2/27/2009

Overview Cross-Sectional Anatomy

• Head & Neck
CT Procedures and Anatomy – Brain
– Vasculature
• Spine
– Cervical
Cross Sectional Anatomy – Overview – Thoracic
& – Lumbar CT MR
• Body
B d Images Images
CT imaging Procedures - Introduction – Chest
– Abdomen
Carolyn Kaut Roth, RT (R)(MR)(CT)(M)(CV) FSMRT – Pelvis
– Vasculature
CEO, Imaging Education Associates
• Musculoskeletal
www.imaginged.com candi@imaginged.com – Upper extremities
– Lower extremities
2009 2009
Slide # 1 Slide # 2

Head Cranial Bones & Brain Lobes

CT MRI
Images Images
Midline Sagittal T1WI Cranial Bones Brain Lobes
Midline Sagittal reformat
Parietal
Frontal
Para Sagittal Pariental
Occipital
Para Sagittal reformat Occipital
Temporal
Frontal

Temporal

Axial PDWI
Axial

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

It is located “inside” the Sylvian (Lateral) Fissure
Coronal Direct or reformat Coronal T2WI

2009 2009
Slide # 3 Slide # 4

Brain Anatomy: Mid-Sagittal What separates the lobes?

Frontal lobe Parietal lobe
Frontal bone
Tentorium…
Temporal lobe Occipital lobe separates
Parietal lobe cerebrum from
Parietal bone Frontal lobe cerebellum
Sylvian fissure
Occipital lobe Sylvian Fissure or Lateral Fissure…
(Insula located within)
Occipital bone Separates the Frontal lobe from the parietal lobe
Inside is the 5th lobe of the brain, the “Insula” & the MCA Longitudinal Fissure…
Axial CT Image Brain Specimen Right and Left lobes
The red line (box) indicates the (inside is the Falx Cerebri)
pp
approximate location of the midline Parietal lobe
sagittal slice
Parietal lobe Frontal
lobe Occipital lobe
Longitudinal Fissure
Occipital Sylvian Fissure
Frontal
lobe
lobe
Cerebellum
Cerebellum

Midline Sagittal Midline Sagittal

CT Image MRI Image Tentorium
Tentorium
2009 2009
Slide # 5 Slide # 6

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Sagittal Plane Brain Anatomy: Gray & White Matter

Midline Sagittal Parasagittal

Brain specimin
White Gray
White Gray Matter Matter
Matter Matter

Parasagittal
Midline Sagittal

Midline Sagittal Midline Sagittal
Sagittal Axial Coronal
CT Image MRI Image
2009 2009
Slide # 7 Slide # 8

Brain Anatomy: Corpus Callosum

Fractional Anisopetry
Corpus Corpus Corpus Corpus Corpus Corpus
Callosum Callosum Callosum Callosum Callosum Callosum
(genu) (body) (splenium) (genu) (body) (splenium)

Midline Sagittal 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 Slide # 10

Brain Anatomy: Brain Stem Brain Anatomy: Midline Structures

Anterior horn 
Cerebral  Lateral ventricle
Anterior horn  Thalamus
peduncles
Cerebral  lateral ventricle Third ventricle
Pons
peduncles  Thalamus Optic chiasm
Medulla
Pons Third ventricle Pituitary stalk
Pituitary stalk
Spinal Cord
Spinal Cord
Medulla Sella turcica Pituitary gland
Spinal Cord
Clivus Clivus

Midline Sagittal Midline Sagittal Midline Sagittal

Midline Sagittal
CT Image CT Image MRI Image
MRI Image
Hint‐ we know that we are in the midline when we see the pituitary and sella Turcica
Hint‐ we know that we are in the midline when we see the spinal cord

2009 2009
Slide # 11 Slide # 12

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Brain Anatomy: Para-Sagittal Coronal Plane

Parietal
Frontal Occipital
Temporal Cerebellum Maxillary Sinus
Teeth
Sulci
gyri para Sagittal
Parietal lobe MRI Image
coronal slice
Occipital lobe
more anterior

Sylvian (lateral) fissure
MCA flow through
The Insula is inside
coronal slice
Frontal lobe more posterior
Cerebellum

Temporal Lobe Sagittal Axial Coronal

para Sagittal coronal slice

2009 CT Image Slide # 13 2009 very posterior
Slide # 14

Coronal Facial Bone Anatomy High Resolution Brain Protocol

Christi galli
Cribriform plate • Lateral & AP Scout
Orbital roof 120 kv, 80 ma, 50 fov
Nasal conchae • Axial
120 kv, 220 ma, 28cm fov
Maxilla 512 x 512 matrix
1-3 mm to frontal sinus
Maxilla -straight- floor of maxillary sinus
Mandible perpendicular to table- gantry
Fracture straight
9 mm to top of head
Frontal bone
or Soft tissue windows
Nasal bone 5mm / 5mm through fossa
Maxilla 8 -9mm entire head
125 W 55 L Head
Temporal bone • Coronal
Zygoma 120 kv, 220 ma, 16-20cm fov
512 x 512 matrix
3 mm to frontal sinus
Coronal CT reformatted image of Trauma angled perpendicular to mandible
250 W 30 L (soft tissue)
Coronal Oblique CT 2000 W 350 L (bone)

2009 2009 Bone windows

Slide # 15 Slide # 16

Coronal Through Pituitary Gland Brain Anatomy Coronal Posterior

Optic chiasm
Pituitary stalk

This red line indicates the location of 
the coronal slice This red line indicates the location of 
Do you see the seagull? the coronal slice

Parietal lobe
Longitudinal fssure
Pituitary gland (w/tumor)
Pit stalk (infundibulum)
Pit stalk (infundibulum)
Cisterna Ambiens
Optic chiasm
w/Pineal gland
Lateral ventricles
Cerebral aqueduct
Septum pellucidum
Tentorium
Temporal lobes
4th ventricle
Cerebellum

Coronal CT Coronal MR
Coronal CT image Coronal MR image
2009 2009
Slide # 17 Slide # 18

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Imaging Planes Axial Slice Locations

Axial Slice locations Axial – SLICE # 1 Axial – SLICE # 2
5  4  3  2  1

Angled with base of skull
g

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

2009 2009
Slide # 19 Slide # 20

Brain Anatomy: Axial Superior Brain Anatomy: Axial @ Ventricles

This red line indicates the 
location of the axial slice
Axial  
This red line indicates the  Gray matter proton density weighted 
location of the axial slice MR image
White matter
Gray matter ribbons
Anterior Superior Anterior Horns of the
sagittal sinus Lateral Ventricles

Frontal lobe
White matter Septum pellucidum

falx cerebri- Longitudinal

enhanced on fissure
CT image Chroriod Plexus
Sulci
Parietal lobe gyri Posterior Horns of
Cortical bone the Lateral
Ventricles
Superior
Sulci & Gyri sagittal sinus Subcutaneus
fat
Posterior Axial CT image Axial T1 weighted MR image
Axial CT image Superior location Axial MR image Superior location
Just because the structure is gray, does not automatically make it gray matter!

2009 2009
Slide # 21 Slide # 22

Brain Anatomy: Axial Basil Ganglia White Matter Tracts

Axial  
T1 weighted 
MR image
Caudate nucleus
Caudate Nucleus

Lentiform nucleus
External Capsule Putamen & globus pallidus

Lentiform Nucleus Internal capsule

Internal Capsule Thalamus

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 2009
Slide # 23 Slide # 24

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Brain Anatomy: Axial Orbits Brain Anatomy: Axial Orbits

This red line indicates the  Cerebellum
location of the axial slice At the level of the 
vermis

This red line indicates the 
location of the axial slice

Frontal sinus
Orbit
Nasal conchae
Lens
Shenoid sinus Globe of the eye
Optic nerve
Optic nerve
Lateral rectus muscle
Temporal Lobe Rt. Medial rectus muscle
Lt. Medial rectus muscle
Basilar Artery Temporal lobe
Pons
4th ventricle
Mastiod air cells
Cerebellum

Axial MR image Axial CT image Axial MR image

2009 2009
Axial CT image Slide # 25 Slide # 26

Brain Anatomy: IAC’s Brain Anatomy: IAC’s

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

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

Temporal Lobe
Temporal Lobe Temporal bone
Temporal bone
Temporal bone IAC
IAC Mastoid Air Cells
Mastoid Air Cells Coclea
7th & 8th cranial nerves Semicircular canals

Axial CT image
Axial CT image
Axial MR image
Axial MR image
2009 2009
Slide # 27 Slide # 28

Axial Brain Anatomy: Midbrain Overview Cross-Sectional Anatomy

This red line
indicates the
approximate
This red line
indicates the location of the • Head
approximate axial slice
location of the
Cerebellum
axial slice
At the level of the vermis – Anterior Circulation
Frontal Lobe
Falx Cerebri – Posterior Circulation
Sylvian Fissure
MCA
occlusion – COW (circle of Willis)
Temporal lobe

Cerebral peduncles
Red nucleus
• Neck
Cerebral Acqueduct
Vermis
Cerebellum – Carotid Arteries
Occipital Lobe
– Vertebral Arteries
Axial CT image Axial MR image
2009 2009
Slide # 29 Slide # 30

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Cerebral Vasculature Circle of Willis - CTA

Sagittal Coronal

2009 2009
Slide # 31 Slide # 32
Axial

Cerebral Circulation – Coronal (COW) Left (Anterior & Middle) Artery – Coronal
Superior

Left (ACA ) Anterior 
Cerebral Artery Left (MCA ) 
Middle Cerebral 
Artery
(ACOM )
(ACOM ) 
Anterior 
Communicating 
Right Left (ICA ) 
Artery
Internal 
Carotid 
Artery Coronal  CTA Image

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

Coronal CTA
2009
Inferior 2009
Slide # 33 Slide # 34

Right & Left (Anterior & Middle) Artery – Coronal Right & Left Vertebral Arteries & Basilar Artery –
Coronal
(ACA ) Anterior 
Cerebral Artery
(MCA ) Middle 
Cerebral Artery (ACOM ) Anterior 
Communicating Artery

(PCA ) Posterior 
AP image
g AP image Cerebral Artery

Basilar Artery

(ICA ) Internal 
Carotid Artery

Coronal image
Vertebral Artery

AP image Coronal image
AP image
2009 2009
Slide # 35 Slide # 36

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Intra-Cerebral Circulation - COW Cerebral Circulation – Coronal (COW)

Superior
(ACA ) Anterior 
Cerebral Artery (ACA ) Anterior 
(MCA ) Middle  Cerebral Artery
(ACOM ) Anterior  (ACOM ) Anterior  (MCA ) Middle 
Cerebral Artery
Communicating Artery Communicating Artery Cerebral Artery

(PCA ) Posterior  (PCA ) Posterior 
Cerebral Artery Cerebral Artery
AP image

Basilar Artery
(ICA ) Internal 
Right Carotid Artery
Left

(ICA ) Internal  Basilar 
Carotid Artery Artery
Vertebral Artery

Coronal  CTA Image Vertebral Artery

AP image
2009
Slide # 37 Coronal CTA
2009
Inferior
Slide # 38

Cerebral Circulation – Sagittal (COW) Anterior & Middle Cerebral Arteries – Sagittal
Superior (ACA ) Anterior 
Cerebral Artery
(MCA ) Middle 
Cerebral Artery

(ICA ) Internal 
Carotid Artery

Internal carotid (Anterior and 
Anterior and Middle circulation
d ddl l Middle circulation)
Anterior Posterior Lateral DSA Lateral angiogram

(PCOM ) Posterior 
Communicating 
Artery
Right (ICA )  Left (ICA ) 
Internal Carotid  Internal Carotid 
Sagittal CTA
2009 Inferior 2009 Artery Artery
Slide # 39 SlideLateral Radiograph 
# 40
Sagittal CTA

Posterior Cerebral Arteries - Sagittal Cerebral Circulation – Sagittal

(PCA) Posterior 
(PCA) Posterior  (ACA ) Anterior  Cerebral Artery
Cerebral Artery Cerebral Artery
(MCA ) Middle  Basilar   Vertebral 
Cerebral Artery Artery Artery

Basilar  
Artery
Vertebral  (ICA ) Internal 
Artery Carotid Artery
Sagittal CTA
Anterior and Middle circulation Posterior cerebral  circulation
Lateral Radiograph 
Lateral DSA Lateral DSA
(PCOM ) Posterior 
Communicating 
Posterior cerebral   Artery
circulation
Lateral DSA

Lateral Radiograph 
2009 2009 Sagittal CTA
Slide # 41 Slide # 42

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Cerebral Circulation – Sagittal (COW) Cerebral Circulation – Axial (COW)

Superior Superior
(ACA ) Anterior 
Cerebral Artery
(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
Inferior
Slide # 43 Slide # 44

Anterior
Cerebral Circulation - Axial (Circle of Willis) (ACOM ) Anterior
(ACA ) Anterior
Cerebral Artery Intra-Cerebral
Communicating Artery
(MCA ) Middle
Anterior  (ACA ) Anterior 
(ICA ) Internal
Cerebral Artery Circulation – Axial COW
Cerebral Artery Carotid Artery
(ACOM ) Anterior  (PCOM ) Posterior
Communicating  Communicating Artery
Artery (MCA ) Middle  Right Basilar Left
(PCA ) Posterior Artery
Cerebral Artery Cerebral Artery

(ICA ) Internal 
Carotid Artery

(PCOM ) Posterior 
Anterior
Communicating 
Basilar Artery Artery
Left
Right (PCA ) Posterior 
Left
Cerebral Artery

Left

Axial CTA
2009
Posterior  2009
Slide # 45 Slide # 46

Anterior Cerebral Arteries (right & left) (ACOM ) Anterior

Anterior (ACA ) Anterior
Cerebral Artery Axial COW
Communicating Artery
Anterior  (ACA ) Anterior 
Anterior cerebral arteries
(ACOM ) Anterior 
Cerebral Artery
(ICA ) Internal
–
Communicating  Carotid Artery
Artery (MCA ) Middle  Right (MCA ) Middle Left
Cerebral Artery Cerebral Artery

(ICA ) Internal 
Carotid Artery
Axial CTA Posterior

Anterior

Right Left Left

Left

Axial CTA
2009
Posterior  2009
Slide # 47 Slide # 48

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Posterior Cerebral Arteries (right & left) Anterior

Axial COW
Anterior  Posterior cerebral arteries
(PCOM ) Posterior
Communicating Artery –
Basilar
Right (PCA ) Posterior Artery Left
Cerebral Artery

(PCOM ) Posterior  Axial CTA

Posterior
Communicating 
Artery

Basilar Artery
Right (PCA ) Posterior 
Left
Cerebral Artery

Axial CTA
2009
Posterior  2009
Slide # 49 Slide # 50

Cerebral Circulation - Axial (Circle of Willis) CTA-Rapid Brain Protocol

CTA-
Anterior  (ACA ) Anterior 
\• AP & Lateral Scout
Cerebral Artery – 120 kv, 80 ma, 50 fov
(ACOM ) Anterior 
• Axial
Communicating 
Artery (MCA ) Middle 
120 kv, 420 ma
Cerebral Artery 512 x 512 matrix, 24cm fov
.675 mm through COW
(ICA ) Internal 
then
Carotid Artery
9mm through entire head
(PCOM ) Posterior  -straight- floor of maxillary
Communicating  sinus perpendicular to table
table-
gantry straight
Basilar Artery Artery
-Contrast if 100 -120cc’s
Right (PCA ) Posterior 
Left
non-ionic 350 mg/ml
Cerebral Artery - 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

Axial CTA
2009
Posterior  2009
Slide # 51 Slide # 52

Circle of Willis - CTA Head Veins

Sagittal Coronal

2009 2009
Slide # 53 Slide # 54
Axial

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Overview Cross-Sectional Anatomy Neck Vasculature

• Head
– Anterior Circulation

– Posterior Circulation

– COW (circle of Willis)

• Neck
– Carotid Arteries

– Vertebral Arteries
2009 2009
Slide # 55 Slide # 56

Carotid Arteries – Sagittal Vertebral Arteries – Sagittal

(ICA ) Internal
Carotid Artery
(PCA ) 
Posterior 
Cerebral 
Basilar Artery
Artery

(ECA ) External
Carotid Artery

Right and Left

CCA - common
carotid arteries

Vertebral
Artery

Sagittal Neck  Sagittal Neck  Sagittal Neck  Sagittal Neck 

2009 2009
Slide # 57 Slide # 58

Carotid Arteries – Sagittal Carotid Arteries – Sagittal

(ICA ) Internal
Carotid Artery
(PCA ) 
Posterior 
Cerebral 
Basilar Artery
Artery

(ECA ) External
Carotid Artery

Right and Left

CCA - common
carotid arteries

Vertebral
Artery

Sagittal Neck  Sagittal Neck  Sagittal Neck  Sagittal Neck 

2009 2009
Slide # 59 Slide # 60

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Overview Cross-Sectional Anatomy Protocol for Neck

• AP & Lat scout
• Head 120 kv, 80 ma, 50cm FOV
• Axial
– Anterior Circulation 120 kv 280 ma
5/5 mm, 23 cm FOV
– Posterior Circulation 512 x 512 matrix
• Scan frontal sinus to carina-
include mandible
– COW (circle of Willis) • Contrast
100 cc’s non-ionic 240-300
• Neck mg/ml
-2 cc/sec for 20g cath
– Carotid Arteries -delay scan 70 second
post injection
-250 W 30 L (soft tissue)
– Vertebral Arteries -2000 W 350 L (bone)
2009 2009
Slide # 61 Slide # 62

Scan Planning CTA‐Rapid Neck Protocol

• 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 table-
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 reconstructed
to a field of 128mm

2009 2009
Slide # 63 Slide # 64

Imaging Planes Median Line

Image Comparison in the C-spine
Mid-sagittal Plane Slice
Frontal or
Parasagittal Planes Coronal Plane location
CT Images Transverse
Or Axial
MRI Images C2
Plane

C3
Axial Axial
C4

C5
Coronal
Coronal
Reformat C6

C7
Sagittal
Sagittal
Reformat
Lateral radiograph Sagittal CT Sagittal T1 MRI
Sagittal Axial Coronal
2009 2009
Slide # 65 Slide # 66

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Spinal Anatomy Brachial Plexus & Lumbar Plexus pinal Anatomy Vertebral bodies & Intervertebral disks
C1
C2
Fracture C3

Brachial plexus
Cervical vertebrae
CORONAL MRI

Spinal cord
Intervertebral Disk
Anulus (dark)
Lumbar vertebrae Nucleus pulposis (bright)
Lumbar plexus Conus medularis
Sacral plexus L4
L5
Sacrum  S1
CORONAL CT SAGITTAL MRI

2009 CORONAL MRI 2009 SAGITTAL MRI

Slide # 67 Slide # 68
SAGITTAL CT

Imaging Planes – C Spine & Neck Neck CT - Laryngocele

Anterior arch c1
The dens

Laryngeal
Cartilages

Larynx
Cervical vertebra
Pedicle
Dorsal and ventral
nerve roots
Spinal cord
Lamina Internal Laryngocele
Spinous process Causes stridor
Spinal muscles
Axial MR image
Axial CT image
2009 2009
Slide # 69 Slide # 70

“C-spine” “Arnold Chiari Malformation”

Cerebellar Tonsils
Vertebral body Syrinx 
Pedicle
Lamina
foramina
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 2009
Slide # 71 Slide # 72
SAGITTAL CT SAGITTAL MRI

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Apical Herniation: Ehlers-Danlos syndrome Sagittal T-spine Anatomy

Approximate 
Approximate 
location for 
location for  sagittal
sagittal 
reformat
MRI AXIAL
CT AXIAL T1 (1st thoracic vertebrae) T1
T2 Ligamentum
T1 T 12 (12th thoracic vertebrae) T3
T4
flavum
T2 Spinal Cord T5
T3 Vertebral bodies T6

T4
((curvature = kyphosis)
yp ) T7
T8
T5 Intervertebral Disk T9
T10
T6 Spinus process
T11
T7 Conus
T12
T8 Cauda equina
L1
T9
CSF around the nerves
L2
Posterior longitudinal ligament
T10
(along the posterior vertebral bodies from C1 – L3
sacrum) L4
T11

T12
Anterior longitudinal ligament L5
(along the anterior vertebral bodies from C1 –
S1
2009 Sagittal
2009Reformatted sacrum)
Slide # 73 Slide # 74
CT SAGITTAL MRI

Thoracic Spine Lumbar Spine

Approximate 
location for  Vertebral body
axial Pedicle
Lamina
Approximate  Facet joints
location for 
axial

CT AXIAL MRI AXIAL

SAGITTAL CT
SAGITTAL MRI L 1
Aorta L 5
Vertebral body Vert bodies
Lung
Lung  lordosis
Costo‐vertebral joint
Disk
Pedicle
Ligamentum flavum
Rib
Posterior longitudinal ligament
Spinal canal
Spinal cord
CSF (cerebrospinal fluid)
Transverse process
Lamina
Spinus process MRI AXIAL
CT AXIAL Ligamentum flavum
2009 Erector spinae muscles 2009
Slide # 75 Slide # 76 SAGITTAL MRI
SAGITTAL CT

Anatomy Musculoskeletal System Imaging Planes - TMJ

Median Line
TMJ TMJ Mid-sagittal Plane Mid Frontal
Coronal Plane
Parasagittal Planes

Axial
Transverse
Plane

Coronal

Sagittal
CT Images MRI Images
2009 2009
Slide # 77 Slide # 78
Sagittal Axial Coronal

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Overview musculoskeletal Anatomy - TMJ Corocoid vs coronoid…

“There’s a sea (C) between two Nations”

Localizer for sagittal oblique sections Localizer for coronal oblique sections

Shoulder radiograph
Temporal bone Sagittal MR Elbow
TMJ 3D CT reformatted image
Fossa
(meniscus within)
Mandibular
condyle
Mandible

Shoulder CT
Sagittal reformatted CT
Lateral radiography (Elbow)

2009
Sagittal Oblique TMJ Coronal Oblique TMJ CoroNoid
2009
CoroCoid CoroNoid
Slide # 79 Slide # 80

Anatomy Musculoskeletal System The lumps and bumps of the shoulder

Shoulder

Shoulder

• Shoulder
– Scapula
• Spine of the scapula
• Coracoid pprocess
• Acromion process
– Clavicle
– Humerus
• Head of the humerus
• Greater tubercle
• Lesster tubercle
Reformatted CT Image shoulder

2009 2009
Slide # 81 Slide # 82

Surgical Fixation Overview musculoskeletal Anatomy - Shoulder

Median Line Frontal or
Midline Sagittal Plane Coronal Plane
Parasagittal Planes
AC Joint Transverse
Or Axial
Clavicle Plane
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 Coronal oblique
muscle & tendon or perpendicular to the glenoid fossa
2009 2009
Slide # 83 Slide # 84

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Structures of the rotator cuff …(SITS) Shoulder Structures

Spine of the scapula Deltoid

Supraspinatus tendon. Spine of the scapula
Infraspinatus tendon
Teres minor tendon
Subscapularis tendon
Bicepts muscle

Axial Shoulder CT
Reformatted CT Image
Reformatted CT Image
Trapezius Sagittal Oblique Shoulder

Deltoid Trapezius
RC (S.I.T.S.) Deltoid
Supraspinatus Supraspinatus tendon
Infraspinatus Rotator cuff
Teres Minor
Glenoid fossa
Subscapularis Glenoid labrum
Axial MR Image Coronal oblique MR Image
Axial MR Image Coronal oblique MR Image
2009 2009
Slide # 85 Slide # 86

Bony Structures of the shoulder Anatomy Musculoskeletal System

Acromion
A/C joint Spine of the scapula
(acromio‐clavicular joint)
Clavicle
Humeral Head
Humerus
Elbow
Corocoid process

Sagittal Oblique Shoulder Reformatted CT Image

Elbow
Acromion
Rotator cuff
Humeral Head
Glenoid fossa
Glenoid rim
Scapula
Humerus

Axial MR Image Coronal oblique MR Image

2009 2009
Slide # 87 Slide # 88

Bones of the Elbow Joint Muscles, Tendons & Ligaments of the Elbow Joint
Humerus
Olecranon process
Joint space Tricepts muscles
Trochlea Bicepts Muscles
Capetellum Extensor tendons
Coronoid process
Ulna  Brachoiadialis muscle

Axial MR Image Axial MR Image

Sagittal Oblique Elbow Sagittal Oblique Elbow

Tricepts muscles
Humerus Trochlea Ulnar collateral ligament
Olecranon fossa Humero‐ulnar joint Brachoiadialis muscle
Capetellum Radio‐ulnar joint Radial collateral ligament
Humero‐radial joint
Capetellum

“Cap on Head”
2009 Coronal oblique MR Image 2009 Coronal oblique MR Image
(Capetellum on the head of the radius) Slide # 89 Slide # 90

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Anatomy Musculoskeletal System Overview musculoskeletal Anatomy – Wrist

Never Lower Tillie’s Pants…Grandmother Might Come Home

Navicular
Wrist Lunate
Wrist
Triquetruim
Pisiform
Greater Mutlangular
Lesser Multangular
Capatate
Hammate
Coronal MRI
Coronal reformatted CT

2009 2009
Slide # 91 Slide # 92

Overview musculoskeletal Anatomy – Wrist Overview musculoskeletal Anatomy – Wrist

Some Lovers Try Positions….That They Can’t Handle
Trapezium
Trapezoid
Capetate
Hammate
Hook of the
Scaphoid Hammate
Lunate TFCC (triangulo-
Triquetruim fibrocartilege complex)
Pisiform Carpal Tunnell
Trapezium
Trapezium
Trapezoid
Flexor tendons
Trapezoid Median Nerve
Capetate
Capetate Coronal MRI
Hammate
Hammate
Distal Radius
Aneurysm Distal Ulna
Raidal arteru Radio‐ulnar joint
Coronal reformatted CT
Ulnar artery Coronal MRI
Axial MRI
2009 2009
Slide # 93 Slide # 94

Wrist Pathology Handshake

Aneurysm

Fracture

2009 2009
Slide # 95 Slide # 96

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Anatomy Musculoskeletal System Bony anatomy of the HIP

Acetabulim
Ilium Femoral Head
Ishium Femoral Neck
Pubis Greater Trocanter
Lesser trocanter

Femoral Shaft
Hip Obturator foramen
Hip

Reformatted CT Image Hip

2009 2009
Slide # 97 Slide # 98

BONE METS Hips & Pelvis

Ilum
Iliac arteries
Psoas Muscles
Obturator foramen
Compressed
vertebral body Gleuteal Muscles
Coronal reformatted CT
Met to the pelvic
bone
Mass

Reformatted Sagittal
CT Image Spine Axial pelvis CT
Reformatted Coronal CT Image pelvis Obturator Internus muscles
Obturator Externus
2009 2009
Slide # 99 Coronal CT Slide # 100

Femoral Head
Structures of the HIP Femoral Neck  NAVEL
Greater Trocanter
Lesser trocanter Nerve, Artery, Vein, Empty space, Lymph node
(ASIS) Ilium   Femoral Shaft
Acetabulim  
Obturator foramen  
Ishium   Psoas Muscle
Pubis   Iliacus Muscle
Gleuteus Maximus
Gleuteus minimus
Quadracepts Muscle
Hamstrings

Reformatted CT Image Hip

Coronal MRI of the Hips
Ilium  
Acetabulim   bladder Nerve
Glenoid Labrum Artery
Femoral Neck   Vein
Femur   Empty space
Obturator Internus muscles Lymph nodes
Obturator Externus Quadracepts Muscle 
Gleuteus Maximus
Coronal MRI of the Hips
2009
Slide # 101
2009
Slide #Rectum
102
Axial MRI of the Hips

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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
Knee Tibia
Knee Fibula
Coronal reformatted CT

2009 Sagittal knee MRI

2009
Slide # 103 Slide # 104

Lower Extremity Anatomy Muscles of the Knee

Anterior cruciate ligament (ACL)

Posterior cruciate ligament (PCL) Axial pelvis CT Hamstring muscles

Quadracepts Tendon
Quadracepts muscles Attaches the quatracepts muscles
Femur Gastrocnemius muscles
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

Axial femur CT Quatracepts muscles

Hamstring Muscles
Femoral coldyles
Meniscus ([posterior horn, lateral meniscus)
Patella

Axial knee CT
Axial Femur MRI Axial CT
Para2009sagittal slice (MRI)Tibia
Fibula Slide # 105
Coronal 2009
Slide # 106
reformatted CT

Meniscus and other structures of the knee Lower Leg Fracture

Medial  
Lateral aspect of the  retinaculum
patello‐femoral joint Fracture
Lateral retinaculum

Anterior horn of the  Fracture
meniscus

Posterior horn of the 
Posterior horn of the
meniscus AP Scout

Para Sagittal knee MRI Axial knee MRI

Medial collateral ligament 
Lateral collateral ligament 
Medial meniscus
Lateral meniscus
Lat Scout
2009 2009
Slide knee
Coronal # 107 MRI Slide # 108

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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 Foot and ankle

2009 2009
Slide # 109 Slide # 110

Ankle Ligaments and Tendons Review, Peripheral Vascular Anatomy

Tibia
Fibula
Abdominal Aorta
(AAA- abdominal aortic aneurysm)
Mortise joint
Medial collateral ligaments Iliac Arteries
Lateral collateral ligaments

Femoral Arteries
Tibio‐talar joint
Posterior longitudinal ligamen
Achilles tendon
Popliteal Arteries

Trifurcation…
(anterior tibial)
(posterior Tibial)
(Pernoeus Brevis)

2009 Coronal MRA

2009 Coronal reformatted CTA
Slide # 111 Slide # 112
Coronal reformatted CT

Hand Vasculature What Do We Do With All The Images?

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

2009
Slide # 113 Slide # 114

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Median Line Frontal or

Imaging Planes Coronal Plane
Chest Coronal, Heart & Lungs
Mid-sagittal Plane

CT Images Parasagittal Planes MRI Images

Transverse
MRA
Or Axial
Plane
Axial CTA
Axial
Heart

Coronal Reformat Coronal

Lungs
Sagittal Reformat Sagittal
Enhanced  Coronal CT Coronal MRI
2009 2009
Sagittal
Slide # 115Axial   Coronal  Slide # 116

Chest Coronal, Vasculature 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 Lower lobe of the right lung
Pulmonary Veins Lower lobe of the left lung

Diaphragm

Coronal MRI
Coronal CT

Enhanced  Coronal CT
Coronal MRI
2009 2009
Slide # 117 Slide # 118

Chest Coronal Muscles of the Chest Sagittal Chest – “Candy Cane Shot”
Pectoralis muscles
Heart Muscle

Aortic Arch
Axial MRI
Axial CT
Trapezius
Ascending Aorta
Latissimus
Descending Aorta

Intercostal Muscles Heart
Sagittal MRI

Diaphragm 

Sagittal CT
Coronal CT Coronal MRI
2009 2009
Slide # 119 Slide # 120

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Axial chest Axial slice #1

Basic “Vanilla” 
Axial slice #2
Axial slice #3
Thorax Protocol
Axial slice #1
Axial slice #2
Axial slice #3

Pectoralis Muscle
Aortic Arch • AP Scout
120 kv, 60 ma, 50 cm FOV
Latissimus Muscle Axial slice #1 • Axial
Axial slice #1 Spine (vertebral body) 120 kv
kv, 180 ma
ma,
Ascending Aorta 36 cm FOV (fit anatomy)
512 x 512 matrix
Pulmonary arteries generally 5mm
Pulmonary veins 1500 W & 500 L(lung windows)
Axial slice #2 450 W & 30 L (mediastinal windows)
Axial slice #2 Descending Aorta
30 sec (or less) breath-hold
Heart can be modified

2009 2009
Slide # 121 Axial slice #3 Slide # 122
Axial slice #3

Lung Nodule ‐ MDCT Evaluation of Stent Placement

3D rendering of normal lung MDCT evaluation of airway stent 
after chemical injury

2009 2009
Slide # 123 Slide # 124

CTA CORONAL
Heart Heart anatomy MRI 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 MRI AXIAL
arch

2009 2009
Slide # 125 Slide # 126

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CTA CORONAL
Heart Anatomy Heart Anatomy MRI CORONAL

Heart flow Heart flow
SVC (superior vena cava) CTA CORONAL IVC & SVC (Inferior & Superior vena cava)
RA (right atrium) MRI CORONAL RA (right atrium)
Tri cuspid valve Tri cuspid valve
Rv RV (right ventricle)
P valve
P valve P valve
P valve
Pa Pa
Lungs Lungs
Pv P‐S v
La La
Bi Bi
Lv Lv
Aortic valve Aortic valve
Aorta – coronary CT AXIAL MRI AXIAL Aorta – coronary CT AXIAL MRI AXIAL
arch arch

2009 2009
Slide # 127 Slide # 128

CTA CORONAL CTA CORONAL
Heart Anatomy MRI CORONAL Heart Anatomy MRI CORONAL

Heart flow Heart flow
IVC & SVC (Inferior & Superior vena cava) IVC & SVC (Inferior & Superior vena cava)
RA (right atrium) RA (right atrium)
Tri cuspid valve Tri cuspid valve
RV (right ventricle) RV (right ventricle)
Pulmonary valve
Pulmonary valve Pulmonary valve
Pulmonary valve
PA (Pulmonary artery) PA (Pulmonary artery)
Lungs Lungs
Pv PV (pulmonary veins)
La LA
Bi Bi
Lv LV
Aortic valve Aortic valve
Aorta – coronary CT AXIAL MRI AXIAL Aorta – coronary CT AXIAL MRI AXIAL
arch Arch

2009 2009
Slide # 129 Slide # 130

Heart anatomy CTA CORONAL

MRI CORONAL Heart anatomy CTA CORONAL
MRI CORONAL

Heart flow Heart flow
IVC & SVC (Inferior & Superior vena cava) IVC & SVC (Inferior & Superior vena cava)
RA (right atrium) RA (right atrium)
Tri cuspid valve Tri cuspid valve
RV (right ventricle) RV (right ventricle)
Pulmonary valve
Pulmonary valve Pulmonary valve
Pulmonary valve
PA (Pulmonary artery) PA (Pulmonary artery)
Lungs Lungs
PV (pulmonary veins) PV (pulmonary veins)
LA (Left Atrium) LA (Left Atrium)
Bi Bi cuspid valve
LV LV
Aortic valve Aortic valve
Aorta – coronary CT AXIAL MRI AXIAL Aorta – coronary CT AXIAL MRI AXIAL
Arch Arch

2009 2009
Slide # 131 Slide # 132

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CTA CORONAL CTA CORONAL
Heart anatomy MRI CORONAL Heart anatomy MRI CORONAL

Heart flow Heart flow
IVC & SVC (Inferior & Superior vena cava) IVC & SVC (Inferior & Superior vena cava)
RA (right atrium) RA (right atrium)
Tri cuspid valve Tri cuspid valve
RV (right ventricle) RV (right ventricle)
Pulmonary valve
Pulmonary valve Pulmonary valve
Pulmonary valve
PA (Pulmonary artery) PA (Pulmonary artery)
Lungs Lungs
PV (pulmonary veins) PV (pulmonary veins)
LA (Left Atrium) LA (Left Atrium)
Bi cuspid valve Bi cuspid valve
LV (Left Ventricle) LV (Left Ventricle)
Aortic valve Aortic valve
Aorta – coronary CT AXIAL MRI AXIAL Aorta – coronary CT AXIAL MRI AXIAL
Arch Arch

2009 2009
Slide # 133 Slide # 134

Heart and Pulmonary Arteries Aortic Arch – the “ A, B, C’s”

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 Slide # 136

Aortic Arch – the “ A, B, C’s” Aortic Arch – the “ A, B, C’s”

Ascending aorta Ascending aorta
Coronaries Coronaries
Brachiocephalic (aka Innominate) Brachiocephalic (aka Innominate)
right common carotid right common carotid
right subclavian right subclavian
right vertebral right vertebral
Left common carotid Left common carotid

Left Subclavian Left Subclavian
Left vertebral Left vertebral

MRA CORONAL MRA CORONAL

CTA CORONAL CTA CORONAL

2009 2009
Slide # 137 Slide # 138

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Aortic Arch – the “ A, B, C’s” Coronary Calcifications

Ascending aorta • Calcium is an indicator 
Coronaries
Brachiocephalic (aka Innominate) for a disease artery 
right common carotid (CAD)
right subclavian
right vertebral • Calcification in the 
Left common carotid
coronary artery reveals 
Left Subclavian
Left vertebral
the condition of 
coronary 
arteriosclerosis
MRA CORONAL
• Leads to heart attacks
Grossly calcified left coronary 
CTA CORONAL artery
2009 2009
Slide # 139 Slide # 140

Situs Inversus Cross Sectional Abdomen

2009 2009
Slide # 141 Slide # 142

Frontal or
Abdomen Images Imaging Planes Median Line
Coronal Plane

Mid-sagittal Plane

Parasagittal Planes

Transverse
Or Axial
Plane

Sagittal Axial Coronal

CT Images

2009 Axial
2009 Coronal Sagittal
Slide # 143 reformat reformatSlide # 144

24
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Frontal or
Imaging Planes Coronal Plane Coronal Abdomen
Median Line
Mid-sagittal Plane
Parasagittal Planes Approximate Slice  Approximate Slice 
location location

Transverse Kidneys
Or Axial
Plane Adrenals

Spleen
p

Sagittal Axial Coronal Liver

CT Images Psoas
Muscles

Gleuteus
Muscles
Coronal  MR image

Axial Coronal Sagittal Coronal  CT image

2009 2009
Slide # 145 Slide # 146

Coronal Abdomen Coronal Abdomen

Approximate Slice  Approximate Slice  Approximate Slice 

location location location
Approximate Slice  Liver Stomach Lesser curvature
Spleen Spleen
location Spleen Structures of the stomach:
Liver
Stomach Lesser curvature
Liver  umor Fundus
Mass Pylorus
Greater curvature

Small Bowel
Bowel Structures of the Small bowel
Small Bowel Duodenum
Structures of the Small bowel Jejunem
Duodenum Ileum
Jejunem
Ileum Large bowel (colon)
Ascending colon
Transverse colon Coronal  MR image
Coronal  CT image
2009
Coronal  MR image Coronal  CT image
2009 Descending colon
Slide # 147 Slide # 148
body anatomy Slide 2b Sigmoid colon

Axial Abdomen Axial Abdomen

Diaphragm Diaphragm

Approximate Slice  Approximate Slice  Approximate Slice 

location Approximate Slice 
location location
location

Liver
Liver
Spleen
Spleen
Stomach
Stomach
Aorta
Aorta
Vena cava
Vertebral
body Axial  MR image
Axial  CT image Vertebral
Axial  CT image Axial  MR image
body

2009 2009
Slide # 149 Slide # 150

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Axial Abdomen Axial Abdomen

Approximate Slice  Approximate Slice 
location location Approximate Slice 
location Rectus abdominus muscles
Approximate Slice 
location
Liver
Liver
Gall bladder
Spleen
Pancreas
Pancreas
Kidneys

Kidneys

Axial  CT image Axial  MR image
Axial  CT image Axial  MR image

2009 2009
Slide # 151 Slide # 152

Sagittal Abdomen Sagittal Abdomen

Approximate Slice  Approximate Slice 
location location

Thoracic
Spine

Liver
Pancreas
Lumbar Spine
Aorta

Bowel

Sacrum

Coccyx

Bladder

Sagittal  CT image Symphysis Pubis Sagittal  MR image

2009 2009
Slide # 153 Slide # 154

Basic “Vanilla” Abdomen & Pelvis Protocol Renal Calculus (Stones)

• No oral contrast
• AP Scout • No IV contrast
80 kv 120 ma • Run to the bladder
50 cm FOV For ureters
• Axial Slice #1

120 kv,, 220 ma,,

36 fov (fit anatomy) Slice #1 Slice #2
512 x 512 Slice #2

5mm – 8 mm
Slice #3
500 W & 50 L
30 sec breath-hold Slice #4 Slice #3

can be modified
Slice #4

2009 2009
Slide # 155 Slide # 156

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Non‐Contrast Pathology Basic “Vanilla” Abdomen & Pelvis Protocol
Trauma with sprinkles
• 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
3D Reconstruction of Kidney Fracture Barium (dilute for CT) 32 oz

2009 2009
Slide # 157 Slide # 158

Abdominal Vasculature Abdominal Vasculature

“See Spot Run In..” “See Spot Run In..”
(“C” not see) Celiac, SMA, Renals (right & Left), IMA (“C” not see) Celiac, SMA, Renals (right & Left), IMA
SMA
“C”=Celiac superior  
gastric mesenteric    
hepatic artery
splenic
Arises anteriorly 
Arises the aorta  from the aorta at 
at the level of  the level of L2‐3
L1
Provides blood 
Provides blood  supply to the 
supply to the  stomach, small 
stomach,  bowel and part of 
spleen and liver the colon

Coronal CTA Image Coronal MRA image

Coronal CTA Image Coronal MRA image
2009 2009
Slide # 159 Slide # 160

Abdominal Vasculature Abdominal Vasculature

“See Spot Run In..” “See Spot Run In..”
(“C” not see) Celiac, SMA, Renals (right & Left), IMA (“C” not see) Celiac, SMA, Renals (right & Left), IMA
IMA
Infererior
Renal arteries Mesenteric
right Artery
left
Arises anteriorly 
&i f i l f
& inferiorly from 
Arises Bilaterally  the aorta at the 
and posteriorly  level of L 4‐5
from the aorta at 
the level of L3‐4 Provides blood 
supply to the 
Provides blood  inferior colon, 
supply to the right  sigmoid and 
& left kidney rectum

Coronal CTA Image Coronal MRA image Coronal CTA Image Coronal MRA image

2009 2009
Slide # 161 Slide # 162

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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)

(AAA) Femoral Arteries
Abdominal Superficial femoral & common 
Aortic  femoral
Aneurysm  (at the level of the Femur)

Abdominal Popliteal Arteries
Aorta (at the level of the Knee)

Iliac arteries Trifurcation
(Lower Leg)
*Anterior Tibeal
*Posterior Tibealis
*Peroneus Brevis
Coronal CTA Image Coronal MRA image
(at the level of the Foot)
Dorsalis Pedis
Coronal CTA Image Coronal MRA image Medial Malalear
2009 2009
Slide # 163 Slide # 164

Abdominal Vasculature Abdominal Veins

(IVC)
Review Vasculature… Inferior 
vena cava
Almost ALL Arteries:
Portal vein
– Carry oxygenated blood away from the Splenic vein
heart
– Carry oxyhemaglobin blood to organs Left renal vein
Almost ALL Veins: (SMV)
– Carry deoxygenated blood to the heart Superior 
mesenteric 
– Carry
y deoxyhemaglobin
y g away y from Vein
organs
Exceptions: (IVC)
– Portal vein- Inferior 
• Carries deoxyhemaglobin to the liver vena cava
– Pulmonary veins-
Right iliac
• Carries deoxyhemaglobin to the lungs
vein
– Pulmonary arteries-
• Carries oxyhemaglobin to the heart Coronal abdominal venogram

2009 2009
Slide # 165 Slide # 166

Biliary ducts Biliary System

Hepatic ducts

Cystic duct
Pancreatic duct
Pancreatic duct
Common bile duct
Gall bladder

MRCP
MR cholangiopancreatography
Coronal 
2009 2009
Slide # 167 Slide # 168
body anatomy Slide 7

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APPENDICITIS CROHNS DISEASE

• INFLAMATION 
OF THE 
APPENDIX • REGIONAL ILEITIS
REGIONAL ILEITIS

• TYPICALLY  • ETILOGY 
APPEARS 
PUS/AIR FILLED
2009 2009
Slide # 169 Slide # 170

Female Pelvis Anatomy

DIVERTICULITIS Fundus
Endometrium

Approximate Slice 
locations
Sagittal ultrasound image
Uterus

Fundus
• INFLAMED  Junctional Zone
Endometrium
DIVERTICULUM
Cervix

• CT PRESENTATION Vagina
Bladder 
Symphysis pubis 

Sagittal Reformatted CT Sagittal MRI (T2 image)

2009 2009
Slide # 171 Slide # 172
body anatomy Slide 8a

Female Pelvis Anatomy Female Pelvis Anatomy

Approximate Slice  Approximate Slice 
Approximate Slice  locations locations
locations CT #1 MR #1
CT #2 MR #2

Uterus
Rectus abdominus muscles
Junctional Zone
Endometrium Uterus
endometrium
Ovary Gleuteal muscles
Fallopian tube
rectum
Bl dd
Bladder
Axial CT #1 Axial MR #1

Bladder
Muscles
Coronal Reformatted CT
Gleuteal Muscles Ovary  
Ileum Femoral head
Acetabulum Coronal MRI (T2 image) Obturator Internus muscles

Cervix
Obturator internus muscles Vagina 
Obturator extermus muscles
Axial CT #2 Axial MR #2
2009 2009
Slide # 173 Slide # 174

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Male Pelvis Anatomy Male Pelvis Anatomy

Approximate Slice  Approximate Slice  Approximate Slice 
locations locations locations

Approximate Slice 
locations
NAVEL

Symphysis Pubis
Symphysis Pubis
Psoas Muscles
Bladder Prostate 
Central gland
Prostate (base) Peripheral zone 
Seminal vessicles (normal)
Vas defferens Peripheral zone
Urethra (cancer)
Apex of the Prostate
Axial CT
Neuro vascular bundle
Pubic bone Axial MR 
Coronal Oblique MRI (T2 image)
Obtuaturator  Gleuteal Muscles Rectum High resolution (small FOV)
High resolution (small FOV)
Coronal Reformatted CT Internus Muscles

2009 2009
Slide # 175 Slide # 176

Male Pelvis Anatomy Basic Pelvis Protocol

• AP Scout
80 kv 120 ma

Approximate Slice  • Axial
locations -120 kv, 220 ma,
-36 fov (fit anatomy)
-512 x 512
-generally 5mm
Seminal vessicles
-500 W & 50 L
Urinary Bladder
y -30 sec breath-hold
can be
b modified
difi d
Prostate Base If contrast
Peripheral zone • Post contrast
-Contrast if 100 cc’s
Prostate Apex non-ionic 300 mg/ml
3 cc/sec for 20g
Rectum angiocath
Sagittal MRI (T2 image) delay scan 25-30
High resolution (small FOV) seconds min post
Rectus abdominus 
Muscles
injection- to peak
Sagittal Reformatted CT enhancement
Symphysis Pubis

2009 2009
Slide # 177 Slide # 178

Male Pelvis Male and Female Pelvis

2009 2009
Slide # 179 Slide # 180

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