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IMAGING ANATOMY: Brain
and Spine
Karen L. Salzman, MD
Professor of Radiology and Imaging Sciences, Neuroradiology Section Chief
and Fellowship Director, Leslie W. Davis Endowed Chair in
Neuroradiology, University of Utah School of Medicine, Salt Lake City,
Utah
Jeffrey S. Ross, MD
Consultant, Neuroradiology Division, Department of Radiology, Mayo
Clinic in Arizona
Professor of Radiology, Mayo Clinic College of Medicine, Phoenix, Arizona
Kevin R. Moore, MD
Pediatric Radiologist and Neuroradiologist, Primary Children’s Hospital,
Salt Lake City, Utah
Table of Contents
Cover image
Title page
Copyright
Dedications
Contributing Authors
Preface
Acknowledgments
Sections
Part I: Brain
Chapter 21: Primary Visual and Visual Association Cortex (Areas 17,
18, 19)
SECTION 3: VASCULAR
INDEX
Copyright
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
ISBN: 978-0-323-66114-0
Inkling: 9780323661157
Notices
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any
information, methods, compounds or experiments described
herein. Because of rapid advances in the medical sciences, in
particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility
is assumed by Elsevier, authors, editors or contributors for any
injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas
contained in the material herein.
For Lucy
AGO
KLS
For Emma
JSA
AWT
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For Peggy
JSR
KRM
Contributing Authors
Giuseppe Barisano, MD, Research Scientist, Laboratory of Neuro
Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics
Institute, Keck School of Medicine of USC, University of Southern
California, Los Angeles, California
Ryan P. Cabeen, PhD, Postdoctoral Scholar, Laboratory of Neuro
Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics
Institute, Keck School of Medicine of USC, University of Southern
California, Los Angeles, California
Adriene C. Eastaway, MD, MS, University of Utah School of
Medicine, Salt Lake City, Utah
Edward P. Quigley, III, MD, PhD, Associate Professor, Radiology and
Imaging Sciences, Adjunct Associate Professor Neurology, University of
Utah Medical Center, Salt Lake City, Utah
Farshid Sepehrband, PhD, MS, BS, Assistant Professor, Laboratory of
Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine of USC, University of
Southern California, Los Angeles, California
LEAD EDITOR
Rebecca L. Bluth, BA
TEXT EDITORS
Arthur G. Gelsinger, MA
Nina I. Themann, BA
Terry W. Ferrell, MS
Megg Morin, BA
Kathryn Watkins, BA
IMAGE EDITORS
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
ILLUSTRATIONS
Richard Coombs, MS
Lane R. Bennion, MS
Laura C. Wissler, MA
Main Text
TERMINOLOGY
Definitions
• Bregma
Meeting of sagittal, coronal sutures
(anterior fontanelle in neonates)
• Lambda
Meeting of sagittal, lambdoid sutures (site
of posterior fontanelle in neonates)
• Pterion
H-shaped junction
– Between frontal, parietal bones plus
greater sphenoid wing, squamous
temporal bone
Site of anterolateral, i.e., sphenoidal,
fontanelle
GROSS ANATOMY
Overview
• Scalp
Scalp has 5 layers
– Skin
Epidermis, dermis, hair, sebaceous
glands
– Subcutaneous tissue
Very vascular fibroadipose tissue
– Epicranial tissue
Scalp muscles, galea aponeurotica
– Subaponeurotic tissue
Loose areolar connective tissue
– Pericraniu m
Periosteum of skull
Continues through sutures to outer
layer of dura
• Skull (28 separate bones, mostly connected by
fibrous sutures)
Cranium has several parts
– Calvarial vault
– Cranial base
– Facial skeleton
Calvarial vault composed of several bones
– Frontal bone
– Paired parietal bones
– Squamous occipital bone
– Paired squamous temporal bones
3 major serrated fibrous joints ( sutures )
connect bones of vault
– Coronal suture
– Sagittal suture
– Lambdoid suture
Outer, inner tables
– 2 thin plates of compact cortical bone
– Separated by diploic space (cancellous
bone containing marrow)
Endocranial surface
– Lined by outer (periosteal) layer of dura
– Grooved by vascular furrows
– May have areas of focal thinning
(arachnoid granulations), foramina
(emissary veins)
IMAGING ANATOMY
Overview
Imaging Pitfalls
EMBRYOLOGY
Embryologic Events
Image Gallery
Print Images
GRAPHICS
Graphic depiction of cranium, frontal view, is
shown. Frontal bone is rendered in purple. Two
parts of the sphenoid bone are shown here: The
greater and lesser wings, separated by the
superior orbital fissure (SOF). The optic canal lies
just above the SOF and is separated from it by a
bony optic strut.
Lateral view of the calvarial vault is shown. The
pterion is a small area on the lateral skull at the
intersection of the frontal, sphenoid, parietal, and
temporal squama. It is an important landmark for
surgical approach to the sylvian fissure and
middle cranial fossa.
Scalp and calvarium are depicted in cross
section. The 5 scalp layers are depicted. Skin
consists of epidermis and dermis. Hair follicles
and a sebaceous gland, the subcutaneous
fibroadipose tissue, sweat glands and ducts, as
well as superficial and deep cutaneous vascular
plexi are shown.
AXIAL NECT
Five sequential axial NECT images presented
from inferior to superior through skull base,
calvarium, are depicted. Section through skull
base shows major bones, sutures forming skull
base. Sphenosquamosal, petrooccipital,
occipitomastoid sutures are normally well seen
and should not be confused with fractures.
Section through upper skull base shows anterior,
middle, and posterior cranial fossae as well as
formation of lower vault by frontal, greater wing
sphenoid, squamous temporal, and occipital
bones.
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even locally. An observer on the spot says: “In the disposition of their
destroyers, the authorities did not seem disposed to give them a free
hand, or to allow them to take any chances.” And again, “The torpedo
boats were never sent out with the aim of attacking Japanese ships,
or transports. If out, and attacked, they fought, but they did not go
out for the purpose of attacking, although they would to cover an
army flank.” These two actions define the rôle indicated by the
expression, “Fortress Fleet.” The Japanese expressed surprise that no
attempt by scouting was made to ascertain their naval base, which
was also the landing place of their army; and, although the sinking of
the two battleships on May 15 was seen from Port Arthur, no effort
was made to improve such a moment of success, and of
demoralization to the enemy, although there were twenty-one
destroyers at Port Arthur; sixteen of which were under steam and
outside. So, at the very last moment, the fleet held on to its defensive
rôle; going out only when already damaged by enemy’s shells, and
then not to fight but to fly.
It is a curious commentary upon this course of action, that, as far
as any accounts that have come under my eye show, the fleet
contributed nothing to the defense of the fortress beyond landing
guns, and, as the final death struggle approached, using their
batteries in support of those of the fortress; but the most extreme
theorist would scarcely advocate such an end as the object of
maintaining a fleet. The same guns would be better emplaced on
shore. As far as defense went, the Russian Port Arthur fleet might as
well have been at Cronstadt throughout. Indeed, better; for then it
would have accompanied Rozhestvensky in concentrated numbers,
and the whole Russian navy there assembled, in force far superior,
would have been a threat to the Japanese command of the sea much
more effective, as a defense to Port Arthur, than was the presence of
part of that fleet in the port itself.
The Russian fleet in the Far East, assembled as to the main body in
Port Arthur, by its mere presence under the conditions announced
that it was there to serve the fortress, to which it was subsidiary.
Concentrated at Vladivostok, to one side of the theater of war, and
flanking the enemy’s line of communications to that which must be
the chief scene of operations, it would have been a clear evident
declaration that the fortress was subsidiary to the ships; that its chief
value in the national military scheme was to shelter, and to afford
repairs, in short, to maintain in efficiency, a body which meant to go
out to fight, and with a definite object. The hapless Rozhestvensky
gave voice to this fact in an expression which I have found attributed
to him before the fatal battle at Tsushima: that; if twenty only of the
numbers under his command reached Vladivostok, the Japanese
communications would be seriously endangered. This is clear “Fleet
in Being” theory, and quite undiluted; for it expresses the extreme
view that the presence of a strong force, even though inferior, near
the scene of operations, will produce a momentous effect upon the
enemy’s action. The extreme school has gone so far as to argue that it
will stop an expedition; or should do so, if the enemy be wise. I have
for years contended against this view as unsound; as shown to be so
historically. Such a “fleet in being,” inferior, should not be accepted
by an enemy as a sufficient deterrent under ordinary circumstances.
It has not been in the past, and the Japanese did not so accept it. The
Russian “fleet in being,” in Port Arthur, did not stop their
transportation; although they recognized danger from it, and
consistently took every step in their power to neutralize it. Their
operations throughout were directed consistently to this end. The
first partially successful torpedo attack; the attempts to block the
harbor by sinking vessels; the distant bombardments; the mines laid
outside; and the early institution and persistence in the siege
operations,—all had but one end, the destruction of the fleet, in
being, within; but, for all that, that fleet did not arrest the transport
of the Japanese army.
These two simultaneous operations, the transport of troops despite
the fleet in being, and the persevering effort at the same time to
destroy it—or neutralize it—illustrate what I have called adjustment
between opposite considerations. The danger from the fleet in being
is recognized, but so also is the danger in delaying the initiation of
the land campaign. The Fleet in Being School would condemn the
transportation, so long as the Port Arthur fleet existed. It actually did
so condemn it. The London Times, which is, or then was, under the
influence of this school, published six weeks before the war began a
summary of the situation, by naval and military correspondents, in
which appears this statement: “With a hostile fleet behind the guns
at Port Arthur, the Japanese could hardly venture to send troops into
the Yellow Sea.” And again, four weeks later: “It is obvious that, until
the Russian ships are sunk, captured, or shut up in their ports with
their wings effectually clipped, there can be no security for the sea
communications of an expeditionary force.” These are just as clear
illustrations of the exaggeration inherent in the Fleet in Being theory,
which assumes the deterrent influence of an offensive threatened by
inferior force, as the conduct of the Russian naval operations was of
the inefficiency latent in their theory of Fortress Fleet.
If security meant the security of peace, these Fleet in Being
statements could be accepted; but military security is an entirely
different thing; and we know that, coincidently with the first torpedo
attack, before its result could be known, an expeditionary Japanese
force was sent into the Yellow Sea to Chemulpo, and that it rapidly
received reinforcements to the estimated number of fifty or sixty
thousand. The enterprise in Manchuria, the landing of troops west of
the mouth of the Yalu, was delayed for some time—two months,
more or less. What the reason of that delay, and what determined the
moment of beginning, I do not know; but we do know, not only that
it was made in face of four Russian battleships within Port Arthur,
but that it continued in face of the increase of their number to six by
the repair of those damaged in the first torpedo attack. As early as
May 31, it was known in Tokyo that the damaged ships were nearly
ready for the sortie, which they actually made on June 23.
It is doubtless open to say that, though the Japanese did thus
venture, they ought not to have done so. Note therefore that the
Japanese were perfectly alive to the risks run. From the first they
were exceedingly careful of their battleships, knowing that on them
depended the communications of their army. The fact was noted
early in the war by observers on the spot. This shows that they
recognized the full menace of all the conditions of the Russian fleet
in Port Arthur, also of the one in the Baltic, and of the danger to their
communications. Nevertheless, though realizing these various
dangers from the hostile “fleets in being,” they ventured.
About the middle of March, that is, six weeks after the war began,
a report, partly believed by the Japanese authorities, came in that the
Port Arthur ships had escaped in a snow storm, on March 11. It is
reported that all transportation of troops stopped for some ten days.
It may be remembered that in our war with Spain, a very similar
report, from two different and competent witnesses, arrested the
movement of Shafter’s army from Key West until it could be verified.
In the case of the Japanese, as in our own, the incident illustrates the
possible dangers from a “fleet in being.” In neither report was there
an evident impossibility. Had either proved true the momentary
danger to communications is evident; but the danger is one the
chance of which has to be taken. As Napoleon said, “War cannot be
made without running risks.” The condition that an enemy’s fleet
watched in port may get out, and may do damage, is entirely
different from the fact that it has gotten out. The possibility is not a
sufficient reason for stopping transportation; the actual fact is
sufficient for taking particular precautions, adjusting dispositions to
the new conditions, as was done by ourselves and by the Japanese in
the circumstances. The case is wholly different if the enemy has a
fleet equal or superior; for then he is entirely master of his
movement, does not depend upon evasion for keeping the sea, and
communications in such case are in danger, not merely of temporary
disarrangement but of permanent destruction. No special warning is
needed to know this; the note of the “Fleet in Being” School is
insistence on the paralyzing effect of an inferior fleet.
Divided Forces[103]
[As the date indicates, the essay was written at the time of the
Revolution in Hawaii, six years before its annexation. The part of the
essay preceding points out the predominant interest of the United
States in the Islands owing to their control of our trade routes and
naval approaches, and refers to the benefit to the world from British
colonial expansion.—Editor.]
But if a plea of the world’s welfare seem suspiciously like a cloak
for national self-interest, let the latter be accepted frankly as the
adequate motive which it assuredly is. Let us not shrink from pitting
a broad self-interest against the narrow self-interest to which some
would restrict us. The demands of our three great seaboards, the
Atlantic, the Gulf, and the Pacific,—each for itself, and all for the
strength that comes from drawing closer the ties between them,—are
calling for the extension, through the Isthmian Canal, of that broad
sea common along which, and along which alone, in all the ages
prosperity has moved. Land carriage, always restricted and therefore
always slow, toils enviously but hopelessly behind, vainly seeking to
replace and supplant the royal highway of nature’s own making.
Corporate interests, vigorous in that power of concentration which is
the strength of armies and of minorities, may here withstand for a
while the ill-organized strivings of the multitude, only dimly
conscious of its wants; yet the latter, however temporarily opposed
and baffled, is sure at last, like the blind forces of nature, to
overwhelm all that stand in the way of its necessary progress. So the
Isthmian Canal is an inevitable part in the future of the United
States; yet one that cannot be separated from other necessary
incidents of a policy dependent upon it, whose details cannot be
foreseen exactly. But because the precise steps that hereafter may be
opportune or necessary cannot yet be foretold certainly, is not a
reason the less, but a reason the more, for establishing a principle of
action which may serve to guide as opportunities arise. Let us start
from the fundamental truth, warranted by history, that the control of
the seas, and especially along the great lines drawn by national
interest or national commerce, is the chief among the merely
material elements in the power and prosperity of nations. It is so
because the sea is the world’s great medium of circulation. From this
necessarily follows the principle that, as subsidiary to such control, it
is imperative to take possession, when it can be done righteously, of
such maritime positions as contribute to secure command. If this
principle be adopted, there will be no hesitation about taking the
positions—and they are many—upon the approaches to the Isthmus,
whose interests incline them to seek us. It has its application also to
the present case of Hawaii.
There is, however, one caution to be given from the military point
of view, beyond the need of which the world has not yet passed.
Military positions, fortified posts, by land or by sea, however strong
or admirably situated, do not confer control by themselves alone.
People often say that such an island or harbor will give control of
such a body of water. It is an utter, deplorable, ruinous mistake. The
phrase indeed may be used by some only loosely, without forgetting
other implied conditions of adequate protection and adequate
navies; but the confidence of our own nation in its native strength,
and its indifference to the defense of its ports and the sufficiency of
its fleet, give reason to fear that the full consequences of a forward
step may not be weighed soberly. Napoleon, who knew better, once
talked this way. “The islands of San Pietro, Corfu, and Malta,” he
wrote, “will make us masters of the whole Mediterranean.” Vain
boast! Within one year Corfu, in two years Malta, were rent away
from the state that could not support them by its ships. Nay, more:
had Bonaparte not taken the latter stronghold out of the hands of its
degenerate but innocuous government, that citadel of the
Mediterranean would perhaps—would probably—never have passed
into those of his chief enemy. There is here also a lesson for us.
32. Application of the Monroe Doctrine[107]