Anatomy in Diagnostic Imaging

CoxTENTS

Principles

and techniques

Techniquesbased on X-rays The production and nature of X-rays 13 Interactions of X-rays with matter 15 Conventional imaging with X-rays 18 Digital radiography 21 Computed X-ray tomography 22 X-ray contrast enhancing media 25

Techniquesbasedon nuclear magnetic resonance Principlesof MR-scanning 28 MR-imaging modes and pulse sequences 38

Techniquesbased on ultrasoundreflection The production and nature of ultrasound 41 Interactionsof ultrasoundwith tissues 43 Ultrasoundimaging modes 44 The Doppler effect and Doppler imaging 46

Techniquesbased on radioisotopeemissions Scintigraphy 47 Single photon emissioncomputed tomography (SPECT) and positron emissiontomography (PET) 49

Principlesof nomenclatureand positioning 50

Forearm, supinated, middle, axial CT 66 Forearm,pronated,middle, axial MR 66

Wrist and hand Wrist, dorso-volarX-ray 67 Wrist, lateral X-ray 67 Wrist and hand, axial CT:series 68-71 Metacarpus and fingers, axial CT 71 Wrist, coronalMR 72 Wrist, carpaltunnel, coronalMR 72 Hand, a-p X-ray 73 Skeletal age of hand 73 Hand development, male 74-77 Hand development,female 78-81 Hand, senescent,dorso-volarX-ray 82 Hand, dorso-volar,99mTc-DMB scintigraphy, child 12 years 82

Arteries and veins Shoulder, a-p X-ray, arteriography (digital subtraction) 83 Forearm, a-p X-ray, arteriography 83 Hand, dorso-volarX-ray, arteriography 84 Shoulder,a-p X-ray, phlebography 85

Lower limb Pelvis

Upper limb Shoulderand arm Shoulder,a-p X-ray 55 Shoulder,axial X-ray 55 Clavicle,a-p X-ray 56 Scapula,oblique X-ray 56 Shoulder and arm, a-p X-ray, child one year 56 Shoulderand arm, a-pX-ray, child 5 years 57 Shoulder and arm, 99m1i-14pp, scintigraphy, child 12 years 57 Shoulder,axial CT 58 Shoulder,coronalMR 58 Shoulder,axial MR 59 Arm, upper third, axial MR 60 Arm. middle. axial MR 60

Elbow Elbow, axial CT 61 Elbow, a-p X-ray 62 Elbow lar.eralX-ray 62 Elbow coronalMR 63 Elbow, humeroradialjoint, sagittalMR 63

Forearm Forearm, a-p X-ray 64 Forearm, a-p X-ray, child 2 years 65

Pelvis, female, a-p X-ray, tilted 88 Pelvis, male, a-p X-ray, tilted 88 Sacro-iliacjoints, axial CT (bone settings) 89 Pelvis, 99mfi-\,{PP scintigraphy 89

Hip and thigh Hip, a-pX-ray 90 Hip, Lauenstein,X-ray 90 Pelvis, a-p X-ray, child 3 months 91 Pelvis, X-ray, child 7 years 9l Hip, axial CT 92 Hip, sagittalMR 93 Hip, child, 3 months, coronalUS 93 Thigh, axial MR 94-95

Knee Knee, a-p X-ray 96 Knee, flexed, lateral X-ray 96 Knee, half flexed, tilted X-ray ("intercondylar notch projection") 97 Knee, flexed, axtal X-ray 97 Patella variation (2%), a-V X-ray 97 Knee, flexed, lateral X-ray, old age 98 Knee, child 11 years,lateralX-ray 98 Knee and leg, newborn, a-p X-ray 99 Knee, 99mTc-MDB a-p scintigraphy,child l2 years 99 Knee, axial CT 100-102

58

SHOULDER Scoutview

process 1: Coracoid 2: Righthumeral head,inwardrotated 3: Sternal endof clavicle 4: Lefthumeral head,outwardrotated 5: Planeof section

Shoulder,axialCT 1: Greater tubercle process 2: Coracoid 3: Neckof scapula 4: Spineof scapula 5: Apexof lung

6: Sternal endof clavicle 7: Lesser tubercle groove 8: Intertubercular 9: Greater tubercle 10:Humeral head

1l: Glenoid cavity 12: Firstrib 13:Second rib

Shoulder,coronal MR Planeof sectioningindicatedon sectionB 1: Acromial endof clavicle jointwithdiscus 2: Acromioclavicular 3: Acromion 4: Articular cartilage of humeral head

B: Compact boneof humeral shaft 9: Subscapularis 10:Trapezius l1: Apexof axillawithfat andvessels pvalnr qnrnrl:p

15:Scalenus medius 16:Apexof lung 17:Firstrib 18:Second rib

59

SHOULDER 1

10

z

11

{ 4

72

6

13 I4

6

15

7

16

8 9

Shoulder,axialMR indicated on sectionA Planeof sectioning )ectoralis minor shorthead andbiceps, 3oracobrachialis, Lesser tubercle R inonc ,,vvPvr

l n n' sb h pad ' 'vvv 'v'

Deltoideus Greater tubercle

7: Articular cartilage bursa 8: Subdeltoid 9: Infraspinatus fat 10: Subcutaneous 11:Clavicle andnerves 12:Apexof axillawithfat,vessels

13:Subclavius 14:Subscapularis medius 15:Scalenus 16: Neckof scapula page A-A:Planeof section(A)on previous

8 9 10 11 I2 13 I4 15

Shoulder,axialMR Planeof sectioningindicatedon sectionA Coracobrachialis, andshortheadof biceps Brceps, longhead Deltoideus neckof humerus Surgical Triceps, longhead

major 6: Pectoralis 7: Clavicle minor B: Pectoralis plexus arteryandbrachial 9: Axillary 10:Apexof lung

medius 11:Scalenus 12: Subscapularis 13:Scapula 14:Serratus anterior 15:Infraspinatus

60

ARM

Arm,upperthird,axialMR 1: Biceps brachii, shorthead 2: Bicepsbrachii, longhead 3: Cephalic vein 4: Coracobrachialis 5: Deltoid muscle 6: Shaftof humerus

7: Radial nerve B: Profunda brachiiartery 9: Triceps lateral brachii, head 10: Median andmusculocutaneus nerve l1: Brachial vein 12:Basilic vein

13: Ulnarnerve 14: Brachial artery 15:Triceps brachii, medial head 16:Triceps brachii, longhead

7 8 9 10 11 I2 1 ? I J

L4

Arm, middle,axialMR 1: Biceps brachii 2: Cephalic vein 3: Brachialis muscle 4: Shaftof humerus 5: Radial nerveandprofunda brachii artery

6: Triceps brachii, lateral head 7: Median nerve B: Brachial arteryandveins 9: Basilic veins 10: Musculocutaneous nerve

11:Ulnar nerve 12:Triceps medial brachii, head 13:Triceps brachii, longhead l4: Internal aponeurosis of tricepsbrac

61

ELBOW

I4 15 A

16

7 I7 8

l8

9

19

t0

Elbow,axialCT vein Vledian cubital 3rachial artery liceps(tendon) lrachialis ladialnerve Srachioradialis Articular capsule

longus carpiradialis 8: Extensor extensor tendon 9: Common 10:Anconeus teres 11: Pronator nerve 12:Median flexortendon 13: Common 14:Medial epicondyle

15:Ulnarnerve ligament l6: Medial collateral 17:Trochlea 18:Capitulum 19:Olecranon

Scoutviewfor elbow,axialCT

10 11 I2 13 I4 15 16 17 18

7 B 9

Elbow,axialCT vein Median cubital

8: Headof radius

palmaris longus, carpiradialis, I4: Extensor

62

ELBOW

Elbow,a-pX-ray 1: Shaftof humerus 2: Olecranon fossa,and fossa(superimposed) coronoid 3: Lateral epicondyle 4: Capitulum joint 5: Humeroradial

6: Headof radius 7: Neckof radius B: Shaftof radius ridge 9: Medial supracondylar 10:Medial epicondyle 11:Olecranon

l2: Trochlea process 13:Coronoid 14:Articular of radius circumference 15:Radial tuberosity 16:Shaftof ulna

Elbow,lateralX-ray 1: Capitulum

7: Shaftof radius

13:Coronoid fossa

63

ELBOW

13 3

T4

4

I J

5

16

6

I7

7

18

8 9 10 1i

Elbow,coronal MR umeral shaft lecranon fossa apitulum joint umeroradial eadof radius rachioradialis

7: Neckof radius 8: Supinator 9: Radial tuberosity 10:Yellow bonemarrow 11: Compact bone 12:Triceps brachii

13: Medial epicondyle 14:Trochlea 15: Medial collateral ligament joint 16: Proximal radio-ulnar 1 7 :U l n a muscles 18: Flexor of forearm

13 I4 15

joint,sagittal Elbow,humeroradial MR 'achioradialis

7: Anular lrgament of radius

12:Capitulum

64

FOREARM

Forearm,a-pX-ray 1: Lateral epicondyle 2: Articular foveaof radius 3: Headof radius 4: Neckof radius 5: Tuberosity of radius 6: Shaftof radius

7: Distalendof radius B: Carpal articular surface of radius process 9: Styloid of radius 10:Scaphoid bone 1l: Medial epicondyle 12:Olecranon

process 13: Coronoid l4: Shaftof ulna 15:Neckof ulna 16:Headof ulna process 17:Styloid of ulna 1B:Lunate bone

FOREARM

Forearm,a-pX-ray, child2 years l: Diaphysis of humerus (ossification 2:Capitulum center) 3:Tuberosity of radius 4:Diaphysis of radius

5: Distalepiphysis of radius (ossification center) 6: Firstmetacaroal bone 7: Olecranon B: Coronoid orocess of ulna

9: Diaphysis of ulna 10:Capitate bone(ossification center) 11: Hamate bone(ossification center) 12: Fifthmetacaroal bone

66

FOREARM

Forearm, supinated, middle,axialCT 1: Subcutaneous vein 2: Brachioradialis 3: Radial artery 4: Pronator teres 5: Radius

6: Extensor carpiradialis longus, andbrevis 7: Suoinator 8: Extensor digitorum 9: Extensor caroiulnaris 10: Flexor carpiradialis, andpalmaris longus

1l: Flexor digitorum superficialis 12:Median nerve 13:Flexor carpiulnaris profundus 14:Flexor digitorum 1 5 :U l n a

Forearm,pronated, middle,axialMR 1: Cephalic vein 2: Brachioradialis

pollicis 7: Abductor longus 8: Extensor oollicis brevis

14: Palmaris longus 15: Flexor digitorum superficialis

WRIST

X-ray Wrist,dorso-volar bone 1:Firstmetacarpal bone 2:Capitate bone 3:Trapezoid 4:Trapezium of trapezium 5:Tubercle bone 6:Tubercle of scaphoid

(navicular) bone 7: Scaphoid process of radius Styloid 8: surface of radius articular 9: Carpal bone 10: Fifthmetacarpal bone 11:Hookof hamate bone 12:Hamate

bone l3: Triquetrum bone i4: Pisrform bone 15:Lunate process of ulna 16:Styloid

Wrist,lateralX-ray metacarpal bone 1:First 2:Trapezium

process of radius 6: Stylord of radius surface articular 7'.Carpal bone 8: Hookof hamate

bone 11:Triquetrum bone 12:Lunate process of ulna 13:Styloid

WRIST andHAND.axialCT-series

68 3 5 7 12 4 6 8

I

4 5 6 7 8 9

io Scoutview of wrist and hand

(1.5mmthick)in thefollowing position indicatt l Arrows €, e, ?nd 14: Flexor (tendon) pterygoid muscle 20: Lateral -> pterygoid muscle 21: Medial ---; 22: Ramus of mandible -> velipalatini 23:Tensor -+ 24: Levator velipalatini

jugular vein-+ 26: Internal 27: lnlernal carotidartery-+ lateralis 2B:Rectus capitis -+ anterior 29: Rectus capitis -+ capitis 30: Longus 31:Alarligament ?)'

\ l a r l !ov vh, r eul ,

a r f( ov ' r r i :

u'

J

membrane 33: Tectorial condyle 34: Occipital --> oblongata 35: Medulla 36: Cerebellar tonsil

BRAIN, axialMR-series

185

16 I7

Brain,axialMR-series Scoutviewon page183 1: Orbicularis oris 3: Zygomaticus majormuscle process 4: Pterygoid 26: Cerebellum

190

BRAIN. axialMR-series

Brain,axialMR Scoutviewon page183 1: Nasolacrimal duct quadrangu lobulus 45: Cerebellum, 46: Rednucleus -+ lobulus simplex 47: Cerebellum, 48: Pons 49: Cerebellum, uvulavermis 50: Cerebellum, tonsil-+

235

MR-series BRAIN, sagittal

26 27 28

29 10

30

11 T2

31 32

l3

33

I4 15

34 35

16 I7

19

36 37

20

38

2I

23

39 40 4T

24

42

18

ll

Brain,sagittal MR granulation \rachnoid part-+ -ateral ventricle, central < )orsum sellae sinus iphenoidal rrontal sinus-+ plate )ribriform -thmoidal aircells > t4iddle concha nferior concha Jrbicularis oris-+ -ongus capitis> ?onirrc nenitic :ntorinr

- o n g u sc o l l i :piglottts

Scoutviewon page233 gyrus-+ 15: Precentral (Roland) > 16:Central sulcus 17: Bodyof fornix 18:Anterior commissure 19:Areasubcallosa 20: Optictract-+ nerve 21:Oculomotor 22'.Pons+ 23: Olive 24. Pyramis 27: Posterior cerebral 28:Superior cerebellar artery-+

29: Anterior archof atlas< ?O

Cictprne

m2en2

a

31;Alarligament archof atlas