third ventricle

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

Brain Anatomy: Midline Structures

Slide # 23

Midline Sagittal Parasagittal

Sagittal Axial Coronal

Midline Sagittal Parasagittal

Sagittal Plane

Slide # 24

Brain Anatomy: Para-Sagittal

Frontal lobe

Parietal lobe

Occipital lobe

Cerebellum

Temporal Lobe

Sylvian (lateral) fissure MCA flow through The Insula is inside

Sulci gyri

Maxillary Sinus Teeth

CT Image

MRI Image

para Sagittal

para Sagittal

Parietal Frontal Temporal

Occipital Cerebellum

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Slide # 25

Sagittal Axial Coronal

Axial slice superior

Axial slice inferior

Axial (Transverse) Plane

Slide # 26

Brain Anatomy: Axial Superior

Frontal lobe

Parietal lobe

Sulci gyri

falx cerebri- enhanced on CT image

Superior sagittal sinus

Superior sagittal sinus

Longitudinal fissure

Cortical bone Subcutaneus fat

Sulci gyri

White matter

Axial CT image Superior location Axial MR image Superior location

Gray matter ribbons

This red line indicates the location of the axial slice

This red line indicates the location of the axial slice

Anterior

Posterior

Slide # 27

Brain Anatomy: Axial @ Ventricles

Axial CT image

Axial T1 weighted MR image

Axial

proton density weighted

MR image

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

Gray matter

White matter

Anterior Horns of the

Lateral Ventricles

Septum pellucidum

Chroriod Plexus

Posterior Horns of

the Lateral

Ventricles

Slide # 28

Caudate nucleus

Lentiform nucleus Putamen & globus pallidus

Internal capsule

Thalamus

External capsule

Claustrum

Extreme capsule

Axial CT image

Axial PD weighted MR image

Brain Anatomy: Axial Basil Ganglia

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

Axial

T1 weighted

MR image

Caudate Nucleus

External Capsule

Lentiform Nucleus

Internal Capsule

Thalamus

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Slide # 29

Caudate nucleus

(Gray Matter)

Lentiform nucleus

(Gray Matter)

(Globus pallidus & Putamen )

Thalamus

(Gray Matter)

Axial Proton Density MR Image

Brain Anatomy: Basil Ganglia

Just because the

structure is gray, does

not automatically make

it gray matter!

Slide # 30

Corpus callosum

genu

Corpus callosum

splenium

Axial CT image

Axial PDW MR image

Brain Anatomy: Axial – Corpus Callosum

Axial

T1 weighted

MR image

This red line indicates the location of the axial slice

Slide # 31

Pathology at the level of the Ventricles

• Bone

– Cortical Bone: 800

– Petrous Bone: 3000

– Average Bone: 1000

• Blood

– Fresh: 20-50

– Clotted: 50-75

• Air: -1000

• Lungs: -150 to -850

• Water: 0

• Fat: -100

Slide # 32

Axial Brain Anatomy: Midbrain

Cerebellum

At the level of the vermis

Frontal Lobe

Falx Cerebri

Sylvian Fissure

Temporal lobe

Cerebral peduncles

Red nucleus

Cerebral Acqueduct

Vermis

Cerebellum

Occipital Lobe

Axial CT image Axial MR image

This red line

indicates the

approximate

location of the

axial slice

This red line

indicates the

approximate

location of the

axial slice

MCA

occlusion

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Slide # 33

Brain Anatomy: Axial Orbits

Basilar Artery Pons

4th ventricle Mastiod air cells

Cerebellum

Cerebellum At the level of the vermis

Frontal sinus Orbit

Nasal conchae

Shenoid sinus

Temporal Lobe

Axial CT image

Axial MR image

This red line indicates the location of the axial slice

This red line indicates the location of the axial slice

Slide # 34

Brain Anatomy: Axial Orbits

Lens Globe of the eye

Optic nerve Lateral rectus muscle

Rt. Medial rectus muscle Lt. Medial rectus muscle

Temporal lobe

Axial CT image Axial MR image

Slide # 35

Brain Anatomy: IAC’s

Axial MR image

This red line indicates the location of the axial slice

This red line indicates the location of the axial slice

Temporal Lobe

Temporal bone

IAC

Mastoid Air Cells

7th & 8th cranial nerves

Axial CT image

Slide # 36

Brain Anatomy: IAC’s

Axial MR image

This red line indicates the location of the axial slice

This red line indicates the location of the axial slice

Temporal Lobe Temporal bone IAC Mastoid Air Cells Coclea Semicircular canals

Axial CT image

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Slide # 37

Coronal Plane

Sagittal Axial Coronal

coronal slice

more anterior

coronal slice

more posterior

coronal slice

very posterior Slide # 38

Coronal Facial Bone Anatomy

Coronal Oblique CT

Coronal CT reformatted image of Trauma

Christi galli

Cribriform plate

Orbital roof

Nasal conchae

Maxilla

Maxilla

Mandible

Fracture

Frontal bone

Nasal bone

Maxilla

Temporal bone

Zygoma

Slide # 39

Parietal lobe

Longitudinal fssure

Pituitary gland (w/tumor)

Pit stalk (infundibulum)

Optic chiasm

Lateral ventricles

Septum pellucidum

Temporal lobes

Coronal CT Coronal MR

Coronal Through Pituitary Gland

Do you see the seagull?

Optic chiasm Pituitary stalk

Slide # 40

Brain Anatomy Coronal Posterior

Coronal CT image Coronal MR image

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

location of the coronal slice

Cisterna Ambiens

w/Pineal gland

Cerebral aqueduct

Tentorium

4th ventricle

Cerebellum

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Slide # 41

• MRI + CT

• Pre therapy

Image Fusion

MRI CT

MRI + CT fusion

Slide # 42

Axial

CT Images

Sagittal

Reformat

Coronal

Reformat

Median Line

Mid-sagittal Plane

Parasagittal Planes

Imaging Planes

Sagittal

Axial

Coronal

MRI Images

Frontal or

Coronal Plane Transverse

Or Axial

Plane

Sagittal Axial Coronal

Slide # 43

Lateral radiograph Sagittal CT Sagittal T1 MRI

C2

C3

C4

C5

C6

C7

Slice

location

Image Comparison in the C-spine

Slide # 44

Spinal Anatomy Brachial Plexus & Lumbar Plexus

CORONAL MRI

CORONAL MRI

SAGITTAL MRI CORONAL CT

Brachial plexus Cervical vertebrae

Lumbar vertebrae Lumbar plexus Sacral plexus Sacrum

Fracture

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Slide # 45

Spinal Anatomy Vertebral bodies & Intervertebral disks

SAGITTAL MRI SAGITTAL CT

C1 C2 C3

Spinal cord Intervertebral Disk Anulus (dark) Nucleus pulposis (bright) Conus medularis L4 L5

S1

Slide # 46

Laryngeal

Cartilages

Larynx

Cervical vertebra

Pedicle

Dorsal and ventral

nerve roots

Spinal cord

Lamina

Spinous process

Spinal muscles

Imaging Planes – C Spine & Neck

Axial CT image

Axial MR image

Anterior arch c1 The dens

Slide # 47

“C-spine”

C 1

Dens (C2)

C-7

Lordosis

Vert bopdies

Disk

Cord

esophagus

trachea

Spinal muscles

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

Vertebral body Pedicle Lamina foramina

SAGITTAL MRI SAGITTAL CT

CT AXIAL

MRI AXIAL

Slide # 48

“Arnold Chiari Malformation”

Cerebellar Tonsils

Syrinx

SAGITTAL MRI

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Slide # 49

PET/CT FUSION

Laryngeal

Cancer

Slide # 50

Sagittal T-spine Anatomy

T1 (1st thoracic vertebrae)

T 12 (12th thoracic vertebrae)

Spinal Cord

Vertebral bodies

(curvature = kyphosis)

Intervertebral Disk

Spinus process

Conus

Cauda equina

CSF around the nerves

SAGITTAL MRI Sagittal

Reformatted CT

CT AXIAL MRI AXIAL

Approximate location for sagittal reformat

Approximate location for sagittal

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

T1 T2 T3 T4

T5

T6

T7

T8

T9

T10

T11

T12

L4

L5

S1

L1

L2

L3

T1

T2

T3

T4

T5

T6

T7

T8

T9

T10 T11 T12

Ligamentum

flavum

Slide # 51

Thoracic Spine

Aorta Vertebral body Lung Costo-vertebral joint Pedicle Rib Spinal canal Spinal cord CSF (cerebrospinal fluid) Transverse process Lamina Spinus process Ligamentum flavum Erector spinae muscles

SAGITTAL MRI SAGITTAL CT

MRI AXIAL CT AXIAL

Approximate location for axial

Approximate location for

axial

Slide # 52

Lumbar Spine

L 1 L 5 Vert bodies lordosis

Disk

Ligamentum flavum

Posterior longitudinal ligament

SAGITTAL MRI SAGITTAL CT

CT AXIAL MRI AXIAL

Vertebral body Pedicle Lamina Facet joints