Imaging Anatomy Ultrasound 2Nd Edition Paula J Woodward Full Chapter

Imaging Anatomy.
Ultrasound 2nd
Edition Paula J. Woodward
Visit to download the full and correct content document:
https://ebookmass.com/product/imaging-anatomy-ultrasound-2nd-edition-paula-j-woo
dward/
SECOND EDITION
WOODWARD
GRIFFITH | ANTONIO | AHUJA
WONG | KAMAYA | WONG-YOU-CHEONG
ii
SECOND EDITION
Paula J. Woodward, MD
Professor of Radiology
David G. Bragg, MD and Marcia R. Bragg Presidential Endowed Chair in Oncologic Imaging
Adjunct Professor of Obstetrics and Gynecology
University of Utah School of Medicine
Salt Lake City, Utah
James F. Griffith, MD, MRCP, FRCR K. T. Wong, MBChB, FRCR, FHKCR,

Professor FHKAM (Radiology)
Department of Imaging and Interventional Radiology Consultant & Clinical Associate Professor (Honorary)
The Chinese University of Hong Kong Department of Imaging and Interventional Radiology
Hong Kong (SAR), China Prince of Wales Hospital
Faculty of Medicine
Gregory E. Antonio, MD, The Chinese University of Hong Kong
Hong Kong (SAR), China
DRANZCR, FHKCR
Honorary Professor
Department of Imaging and Interventional Radiology Aya Kamaya, MD, FSRU, FSAR
The Chinese University of Hong Kong Associate Professor of Radiology
Consultant Radiologist Director, Stanford Body Imaging Fellowship
Scanning Department Stanford University School of Medicine
St. Teresa’s Hospital Stanford, California
Jade Wong-You-Cheong, MBChB,
Anil T. Ahuja, MBBS (Bom), MD (Bom), MRCP, FRCR
FRCR, FHKCR, FHKAM (Radiology) Professor
Professor of Diagnostic Radiology & Organ Imaging Department of Diagnostic Radiology
Faculty of Medicine and Nuclear Medicine
The Chinese University of Hong Kong University of Maryland School of Medicine
Prince of Wales Hospital Director of Ultrasound
Hong Kong (SAR), China University of Maryland Medical Center
Baltimore, Maryland
iii
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
IMAGING ANATOMY: ULTRASOUND, SECOND EDITION ISBN: 978-0-323-54800-7
Copyright © 2018 by Elsevier. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as
the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be
noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability 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.
Publisher Cataloging-in-Publication Data
Names: Woodward, Paula J.

Title: Imaging anatomy. Ultrasound / [edited by] Paula J. Woodward.
Other titles: Ultrasound.
Description: Second edition. | Salt Lake City, UT : Elsevier, Inc., [2017] | Includes
bibliographical references and index.
Identifiers: ISBN 978-0-323-54800-7
Subjects: LCSH: Human anatomy--Handbooks, manuals, etc. | Ultrasonic imaging--Handbooks,
manuals, etc. | MESH: Ultrasonography--methods--Atlases. | Anatomy, Cross-Sectional--Atlases.
Classification: LCC QM25.I43 2017 | NLM WN 17 | DDC 616.07’543--dc23
International Standard Book Number: 978-0-323-54800-7

Cover Designer: Tom M. Olson, BA
Cover Art: Richard Coombs, MS
Printed in Canada by Friesens, Altona, Manitoba, Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
iv
Dedication
To Anthony
Why? You know why!
But may you keep asking why (and why not) throughout your life.
In those questions, you’ll find a marvelous adventure.
Love, Lala
PJW
v
Contributing Authors
Jill M. Abrigo, MD, DPBR Anne Kennedy, MD
Clinical Tutor Professor of Radiology
Department of Diagnostic Radiology and Organ Imaging Adjunct Professor of Obstetrics and Gynecology
The Chinese University of Hong Kong Executive Vice Chair of Radiology
Hong Kong (SAR), China Codirector of Maternal Fetal Diagnostic Center
Shweta Bhatt, MD Salt Lake City, Utah
Associate Professor
Department of Imaging Sciences Barton F. Lane, MD
University of Rochester Medical Center Assistant Professor
Rochester, New York Clinical Director of CT
Department of Diagnostic Radiology and Nuclear Medicine
Winnie C. W. Chu, MBChB, FRCR University of Maryland School of Medicine
Professor Baltimore, Maryland
Department of Diagnostic Radiology and Organ Imaging
The Chinese University of Hong Kong Ryan K. L. Lee, MBChB, FRCR, FHKAM (Radiology)
Hong Kong (SAR), China Associate Consultant and Clinical Assistant
Professor (Honorary)
Richard E. Fan, PhD Department of Imaging and Interventional Radiology
Engineering Research Associate Prince of Wales Hospital
Department of Urology Faculty of Medicine
Stanford University School of Medicine The Chinese University of Hong Kong
Stanford, California Hong Kong (SAR), China
Bryan R. Foster, MD Yolanda Y. P. Lee, MBChB, FRCR, FHKCR,

Assistant Professor FHKAM (Radiology)
Department of Radiology Associate Consultant and Clinical Associate
Oregon Health & Science University Professor (Honorary)
Portland, Oregon Department of Imaging and Interventional Radiology
Prince of Wales Hospital
Simon S. M. Ho, MBBS, FRCR Faculty of Medicine
Assistant Professor The Chinese University of Hong Kong
Department of Diagnostic Radiology and Organ Imaging Hong Kong (SAR), China
The Chinese University of Hong Kong
Hong Kong (SAR), China Vivian Y. F. Leung, PhD, RDMS
Adjunct Assistant Professor
Stella Sin Yee Ho, RDMS, RVT, PhD Department of Diagnostic Radiology and Organ Imaging
Adjunct Associate Professor The Chinese University of Hong Kong
Department of Imaging & Interventional Radiology Hong Kong (SAR), China
Prince of Wales Hospital
Faculty of Medicine Eric K. H. Liu, PhD, RDMS
The Chinese University of Hong Kong Adjunct Associate Professor
Hong Kong (SAR), China Department of Imaging and Interventional Radiology
Chander Lulla, MD, DMRD

Consultant Sonologist
RIA Clinic
Mumbai, India
vi
Thomas A. Miller, DO Sathi A. Sukumar, MBBS, FRCP (UK), FRCR
Assistant Professor of Pediatrics Consultant Radiologist
Division of Pediatric Cardiology University Hospital of South Manchester
University of Utah Manchester, United Kingdom
Ali M. Tahvildari, MD
L. Nayeli Morimoto, MD Staff Radiologist
Clinical Instructor VA Palo Alto Healthcare System
Department of Radiology Palo Alto, California
Stanford University School of Medicine Clinical Instructor (Affiliated)
Stanford, California Department of Radiology
Stanford University School of Medicine
Alex W. H. Ng, MBChB, FRCR, FHKCR, Stanford, California
FHKAM (Radiology)
Consultant and Clinical Associate Professor (Honorary) Katherine To’o, MD
Department of Imaging and Interventional Radiology Staff Radiologist
Prince of Wales Hospital Veterans Affairs Palo Alto Health Care System
Faculty of Medicine Palo Alto, California
Hong Kong (SAR), China Ashish P. Wasnik, MD
Assistant Professor
Bhawan K. Paunipagar, MBBS, MD, DNB Department of Radiology
Senior Consultant Radiologist, Head of MRI/CT Division Division of Abdominal Imaging
Department of Radiology University of Michigan Health System
Wockhardt Hospitals, South Mumbai Ann Arbor, Michigan
Mumbai, Maharashtra, India
Nicole S. Winkler, MD
Michael D. Puchalski, MD Assistant Professor of Radiology
Professor of Pediatrics University of Utah
Adjunct Professor of Radiology Salt Lake City, Utah
Associate Director of Pediatric Cardiology
Director of Non-Invasive Imaging
University of Utah/Primary Children’s Hospital
Deyond Y. W. Siu, MBChB, FRCR

Honorary Clinical Tutor
Department of Diagnostic Radiology and Organ Imaging
Roya Sohaey, MD
Director of Fetal Imaging
Oregon Health & Science University
Portland, Oregon
vii
viii
Preface
Anatomy is the fundamental infrastructure upon which all comprehension of the human body builds, in
both health and disease. It is essential to everyone who practices medicine but is critical to those of us
who perform and interpret ultrasound. You cannot understand what is abnormal without a thorough
understanding of what is normal. That is why we wrote this book. This second edition of Imaging
Anatomy: Ultrasound is the single most detailed and inclusive ultrasound anatomy text available on the
market.
I have always found studying anatomy a bit like reading the dictionary—there is a lot of fantastic
information, but there isn’t much of a plot. Such a necessary topic is often difficult to approach. We have
taken it as our mission, however, to break down those barriers and create an accessible anatomy text.
Here is our story:
• The Characters: Each anatomic area (Brain & Spine, Head & Neck, Thorax, Abdomen, Pelvis,
Extremities, and Developmental Anatomy) has its own complete cast of fascinating characters
(organs). There is no hero in this book though; each is as important as the next, from the Parotid
Gland to the Pelvic Floor to the Metatarsals and Toes. They all have their vital role to play.
• The Story Line: Every chapter begins with Gross Anatomy, followed by Imaging Anatomy, which
includes best imaging techniques, helpful tips, and potential pitfalls. The tale is presented in an
engaging, reader-friendly style. Convoluted descriptions are abandoned as key anatomic principles
are outlined in a succinct, bulleted format for quick reference.
• The Illustrations: Never before has there been such a beautifully illustrated ultrasound anatomy
text. The graphics, created by our own very talented group of medical illustrators, are of
extraordinary quality. Those alone would make this book worth the read. But then following the
graphics are extended galleries of detailed, extensively labeled, high-quality ultrasound images. A
page turner for certain.
• The Authors: Given the expansive scope of this book, it required experts in all the various anatomic
regions. I am quite fortunate to have some brilliant sonologists leading and editing their areas:
Drs. James Griffith (Musculoskeletal), Anil Ahuja (Head & Neck), and Aya Kamaya & Jade Wong-
You-Cheong (Abdomen & Pelvis). In addition to the physicians, I must acknowledge the talented
sonographers whose fine work is highlighted throughout this book.
• The Editorial Staff: To publish any book (especially one of this complexity) takes an incredible
group of individuals working behind the scenes to make it happen. I would like to thank the
wonderful Elsevier Salt Lake City editorial and production staff, medical illustrators, and image
editors—with a special shout out to Matt Hoecherl, who helped me immeasurably. I’m extremely
lucky to work with you guys.
It is with a great deal of pride that we present to you the second edition of Imaging Anatomy: Ultrasound.
While it might not be an epic thriller, it does have a compelling narrative to keep the reader engaged
and informed throughout.
David G. Bragg, MD and Marcia R. Bragg Presidential Endowed Chair in Oncologic Imaging
ix
x
Acknowledgments
Lead Editor
Matt W. Hoecherl, BS
Text Editors
Arthur G. Gelsinger, MA
Nina I. Bennett, BA
Terry W. Ferrell, MS
Lisa A. Gervais, BS
Karen E. Concannon, MA, PhD
Megg Morin, BA
Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
Illustrations
Richard Coombs, MS
Lane R. Bennion, MS
Laura C. Wissler, MA
Art Direction and Design

Tom M. Olson, BA
Laura C. Wissler, MA
Production Coordinators
Rebecca L. Bluth, BA
Angela M. G. Terry, BA
Emily C. Fassett, BA
xi
xii
Sections
SECTION 1:
Brain and Spine
SECTION 2:
Head and Neck
SECTION 3:
Thorax
SECTION 4:
Abdomen
SECTION 5:
Pelvis
SECTION 6:
Upper Extremity
SECTION 7:
Lower Extremity
SECTION 8:
Obstetrics and
Developmental Anatomy
xiii
TABLE OF CONTENTS
124 Lower Cervical Level and Supraclavicular Fossa

SECTION 1: BRAIN AND SPINE K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology),
4 Scalp and Calvarial Vault Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM
Winnie C. W. Chu, MBChB, FRCR and Vivian Y. F. Leung, (Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom),
PhD, RDMS FRCR, FHKCR, FHKAM (Radiology)
8 Brain 130 Posterior Triangle
Paula J. Woodward, MD K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology),
38 Orbit Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM
Paula J. Woodward, MD, Stella Sin Yee Ho, RDMS, RVT, (Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom),
PhD, and Deyond Y. W. Siu, MBChB, FRCR FRCR, FHKCR, FHKAM (Radiology)
50 Transcranial Doppler 136 Thyroid Gland
Stella Sin Yee Ho, RDMS, RVT, PhD, Deyond Y. W. Siu, Paula J. Woodward, MD, K. T. Wong, MBChB, FRCR,
MBChB, FRCR, and Paula J. Woodward, MD FHKCR, FHKAM (Radiology), and Anil T. Ahuja, MBBS
74 Vertebral Column and Spinal Cord (Bom), MD (Bom), FRCR, FHKCR, FHKAM (Radiology)
Paula J. Woodward, MD 144 Parathyroid Glands
Paula J. Woodward, MD, K. T. Wong, MBChB, FRCR,
SECTION 2: HEAD AND NECK FHKCR, FHKAM (Radiology), and Anil T. Ahuja, MBBS
86 Neck Overview (Bom), MD (Bom), FRCR, FHKCR, FHKAM (Radiology)
K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology), 150 Larynx and Hypopharynx
Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology),
(Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom), Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM
FRCR, FHKCR, FHKAM (Radiology) (Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom),
92 Sublingual/Submental Region FRCR, FHKCR, FHKAM (Radiology)
K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology), 158 Trachea and Esophagus
Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology),
(Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom), Anil T. Ahuja, MBBS (Bom), MD (Bom), FRCR, FHKCR,
FRCR, FHKCR, FHKAM (Radiology) FHKAM (Radiology), and Paula J. Woodward, MD
98 Submandibular Region 164 Vagus Nerve
K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology), K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology),
Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM
(Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom), (Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom),
FRCR, FHKCR, FHKAM (Radiology) FRCR, FHKCR, FHKAM (Radiology)
104 Parotid Region 170 Carotid Arteries
112 Upper Cervical Level 184 Vertebral Arteries
118 Midcervical Level 190 Neck Veins
xiv
TABLE OF CONTENTS
198 Cervical Lymph Nodes 458 Penis and Urethra
K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology), Paula J. Woodward, MD
Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM 468 Uterus
(Radiology), and Anil T. Ahuja, MBBS (Bom), MD (Bom), Barton F. Lane, MD and Paula J. Woodward, MD
FRCR, FHKCR, FHKAM (Radiology) 482 Cervix
Barton F. Lane, MD
SECTION 3: THORAX 488 Vagina
208 Thoracic Outlet Barton F. Lane, MD
Gregory E. Antonio, MD, DRANZCR, FHKCR, Eric K. H. Liu, 494 Ovaries
Bryan R. Foster, MD
PhD, RDMS, and Paula J. Woodward, MD
504 Pelvic Floor
218 Pleura
Stella Sin Yee Ho, RDMS, RVT, PhD, Deyond Y. W. Siu,
Paula J. Woodward, MD, Gregory E. Antonio, MD,
MBChB, FRCR, and Paula J. Woodward, MD
DRANZCR, FHKCR, and Eric K. H. Liu, PhD, RDMS
224 Diaphragm
SECTION 6: UPPER EXTREMITY
Gregory E. Antonio, MD, DRANZCR, FHKCR, Eric K. H. Liu,
PhD, RDMS, and Paula J. Woodward, MD 530 Sternoclavicular and Acromioclavicular Joints
228 Chest Wall James F. Griffith, MD, MRCP, FRCR and Bhawan K.
Gregory E. Antonio, MD, DRANZCR, FHKCR, Eric K. H. Liu, Paunipagar, MBBS, MD, DNB
PhD, RDMS, and Paula J. Woodward, MD 536 Shoulder
234 Breast James F. Griffith, MD, MRCP, FRCR and Bhawan K.
Nicole S. Winkler, MD Paunipagar, MBBS, MD, DNB
554 Axilla
SECTION 4: ABDOMEN James F. Griffith, MD, MRCP, FRCR and Bhawan K.
248 Liver Paunipagar, MBBS, MD, DNB
Aya Kamaya, MD, FSRU, FSAR 562 Arm
272 Biliary System James F. Griffith, MD, MRCP, FRCR and Bhawan K.
L. Nayeli Morimoto, MD Paunipagar, MBBS, MD, DNB
284 Spleen 570 Arm Vessels
Ali M. Tahvildari, MD and Paula J. Woodward, MD James F. Griffith, MD, MRCP, FRCR and Bhawan K.
292 Pancreas Paunipagar, MBBS, MD, DNB
Barton F. Lane, MD 578 Elbow
302 Kidneys James F. Griffith, MD, MRCP, FRCR and Bhawan K.
Jade Wong-You-Cheong, MBChB, MRCP, FRCR Paunipagar, MBBS, MD, DNB
330 Adrenal Glands 598 Forearm
Paula J. Woodward, MD James F. Griffith, MD, MRCP, FRCR and Bhawan K.
336 Bowel Paunipagar, MBBS, MD, DNB
Sathi A. Sukumar, MBBS, FRCP (UK), FRCR 606 Forearm Vessels
352 Abdominal Lymph Nodes James F. Griffith, MD, MRCP, FRCR and Bhawan K.
Jade Wong-You-Cheong, MBChB, MRCP, FRCR Paunipagar, MBBS, MD, DNB
356 Aorta and Inferior Vena Cava 614 Wrist
Simon S. M. Ho, MBBS, FRCR, Jill M. Abrigo, MD, DPBR, James F. Griffith, MD, MRCP, FRCR and Bhawan K.
and Chander Lulla, MD, DMRD Paunipagar, MBBS, MD, DNB
386 Peritoneal Cavity 628 Hand
Jade Wong-You-Cheong, MBChB, MRCP, FRCR James F. Griffith, MD, MRCP, FRCR and Bhawan K.
394 Abdominal Wall Paunipagar, MBBS, MD, DNB
Jade Wong-You-Cheong, MBChB, MRCP, FRCR 640 Hand Vessels
James F. Griffith, MD, MRCP, FRCR and Bhawan K.
SECTION 5: PELVIS Paunipagar, MBBS, MD, DNB
646 Thumb
408 Iliac Arteries and Veins
Simon S. M. Ho, MBBS, FRCR, Jill M. Abrigo, MD, DPBR,
Paunipagar, MBBS, MD, DNB
and Chander Lulla, MD, DMRD
656 Fingers
424 Ureters and Bladder
Ashish P. Wasnik, MD and Paula J. Woodward, MD
Paunipagar, MBBS, MD, DNB
434 Prostate and Seminal Vesicles
668 Brachial Plexus
Katherine To'o, MD, Richard E. Fan, PhD, and Paula J.
James F. Griffith, MD, MRCP, FRCR, K. T. Wong, MBChB,
Woodward, MD
FRCR, FHKCR, FHKAM (Radiology), and Paula J.
446 Testes and Scrotum
Shweta Bhatt, MD and Paula J. Woodward, MD Woodward, MD
xv
TABLE OF CONTENTS
676 Radial Nerve 872 Embryology and Anatomy of Brain
James F. Griffith, MD, MRCP, FRCR and Bhawan K. Anne Kennedy, MD
Paunipagar, MBBS, MD, DNB 888 Embryology and Anatomy of Spine
684 Median Nerve Paula J. Woodward, MD
James F. Griffith, MD, MRCP, FRCR and Bhawan K. 894 Embryology and Anatomy of Face and Neck
Paunipagar, MBBS, MD, DNB Roya Sohaey, MD
694 Ulnar Nerve 906 Embryology and Anatomy of Chest
James F. Griffith, MD, MRCP, FRCR and Bhawan K. Paula J. Woodward, MD
Paunipagar, MBBS, MD, DNB 914 Embryology and Anatomy of Cardiovascular System
Thomas A. Miller, DO and Michael D. Puchalski, MD
SECTION 7: LOWER EXTREMITY 924 Embryology and Anatomy of Abdominal Wall and
706 Gluteal Muscles Gastrointestinal Tract
Ryan K. L. Lee, MBChB, FRCR, FHKAM (Radiology), Paula J. Woodward, MD
Gregory E. Antonio, MD, DRANZCR, FHKCR, and Eric K. H. 934 Embryology and Anatomy of Genitourinary Tract
Liu, PhD, RDMS
716 Groin
Alex W. H. Ng, MBChB, FRCR, FHKCR, FHKAM (Radiology),
Gregory E. Antonio, MD, DRANZCR, FHKCR, and Eric K. H.
Liu, PhD, RDMS
726 Hip
Gregory E. Antonio, MD, DRANZCR, FHKCR and Eric K. H.
Liu, PhD, RDMS
736 Thigh Muscles
Liu, PhD, RDMS
748 Femoral Vessels and Nerves
Liu, PhD, RDMS
762 Knee
Liu, PhD, RDMS
780 Leg Muscles
Liu, PhD, RDMS
792 Leg Vessels
Gregory E. Antonio, MD, DRANZCR, FHKCR, Eric K. H. Liu,
PhD, RDMS, and Paula J. Woodward, MD
810 Leg Nerves
Liu, PhD, RDMS
814 Ankle
Liu, PhD, RDMS
832 Tarsus
Liu, PhD, RDMS
846 Foot Vessels
Liu, PhD, RDMS
852 Metatarsals and Toes
Liu, PhD, RDMS
SECTION 8: OBSTETRICS AND

DEVELOPMENTAL ANATOMY
860 Embryology and Anatomy of 1st Trimester
Anne Kennedy, MD
xvi
This page intentionally left blank
SECOND EDITION
WOODWARD
GRIFFITH | ANTONIO | AHUJA
WONG | KAMAYA | WONG-YOU-CHEONG
SECTION 1
Brain and Spine
Scalp and Calvarial Vault 4

Brain 8
Orbit 38
Transcranial Doppler 50
Vertebral Column and Spinal Cord 74
Scalp and Calvarial Vault
Brain and Spine
○ Inner tables often slightly irregular (convolutional

TERMINOLOGY markings caused by gyri), grooved by paired middle
Definitions meningeal arteries + vein
• Fontanelle: Broad areas of connective tissue at junction of • Occipital bone
major sutures ○ Deeply grooved by superior sagittal, transverse sinuses
○ Internal occipital protuberance marks sinus confluence
GROSS ANATOMY (torcular Herophili)
• Temporal bones
Overview
○ Thin, inner surface grooved by middle meningeal vessels
• Scalp ○ Outer surface grooved by superficial temporal artery
○ Scalp has 5 layers • Fontanelle: Provide acoustic window for US examination of
– Skin (epidermis, dermis, hair, sebaceous glands) underlying brain parenchyma
– Subcutaneous tissue (very vascular fibroadipose ○ Anterior fontanelle
tissue) ○ Between 2 frontal and 2 parietal bones, usually
– Epicranial tissue (scalp muscles, galea aponeurotica) disappears by age 2
– Subaponeurotic tissue (loose areolar connective ○ When fused, corresponds to bregma: Meeting of
tissue) sagittal, coronal sutures
– Pericranium (periosteum of skull) ○ Posterior fontanelle
• Skull (28 separate bones, mostly connected by fibrous ○ Small, usually closes between 3-6 months of age
sutures) ○ When fused, corresponds to lambda: Meeting of sagittal,
○ Cranium has several parts lambdoid sutures
– Calvarial vault ○ Pterion
– Cranial base – Anterolateral fontanelle; closes between 3-6 months
– Facial skeleton of age
○ Calvarial vault composed of several bones – H-shaped junction between frontal, parietal bones +
– 2 frontal bones separated by metopic suture greater sphenoid wing, squamous temporal bone
– Paired parietal bones ○ Asterion
– Squamous occipital bone – Posterolateral fontanelle, persists until 2 years of age
– Paired squamous temporal bones ○ Mastoid fontanelle
○ 3 major serrated fibrous joints (sutures) connect bones ○ Located at junction of temporosquamous and lambdoid
of vault sutures
– Coronal suture ○ Persists until 2 years
– Sagittal suture
– Lambdoid suture ANATOMY IMAGING ISSUES
○ Outer, inner tables
Imaging Recommendations
– 2 thin plates of compact cortical bone
– Separated by diploic space (cancellous bone • High-frequency linear array transducers provide superb
containing marrow) resolution of near-field structures
○ Endocranial surface • Good skin-to-transducer coupling achieved by copious use
of acoustic coupling gel
– Lined by outer (periosteal) layer of dura
• Superficial standoff pad can be used to increase depth of
– Grooved by vascular furrows
focal zone
– May have areas of focal thinning (arachnoid
• US can be used to evaluate cranial sutures and assists
granulations), foramina (emissary veins)
diagnosis of craniosynostosis (premature fusion of sutures)
IMAGING ANATOMY EMBRYOLOGY
Overview
Embryologic Events
• Scalp: Hypoechoic, 5 layers cannot be further separately
• Skull base formed from endochondral ossification
resolved
• Calvarial vault forms via membranous ossification
• Calvarium echogenic outer/inner tables; diploic space filled
with fatty marrow and appears hypoechoic, suture appears ○ Curved mesenchymal plates appear at day 30
as gap between echogenic calvarium ○ Extend toward each other, skull base
• Frontal bones ○ As paired bones meet in midline, metopic and sagittal
○ Frontal sinuses show wide variation in aeration sutures are induced (coronal suture is present from
onset of ossification)
○ Frontal bones often appear thickened, hyperostotic
(especially in older females) ○ Unossified centers at edges of parietal bone form
fontanelles
• Parietal bones
○ Vault grows rapidly in 1st postnatal year
○ Areas of parietal thinning, granular foveolae (for
arachnoid granulations) common adjacent to sagittal
suture
4
Brain and Spine

SCALP AND CALVARIAL VAULT
Sagittal suture
Anterior fontanelle
Coronal suture
Metopic suture
Frontonasal suture
Anterior fontanelle
Temporosquamosal suture
Coronal suture
Posterior fontanelle
Anterolateral fontanelle (pterion)
Lambdoid suture
Posterolateral/mastoid fontanelle Mendosal suture

(asterion)
Sweat gland and duct
Epidermis
Sebaceous gland Dermis
Hair follicle
Superficial, deep vascular plexi
Subcutaneous fibroadipose tissue

Epicranial aponeurosis
Subaponeurotic areolar tissue
Pericranium
Outer table, calvarium
Diploic space
Inner table, calvarium
Venous "lake"
(Top) Graphic depiction of an infant cranium, frontal view, is shown. The anterior fontanelle is present between 2 frontal and 2 parietal
bones, which usually close by 2 years of age. When fused, this site corresponds to bregma: The meeting point of sagittal and coronal
sutures. (Middle) Lateral view of an infant calvarial vault is shown. The posterior fontanelle is small and usually closes by 3-6 months of
age. When fused, this corresponds to lambda: The meeting of sagittal and lambdoid sutures. The anterolateral fontanelle (pterion)
closes at ~ 3 months of age. The posterolateral fontanelle (asterion) often persists until 2 years of age. (Bottom) 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, and sweat glands and ducts as well as superficial and deep cutaneous vascular plexi are shown.
5
Brain and Spine
US AND T2WI MR, SCALP
US gel
Scalp
Outer table of calvarium
Periosteum covering calvarium
Inner table of calvarium
Superior sagittal sinus

Cortical v. in subarachnoid space
Subarachnoid space
Cerebral cortex
US gel
Scalp
Outer table of calvarium
Cortical v. in subarachnoid space
Subarachnoid space
Cerebral cortex
Cerebral sulcus
Scalp Outer table of calvarium

Diploic space
Superior sagittal sinus Inner table of calvarium
Subarachnoid space
Cerebral hemisphere
(Top) Anterior coronal US scan through the anterior fontanelle shows the scalp covering the frontal bone of the calvarial vault. The 5
layers of the scalp are as follows: Skin, connective tissue consisting of lobules of fat, artery and emissary vein, aponeurosis, loose
connective tissue, which accounts for mobility of the scalp on the underlying bone and periosteum adhering to the outer table of skull.
These 5 layers, however, cannot be resolved by US. (Middle) Midsagittal scan through the anterior fontanelle shows the scalp covering
the frontal bone of the calvarial vault. Beneath the inner table of the calvarial vault is the anechoic subarachnoid space. (Bottom)
Coronal T2 MR shows the hypointense outer and inner table of calvarium. The scalp and diploic space are hyperintense. The superior
sagittal sinus appears as signal void structure below the inner table of calvarium.
6
Brain and Spine

US AND T2WI MR CALVARIUM
Scalp
Calvarium
Suture
Scalp
Calvarium
Suture
Scalp
Suture Outer table of calvarium
Cortical vv. in subarachnoid space
Cerebral cortex
(Top) Coronal US through the anterior fontanelle shows the scalp and calvarium. There is discontinuity in a hypoechoic band extending
from the outer to inner table of the calvarial vault. This represents a normal suture. The scalp appears hypoechoic compared to the
echogenic outer and inner tables of the calvarium. The 5 layers of the scalp cannot be resolved by US. (Middle) Coronal US through the
anterior fontanelle shows another suture of the calvarial vault. The width and curvature of sutures is variable and should not be
mistaken for a bony fracture. (Bottom) Sagittal T2 MR of the scalp and calvarium is shown. The suture line appears with the same
signal intensity as the outer and inner table of calvarium. Cortical veins can be seen within the hyperintense subarachnoid space, which
is immediately under the inner table.
7
Brain
Brain and Spine
• Basal ganglia
GROSS ANATOMY
○ Paired deep gray matter nuclei
Supratentorial Structures ○ Caudate nucleus, lentiform nucleus (including putamen,
• Gyri: Complex convolutions of brain cortex; hypoechoic on globus pallidus)
ultrasound (US) • Thalamus
• Sulci (fissure): CSF-filled grooves or clefts that separate gyri; ○ Paired nuclear complexes, serve as relay station for most
echogenic on US sensory pathways
○ Sulci separate gyri, fissures separate hemispheres/lobes
Posterior Fossa (Infratentorial) Structures
• Frontal lobe
• Protected space surrounded by calvarium & bounded by
○ Central sulcus separates frontal, parietal lobes
tentorium cerebelli superiorly & foramen magnum
○ Precentral gyrus contains primary motor cortex
inferiorly
○ Premotor cortex: Within gyrus just anterior to precentral
• Posterior fossa contents
gyrus (motor cortex)
○ Brainstem (midbrain, pons, & medulla oblongata)
○ 3 additional major gyri: Superior frontal gyrus, middle
anteriorly, cerebellum posteriorly
frontal gyrus, & inferior frontal gyrus
○ Cerebral aqueduct & 4th ventricle
– Superior sulcus separates superior & middle gyri
○ CSF cisterns containing cranial nerves, vertebrobasilar
– Inferior sulcus separates middle & inferior gyri
arterial system & veins
○ Orbital gyri cover base of frontal lobe; gyrus rectus
• Cerebellum
medially
○ Integrates coordination & fine-tuning of movement, &
• Parietal lobe
regulation of muscle tone
○ Posterior to central sulcus
○ 3 surfaces: Superior (tentorial), inferior (suboccipital),
○ Separated from occipital lobe by parietooccipital sulcus anterior (petrosal)
(medial surface)
○ 2 hemispheres & midline vermis
○ Postcentral gyrus: Primary somatosensory cortex
– Divided into lobes & lobules by transverse fissures
○ Superior & inferior parietal lobules lie posterior to
– Major fissures: Primary (tentorial), horizontal
postcentral gyrus
(petrosal), prebiventral/prepyramidal (suboccipital)
○ Supramarginal gyrus lies at end of sylvian fissure cerebellar fissures
○ Angular gyrus lies ventral to supramarginal gyrus ○ Connected to brainstem by 3 paired peduncles
○ Medial surface of parietal lobe is precuneus, in front of – Superior cerebellar peduncle (brachium conjunctivum)
parietooccipital sulcus connects cerebellum to cerebrum via midbrain
• Occipital lobe – Middle cerebellar peduncle (brachium pontis)
○ Posterior to parietooccipital sulcus connects to pons
○ Primary visual cortex on medial occipital lobe – Inferior cerebellar peduncle (restiform body) connects
○ Cuneus on medial surface to medulla
• Temporal lobe • Brainstem
○ Inferior to sylvian fissure ○ 3 anatomic divisions
○ Superior temporal gyrus: Primary auditory cortex – Midbrain (mesencephalon): Upper brainstem,
○ Middle temporal gyrus: Connects with auditory, connects pons & cerebellum with forebrain
somatosensory, visual association pathways – Pons: Bulbous midportion of brainstem, relays
○ Inferior temporal gyrus: Higher visual association area information from brain to cerebellum
○ Includes major subdivisions of limbic system – Medulla: Caudal (inferior) brainstem, relays
• Insula information from spinal cord to brain
○ Lies deep in floor of sylvian fissure, overlapped by ○ Functional divisions
frontal, temporal, parietal opercula – Ventral part: Large descending white matter tracts;
• Limbic system contains midbrain cerebral peduncles, pontine bulb,
○ Includes amygdala, hippocampus, thalamus, medullary pyramids
hypothalamus, basal ganglia, & cingulate gyrus – Dorsal part: Tegmentum, common to midbrain, pons
– Cingulate gyrus extends around corpus callosum & medulla; contains cranial nerve nuclei & reticular
○ Important role in emotion, behavior, & long-term formation
memory
Ventricular System & Subarachnoid Space
• White matter tracts: 3 major types of fibers
• Cerebral ventricles consist of paired lateral, midline 3rd, &
○ Association fibers: Interconnect different cortical regions
4th ventricles
in same hemisphere
• Communicate with each other as well as central canal of
○ Commissural fibers: Interconnect similar cortical regions
spinal cord & subarachnoid space
of opposite hemispheres
• Direction of CSF flow
– Corpus callosum is largest commissural fiber, links
cerebral hemispheres ○ Lateral ventricles → foramen of Monro → 3rd ventricle →
cerebral aqueduct → 4th ventricle → foramina of Luschka
○ Projection fibers: Connect cerebral cortex with deep
& Magendie → subarachnoid space
nuclei, brainstem, cerebellum, spinal cord
○ Bulk of CSF resorption through arachnoid granulations in
– Internal capsule is major projection fiber
superior sagittal sinus
8
Brain
Brain and Spine

• Lateral ventricles – Posterior extension of cavum septi pellucidi
○ Paired, C-shaped, curve posteriorly from temporal horns, – Begins to close from posterior to anterior from 6-
arch around/above thalami month gestation; 97% closed by full term
○ Each has body, atrium, 3 horns (frontal, temporal, & ○ Cavum velum interpositum: Potential space above
occipital) choroid in roof of 3rd ventricle & below fornices
– Occipital horn typically largest – Typically seen in premature infants
– Asymmetry is common, often L > R
– Sizes change with maturity, more prominent in ANATOMY IMAGING ISSUES
preterm infants Imaging Approaches
○ Atrium/trigone: Confluence of horns
• Anterior fontanelle most commonly used approach
– Contains glomus of choroid plexus
○ Sagittal scans
○ Lateral ventricles communicate with each other & 3rd
– Midline scan: Best view for corpus callosum, cerebellar
ventricle via Y-shaped foramen of Monro
vermis
• 3rd ventricle
– Sweep side-to-side from this position documenting
○ Thin, usually slit-like, between thalami
key areas
– May not see fluid, just bright echogenic line on US
□ Caudothalamic groove: Most common site of
○ 80% have central adhesion between thalami (massa germinal matrix hemorrhage
intermedia)
□ Size of lateral ventricle
○ Communicates with 4th ventricle via cerebral aqueduct
□ Far lateral to assess degree of sulcal development
(of Sylvius), passing through dorsal midbrain
○ Coronal scans
• 4th ventricle
– Important to maintain symmetrical imaging of each
○ Infratentorial, diamond-shaped cavity (rhomboid fossa)
1/2 of brain
along dorsal pons & upper medulla
– Symmetrical structures (from anterior to posterior)
○ Fastigium: Blind ending, dorsally pointed midline
include: Frontal horns, bodies & trigones of lateral
outpouching from body of 4th ventricle
ventricles; caudate nuclei, putamen, internal capsule,
– Important marker for true midline vermian plane on & thalami
US
– Midline structures (from anterior to posterior) include:
○ Communicates with subarachnoid space via foramina of Interhemispheric fissure, genu & anterior body of
Magendie & Luschka corpus callosum, cavum septi pellucidi, 3rd ventricle,
○ Terminates inferiorly at obex, which communicates with brainstem
central canal of spinal cord • Posterior fontanelle
• Choroid plexus ○ Best view to evaluate occipital horns for intraventricular
○ Produces CSF hemorrhage
○ Glomus (enlargement of choroid plexus in atrium) – Can misinterpret clot adherent to choroid plexus from
thickest area anterior fontanelle approach alone
○ Tapers & extends anteriorly to foramen of Monro & roof • Mastoid fontanelle
of 3rd ventricle ○ Located at junction of squamosal, lambdoidal, occipital
○ Tapers laterally into roof of temporal horns sutures
○ Present in roof of 4th ventricle but never extends into ○ Transducer placed about 1 cm behind helix of ear & 1 cm
frontal or occipital horns above tragus
• Subarachnoid space/cisterns ○ Allows assessment of brainstem & posterior fossa
○ CSF spaces between pia & arachnoid ○ Best view for 4th ventricle, posterior cerebellar vermis,
○ Numerous trabeculae, septa, membranes cross cerebellar hemispheres, & cisterna magna
subarachnoid space & create smaller compartments • Transtemporal
termed cisterns ○ Temporal bone anterior to ear is thin, allowing imaging
– Supratentorial/peritentorial cisterns: Suprasellar, of brainstem even after sutural closure
interpeduncular, ambient (perimesencephalic), ○ Best view for cerebral peduncles & 3rd ventricle
quadrigeminal cistern, & cistern of velum interpositum
– Infratentorial (posterior fossa) cisterns: Prepontine, Imaging Pitfalls
premedullary, superior cerebellar, cisterna magna, & • Need to know changing appearance with gestational age at
cerebellopontine birth; normal gyral pattern in 26-week preterm infant
○ All cisterns communicate with each other & with would be abnormal in term infant
ventricular system • Slit-like lateral ventricles common in infants, not to be
• Midline cystic structures (normal variants) mistaken for cerebral edema
○ Cavum septi pellucidi: Anterior to foramen of Monro, • Glomus of choroid plexus can be bulbous & irregular, not to
between anterior horns of lateral ventricles be mistaken for blood clot
– 85% closed by 3-6 months after birth, some remain ○ Evaluate with color Doppler & posterior fontanelle view
open into adulthood • Echogenic material in frontal or occipital horns is clot;
□ Once closed called septum pellucidum choroid does not extend into these horns
○ Cavum vergae: Posterior to foramen of Monro,
interposed between bodies of lateral ventricles
9
Brain
Brain and Spine
GYRI AND SULCI
Central sulcus
Postcentral gyrus
Precentral gyrus
Superior frontal gyrus

Supramarginal gyrus
Middle frontal gyrus
Angular gyrus
Inferior frontal gyrus
Superior temporal gyrus Sylvian fissure

Occipital pole
Middle temporal gyrus
Inferior temporal gyrus
Cerebellum
Brainstem

Superior frontal sulcus
Precentral sulcus
Precentral gyrus
Central sulcus
Postcentral gyrus
Postcentral sulcus
Superior parietal lobule
Inferior parietal lobule
Occipital lobe
(Top) Lateral surface of the brain depicts the major gyri and sulci. The frontal lobe extends from the frontal pole to the central sulcus.
The supramarginal and angular gyri are part of the parietal lobe. The superior temporal gyrus contains the primary auditory cortex, and
also forms the temporal operculum. The insular cortex lies within the sylvian fissure beneath the frontal, temporal, and parietal
opercula. (Bottom) Surface anatomy of the cerebral hemisphere, seen from above, shows the gyri and lobules on the left, and the sulci
on the right. The central (Rolandic) sulcus separates the anterior frontal lobe from the posterior parietal lobe. The precentral gyrus of
the frontal lobe is the primary motor cortex while the postcentral gyrus of the parietal lobe is the primary sensory cortex. On
ultrasound, the sulci appear echogenic while the adjacent gyri are hypoechoic.
10
Brain
Brain and Spine

MIDLINE, SUBARACHNOID SPACE
Medial frontal gyrus
Central sulcus
Cingulate sulcus
Precuneus
Cingulate gyrus
Parietooccipital sulcus
Genu of corpus callosum Septum pellucidum

Fornix
Calcarine sulcus
Anterior commissure
Splenium of corpus callosum
Uncus
Parahippocampal gyrus
Central sulcus
Pericallosal cistern
Parietooccipital sulcus
Cistern of velum interpositum

Interpeduncular cistern
Suprasellar cistern Superior cerebellar cistern
Quadrigeminal cistern
Prepontine cistern
Premedullary (medullary)
cistern
Cisterna magna
(Top) This midline sagittal graphic shows a medial view of the cerebral hemisphere. The corpus callosum represents the major
commissural fiber. The fornix and cingulate gyrus are important in the limbic system. The cingulate gyrus is involved with emotion
formation and processing, learning, and memory. (Bottom) Sagittal midline graphic through the interhemispheric fissure depicts
subarachnoid spaces with CSF (blue) between the arachnoid (purple) & pia (orange). The central sulcus separates the frontal lobe
(anterior) from the parietal lobe (posterior). The pia mater is closely applied to the brain surface, whereas the arachnoid is adherent to
the dura. The ventricles communicate with the cisterns and subarachnoid space via the foramina of Luschka and Magendie. The cisterns
normally communicate freely with each other.
11
Brain
Brain and Spine
VENTRICULAR SYSTEM
Foramen of Monro
Body of lateral ventricle
3rd ventricle
Frontal horns
Suprapineal recess
Occipital horns
Location of massa
intermedia Atrium
Pineal recess
Optic (chiasmatic) recess,
3rd ventricle Cerebral aqueduct (of
Sylvius)
Infundibular recess, 3rd
ventricle 4th ventricle
Temporal horn
Foramen of Magendie
Paired foramina of
Luschka Obex
Schematic 3D representation of the ventricular system, viewed in the sagittal plane, demonstrates the normal appearance and
communicating pathways of the cerebral ventricles. CSF flows from the lateral ventricles through the foramen of Monro into the 3rd
ventricle, and from there through the cerebral aqueduct into the 4th ventricle. CSF exits the 4th ventricle through the foramina of
Luschka and Magendie to the subarachnoid space.
12
Brain
Brain and Spine

STANDARD US PLANES VIA ANTERIOR FONTANELLE
(Top) Graphic shows the common coronal planes used in ultrasound brain scanning: Plane A to F from front to back. Cerebral cortex
(CC); body of lateral ventricle (BV); frontal horn (FH); occipital horn (OH); massa intermedia (M); pineal recess (PR); 3rd ventricle (3);
temporal horn (TH); supraoptic recess (SR); infundibular recess (IR); 4th ventricle (4); cerebellum (CB). (Bottom) Graphic shows the
common sagittal planes used in ultrasound brain scanning: Plane A to C from midline to lateral. Cerebellum (CB); cerebral cortex (CC);
corpus callosum (Coc); cavum septi pellucidi (CSP); frontal horn (FH); foramen of Monro (FM); occipital horn (OH); temporal horn (T); 3rd
ventricle (3); 4th ventricle (4).
13
Brain
Brain and Spine
CORONAL US VIA ANTERIOR FONTANELLE

Interhemispheric fissure
Frontal lobes
Cortical sulcus
Orbital roof
Eye
Falx cerebri
Centrum semiovale
Anterior clinoid
Sella turcica
Genu, corpus callosum

Frontal horn
Caudate nucleus (head)
Cingulate sulcus
Sylvian fissure
Internal capsule
Insula Temporal lobe
Middle cranial fossa
(Top) The 1st of 9 coronal ultrasounds of the brain through the anterior fontanelle in a term infant shows the frontal lobes lie in the
anterior cranial fossa with orbital cavities deep to the floor of the skull base. (Middle) An image centered more posteriorly
demonstrates a slightly more echogenic white matter region of the brain parenchyma known as the centrum semiovale. Parts of the
skull base, including the sella turcica and anterior clinoid, can be seen. (Bottom) Image acquired just anterior to the foramen of Monro.
The frontal horns of lateral ventricles are now seen. No choroid plexus should be present in the frontal horns. Any intraventricular
echogenic material seen at this level should raise the suspicion of blood clot. The head of the caudate nucleus is inferior and lateral to
the frontal horn and is separated from the lentiform nucleus by the internal capsule.
14
Brain
Brain and Spine

CORONAL T1 MR
Falx Superior frontal gyrus

Superior frontal sulcus
Inferior frontal sulcus
Orbital roof
Straight gyrus/gyrus rectus
Eye

Centrum semiovale
Straight gyrus
Optic n.
Medial rectus muscle

Cingulate gyrus
Genu, corpus callosum Frontal horn
Caudate head
Internal capsule
Sylvian fissure
Temporal lobe
Middle cranial fossa
(Top) The 1st of 9 coronal T1 MR images through the cerebral hemispheres from anterior to posterior is shown. The images are taken
through planes/levels corresponding to those commonly used for ultrasound scans through the anterior fontanelle. The 3 major frontal
gyri are shown: Superior frontal gyrus, middle frontal gyrus, and inferior frontal gyrus, separated by the superior and inferior frontal
sulci. The straight gyrus (gyrus rectus) is the most medial, covering the base of the frontal lobe. (Middle) Slightly more posteriorly, the
major white matter tracts, the centrum semiovale, are seen. (Bottom) This image shows the frontal horns. Immediately below each
frontal horn is the caudate head, separated from the lentiform nucleus by the internal capsule.
15
Brain
Brain and Spine
Cingulate gyrus
Corpus callosum, body
Lateral ventricle
Cavum septi pellucidi
Caudate
Lateral ventricle
Foramen of Monro
Foramen of Monro
3rd ventricle

Corpus callosum
Lateral ventricle
Choroid plexus in foramen of Monro
Choroid plexus in roof of 3rd ventricle

Choroid plexus in foramen of Monro
Falx
Frontal lobe
Choroid plexus
Thalamus
Sylvian fissure Choroidal fissure
Quadrigeminal cistern Temporal lobe

Tentorium cerebelli
Cerebellar hemisphere
Vermis
(Top) The 4th of 9 coronal ultrasounds through the anterior fontanelle in a term infant is shown. This image is taken at the level of the
foramen of Monro. The lateral ventricles are seen with the body of the caudate nucleus and anterior portions of the thalami below. It is
not uncommon that the ventricles are asymmetric. (Middle) Just slightly more posterior, the choroid plexus is present on the floor of the
lateral ventricles and roof of the 3rd ventricle. The 3 echogenic foci of the choroid plexus, 1 on the roof of the 3rd ventricle and 2
located bilaterally on the floor of the lateral ventricles, are known as the 3-dot sign. (Bottom) A more posterior coronal image at the
level of the quadrigeminal cistern is shown. Another ultrasound landmark, known as the echogenic star, is seen, which comprises the
choroidal fissures as the upper limbs and tentorium cerebelli as the lower limbs. Inferiorly, the vermis appears echogenic, while the
cerebellar hemispheres on both sides are hypoechoic.
16
Brain
Brain and Spine

CORONAL T1 MR
Body, corpus callosum
Foramen of Monro
Lateral ventricle
Caudate Inferior frontal gyrus
3rd ventricle
Superior temporal gyrus

Ambient cistern
Occipitotemporal gyrus
Brainstem

Insula
Lateral ventricle
3rd ventricle Sylvian fissure

Thalamus
Temporal horn Choroidal fissure
Temporal lobe
Brainstem

Falx cerebri
Sylvian fissure
Quadrigeminal cistern
Thalamus
Temporal horn
Tentorium cerebelli Choroidal fissure

Cerebellar vermis
(Top) The 4th of 9 coronal T1 MR images through the cerebral hemispheres from anterior to posterior is shown. The images are taken
through planes/levels corresponding to those commonly used for ultrasound through the anterior fontanelle. This image is taken at the
level of the foramen of Monro where both lateral ventricles unite, becoming the 3rd ventricle in the midline. (Middle) This image shows
the thalami on either side of the 3rd ventricle. (Bottom) This image slightly more posterior shows the quadrigeminal cistern in the
midline. Together with choroidal fissures and tentorium cerebelli on both sides, it gives rise to the characteristic echogenic star
appearance on coronal ultrasound scanning.
17
Brain
Brain and Spine
Parietal lobe
Sylvian fissure
Glomus of choroid plexus
Splenium, corpus callosum

Occipital horn
Falx
Parietal lobe
Periventricular halo
Occipital lobe
Falx
White matter
Occipital lobe
(Top) The 7th of 9 coronal ultrasounds obtained through the anterior fontanelle in a term infant is shown. This image is taken at the
trigone of the lateral ventricles. The glomus of the choroid plexus appears highly echogenic, nearly occupying the whole trigone.
(Middle) This image, slightly posterior to the trigone, shows mildly echogenic white matter regions within the corona radiata, lateral
and parallel to both trigones of the lateral ventricles. These regions are known as the periventricular halo, a normal finding, present in
almost all normal mature and premature neonates. The echogenicity of the halo should be less than that of the choroid plexus and
symmetrical in appearance. (Bottom) The most posterior coronal image shows the cortex of the occipital lobe with multiple echogenic
sulci extending medially from the lateral margin of the brain. The falx is in midline.
18
Brain
Brain and Spine

CORONAL T1 MR
Interhemispheric fissure Falx cerebri
Cingulate gyrus Parietal lobe

Glomus of choroid plexus Sylvian fissure

Vermis
Tentorium cerebelli

Superior parietal lobule
Falx cerebri
Corona radiata
Calcarine sulcus
Middle occipital gyrus
Inferior occipital gyrus
Occipital lobe
(Top) The 7th of 9 coronal T1 MR images through the cerebral hemispheres from anterior to posterior are shown. The images are taken
through planes/levels corresponding to those commonly used for ultrasound scans through the anterior fontanelle. The glomus of the
choroid plexus is prominent within the trigones of the lateral ventricles. (Middle) More posterior image shows the posterior parietal
lobes and occipital lobes. Cerebral hemispheres are separated by the interhemispheric fissure, which contains the falx cerebri. The
ventricular system and cerebellum are no longer seen at this level. The primary visual cortex is on the medial aspect of the occipital
lobe. (Bottom) This most posterior image shows gyri of the occipital lobe and a portion of the superior sagittal sinus, which arches
posteriorly to the torcular Herophili.
19
Brain
Brain and Spine
SAGITTAL US VIA ANTERIOR FONTANELLE
Frontal lobe
Cingulate sulcus
Cingulate gyrus
Callosal sulcus above corpus callosum
Genu, corpus callosum Fornix

Inferior frontal lobe Occipital lobe
3rd ventricle
Pons
4th ventricle
Vermis
Medulla Cisterna magna
Cingulate sulcus
Cingulate gyrus
Callosal sulcus above corpus callosum
Parietal lobe
Thalamus
Occipital lobe
Midbrain
4th ventricle
Pons
Medulla Vermis
Central sulcus
Frontal lobe
Frontal horn of lateral ventricle
Caudate nucleus (head)

Caudothalamic groove Thalamus
Temporal lobe
Cerebellum
(Top) The 1st of 6 sagittal ultrasounds of the brain through the anterior fontanelle in term infant is shown. This image, obtained in the
midline, shows the corpus callosum as a hypoechoic curving line. Callosal and cingulate sulci are parallel to and above the corpus
callosum. The midline also allows evaluation of the posterior fossa structures, including the brainstem anteriorly and the vermis
posteriorly. The 4th ventricle is well seen in this plane and appears as a triangular fluid-filled structure at the level of the mid vermis.
(Middle) Parasagittal image obtained angling slightly lateral to midline: The thalamus and echogenic sulci can now be seen more
clearly. (Bottom) Parasagittal image obtained by angling more laterally shows the caudothalamic groove, the junction between the
caudate nucleus and the thalamus. This is the area of the vascular germinal matrix, which is vulnerable to hemorrhage in preterm
infants.
20
Brain
Brain and Spine

SAGITTAL T1 MR
Cingulate sulcus Superior sagittal sinus
Splenium corpus callosum

Cingulate gyrus
Genu, corpus callosum

Callosal sulcus
Fornix 3rd ventricle
Cerebral aqueduct
Midbrain
Pons
4th ventricle
Medulla
Central sulcus
Thalamus
Midbrain
Pons Tentorium cerebelli

4th ventricle
Prepontine cistern
Premedullary cistern
Frontal lobe
Lateral ventricle Central sulcus
Caudate head Parietal lobe

Caudothalamic groove
Thalamus Parietooccipital sulcus
Temporal lobe
Occipital lobe
(Top) The 1st of 6 sagittal T1 MR images through the cerebral hemispheres from midline to lateral is shown. The images are taken
through planes/levels corresponding to those commonly used for ultrasound scans through the anterior fontanelle. The midline sagittal
image shows the corpus callosum, the largest commissural fiber connecting both cerebral hemispheres. (Middle) Parasagittal image just
off the midline is shown. The tentorium cerebelli is a dural fold separating the brain into supratentorial and infratentorial
compartments. (Bottom) More lateral image shows the caudothalamic groove between the caudate head and thalamus. The
parietooccipital sulcus is an important landmark, differentiating the parietal from the occipital lobes.
21
Brain
Brain and Spine
SAGITTAL US VIA ANTERIOR FONTANELLE
Frontal lobe
Thalamus
Choroid plexus in atrium

Sylvian fissure Occipital horn
Temporal lobe
Cortical sulcus
Cortical gyrus
Peritrigonal blush
Sylvian fissure Occipital lobe
Temporal lobe
Cortical sulcus
Cortical gyrus
Sylvian fissure Temporal lobe
(Top) This parasagittal image shows the glomus of the choroid plexus in the trigone. The glomus tapers anteriorly as it courses along
the floor of the lateral ventricle to the foramen of Monro and continues along the roof of the 3rd ventricle. It also tapers posteriorly
from the trigone into the temporal horn of each lateral ventricle. Glomus may appear bulbous and irregular at the trigone and should
not be mistaken as a blood clot. (Middle) This parasagittal image is obtained just lateral to the lateral ventricle. The echogenic white
matter of the brain just posterior and superior to the ventricular trigone is known as the peritrigonal blush or halo, representing
radiating white fiber tracts (corona radiata). The peritrigonal blush is more prominent in premature than in term neonates. (Bottom)
This is the last and most lateral sagittal image obtained, showing the mature sulcal pattern with hyperechoic sulci and hypoechoic gyri.
22
Brain
Brain and Spine

SAGITTAL T1 MR
Choroid plexus in atrium of lateral

ventricle
Choroid plexus in temporal horn of
Occipital horn
lateral ventricle
Central sulcus
Precentral gyrus Postcentral gyrus
Sylvian fissure
Central sulcus


(Top) This image shows a prominent choroid plexus within the atrium of the lateral ventricle, which tapers posteriorly and extends into
the temporal horn. (Middle) This parasagittal image shows the sylvian fissure bound superiorly by the frontal operculum and inferiorly
by the temporal operculum. The central sulcus separates the frontal lobe anteriorly from the parietal lobe posteriorly. (Bottom) This
image shows the most lateral portion of the sylvian fissure. The temporal lobe is inferior to the sylvian fissure. The superior temporal
gyrus contains the primary auditory cortex. The middle temporal gyrus connects auditory, somatosensory, and visual association
pathways. The inferior temporal gyrus is the higher visual association area.
23
Brain
Brain and Spine
PREMATURE INFANT (23 WEEKS 6 DAYS)
Corpus callosum
Sylvian fissure
Opercula
Tips of temporal horns

Insula
Caudate
Caudothalamic groove Parietooccipital sulcus
Thalamus Occipital lobe
Cerebellum
Sylvian fissure
Eye
Temporal lobe
(Top) This coronal image of a very premature infant, born at 23-weeks 6-days gestational age, shows a very large, square, open sylvian
fissure. The opercula have not yet grown to cover the insula. (Middle) Sagittal image through the caudothalamic groove in the same
case shows the parietooccipital sulcus. The cortex otherwise appears "flat" without gyri/sulcal formation. (Bottom) Another sagittal
image further lateral shows similar findings with no cortical gyri/sulci seen.
24
Brain
Brain and Spine

SYLVIAN FISSURE AT DIFFERENT AGES
Parietal operculum
Sylvian fissure
Insula
Temporal operculum
Thalamus
Temporal lobe
Cerebellar vermis
Cisterna magna
Parietal operculum
Sylvian fissure Insula
Temporal operculum
Tentorium cerebelli
Cisternal magna
Choroid in lateral ventricles and roof of

3rd ventricle
Sylvian fissure
Cortical sulci
3rd ventricle
(Top) A different infant born at 29 weeks 1 day shows more advanced development of the sylvian fissures. The frontal, temporal, and
parietal lobes all have opercula, which have grown to cover the insula. (Middle) At 31 weeks 6 days the opercula have grown to cover
the insula. (Bottom) Another coronal image through the level of the sylvian fissure in a full-term infant shows multiple gyri and sulci
over the convexities of the brain. It is important to understand the developmental anatomic changes; lack of cortical sulci may be
normal for preterm infants, depending on the gestational age at delivery, but is very abnormal at term.
25
Brain
Brain and Spine
SAGITTAL US VIA POSTERIOR FONTANELLE
Posterior fontanelle
Thalamus
Vermis
Midbrain
Pons
4th ventricle
Medulla
Thalamus
Glomus of choroid
(Top) Although routine scanning is performed via the anterior fontanelle, the posterior fontanelle is another alternative, particularly
when it is difficult seeing more posterior structures in the brain. (Middle) This scan through the posterior fontanelle in a 26-week
premature infant was performed to better evaluate the corpus callosum. The splenium is particularly well seen in this view. (Bottom)
Color Doppler image shows flow within the choroid plexus of the glomus. The posterior fontanelle view can be helpful to differentiate
bulky choroid from clot. The occipital horn does not contain choroid plexus, and any echogenic material in the occipital horn should
raise the suspicion of intraventricular hemorrhage.
26
Another random document with
no related content on Scribd:
GUTENBERG BIBLE
This book was illuminated, bound, and
completed for Henry Cremer, Vicar of
Saint Stephens, of Mayence, in the year
of our Lord, one thousand four
hundred and fifty-six, on the feast of
the Ascension of the Glorious Virgin
Mary. Thanks be to God. Alleluia.
Rubricator’s Mark at End of Second Volume of a Defective Copy in the Bibliothèque
Nationale, Paris
The copy I love best to pore over is that bound in four volumes of red
morocco, stamped with the arms of Louis XVI, in the Bibliothèque Nationale.
This perhaps is not so historical as the one De Bure discovered in the library
of Cardinal Mazarin in Paris in 1763,—three hundred years after it was
printed, and until then unknown; but the dignity of those beautifully printed
types on the smooth, ivory surface of the vellum possesses a magnificence
beyond that of any other copy I have seen. Also at the Bibliothèque Nationale
is a defective paper copy in two volumes in which appear rubricator’s notes
marking the completion of the work as August 15, 1456. Think how important
this is in placing this marvel of typography; for the project of printing the Bible
could not have been undertaken earlier than August, 1451, when Gutenberg
formed his partnership with Fust and Schoeffer in Mayence.
GUTENBERG, FUST, COSTER, ALDUS, FROBEN
From Engraving by Jacob Houbraken (1698–1780)
To a modern architect of books the obstacles which the printer at that

time encountered, with the art itself but a few years old, seem insurmountable.
There was the necessity of designing and cutting the first fonts of type, based
upon the hand lettering of the period. As is always inevitable in the infancy of
any art, this translation from one medium to another repeated rather than
corrected the errors of the human hand. The typesetter, instead of being
secured from an employment office, had to be made. Gutenberg himself
perhaps, had to teach the apprentice the method of joining together the
various letters, in a roughly made composing stick of his own invention, in
such a way as to maintain regularity in the distances between the stems of the
various letters, and thus produce a uniform and pleasing appearance. There
existed no proper iron chases in which to lock up the pages of the type, so that
while the metal could be made secure at the top and bottom, there are
frequent instances where it bulges out on the sides.
John Fust, from an Old Engraving
From the very beginning the printed book had to be a work of art. The
patronage of kings and princes had developed the hand-lettered volumes to
the highest point of perfection, and, on account of this keen competition with
the scribes and their patrons, no printer could afford to devote to any volume
less than his utmost artistic taste and mechanical ingenuity. Thus today, if a
reader examines the Gutenberg Bible with a critical eye, he will be amazed by the
extraordinary evenness in the printing, and the surprisingly accurate alignment
of the letters. The glossy blackness of the ink still remains, and the sharpness
of the impression is equal to that secured upon a modern cylinder press.
It has been estimated that no less than six hand presses were employed in
printing the 641 leaves, composed in double column without numerals, catch
words, or signatures. What binder today would undertake to collate such a
volume in proper sequence! After the first two divisions had come off the
press it was decided to change the original scheme of the pages from 40 to 42
lines. In order to get these two extra lines on the page it was necessary to set
all the lines closer together. To accomplish this, some of the type was recast,
with minimum shoulder, and the rest of it was actually cut down in height to
such an extent that a portion of the curved dots of the i’s was clipped off.
Monographs have been written to explain the variation in the size of the
type used in different sections of this book, but what more natural explanation
could there be than that the change was involuntary and due to natural causes?
In those days the molds which the printer used for casting his types were made
sometimes of lead, but more often of wood. As he kept pouring the molten
metal into these matrices, the very heat would by degrees enlarge the mold
itself, and thus produce lead type of slightly larger size. From time to time,
also, the wooden matrices wore out, and the duplicates would not exactly
correspond with those they replaced.
In printing these volumes, the precedent was established of leaving blank
spaces for the initial letters, which were later filled in by hand. Some of these
are plain and some elaborate, serving to make the resemblance to the hand-
lettered book even more exact; but the glory of the Gutenberg Bible lies in its
typography and presswork rather than in its illuminated letters.
Germany, in the Gutenberg Bible, proved its ability to produce volumes

worthy of the invention itself, but as a country it possessed neither the
scholars, the manuscripts, nor the patrons to insure the development of the
new art. Italy, at the end of the fifteenth century, had become the home of
learning, and almost immediately Venice became the Mecca of printers.
Workmen who had served their apprenticeships in Germany sought out the
country where princes might be expected to become patrons of the new art,
where manuscripts were available for copy, and where a public existed both
able and willing to purchase the products of the press. The Venetian Republic,
quick to appreciate this opportunity, offered its protection and
encouragement. Venice itself was the natural market of the world for
distribution of goods because of the low cost of sea transportation.
I have a fine copy of Augustinus: De Civitate Dei (page 205) that I
discovered in Rome in its original binding years ago, printed in Jenson’s Gothic
type in 1475. On the first page of text, in bold letters across the top, the
printer has placed the words, Nicolaus Jenson, Gallicus. In addition to this
signature, the explicit reads:
This work De Civitate Dei is happily completed, being done in Venice by that
excellent and diligent master, Nicolas Jenson, while Pietro Mocenigo was Doge, in the
year after the birth of the Lord, one thousand four hundred and seventy-five, on the
sixth day before the nones of October (2 October)
Nicolas Jenson’s Explicit and Mark

Jenson’s Gothic Type. From Augustinus: De Civitate Dei, Venice, 1475 (Exact size)
Jenson was a printer who not only took pride in his art but also in the
country of his birth! He was a Frenchman, who was sent to Mayence by King
Charles VII of France to find out what sort of thing this new art of printing
was, and if of value to France to learn it and to bring it home. Jenson had been
an expert engraver, so was well adapted to this assignment. At Mayence he
quickly mastered the art, and was prepared to transport it to Paris; but by this
time Charles VII had died, and Jenson knew that Louis XI, the new monarch,
would have little interest in recognizing his father’s mandate. The Frenchman
then set himself up in Venice, where he contributed largely to the prestige
gained by this city as a center for printing as an art, and for scholarly
publications.
Jenson had no monopoly on extolling himself in the explicits of his books.
The cost of paper in those days was so high that a title page was considered an
unnecessary extravagance, so this was the printer’s only opportunity to record
his imprint. In modern times we printers are more modest, and leave it to the
publishers to sound our praises, but we do like to place our signatures on well-
made books!
The explicit in the hand-written book also offered a favorite opportunity
for gaining immortality for the scribe. I once saw in an Italian monastery a
manuscript volume containing some 600 pages, in which was recorded the fact
that on such and such a day Brother So-and-So had completed the transcribing
of the text; and inasmuch as he had been promised absolution, one sin for
each letter, he thanked God that the sum total of the letters exceeded the sum
total of his sins, even though by but a single unit!
Among Jenson’s most important contributions were his type designs,
based upon the best hand lettering of the day. Other designers had slavishly
copied the hand-written letter, but Jenson, wise in his acquired knowledge,
eliminated the variations and produced letters not as they appeared upon the
hand-written page, but standardized to the design which the artist-scribe had
in mind and which his hand failed accurately to reproduce. The Jenson Roman
(page 22) and his Gothic (page 205) types have, through all these centuries,
stood as the basic patterns of subsequent type designers.
Jenson died in 1480, and the foremost rival to his fame is Aldus Manutius,
who came to Venice from Carpi and established himself there in 1494. I have
often conjectured what would have happened had this Frenchman printed his
volumes in France and thus brought them into competition with the later
product of the Aldine Press. The supremacy of Italy might have suffered,—
but could Jenson have cut his types or printed his books in the France of the
fifteenth century? As it was, the glories of the Aldi so closely followed Jenson’s
superb work that Italy’s supreme position in the history of typography can
never be challenged.
For his printer’s mark Aldus adopted the famous combination of the
Dolphin and Anchor, the dolphin signifying speed in execution and the anchor
firmness in deliberation. As a slogan he used the words Festina lente, of which
perhaps the most famous translation is that by Sir Thomas Browne, “Celerity
contempered with Cunctation.” Jenson’s printer’s mark (page 203), by the way,
has suffered the indignity of being adopted as the trademark of a popular
brand of biscuits!
Device of Aldus Manutius
The printing office of Aldus stood near the Church of Saint Augustus, in
Venice. Here he instituted a complete revolution in the existing methods of
publishing. The clumsy and costly folios and quartos, which had constituted
the standard forms, were now replaced by crown octavo volumes, convenient
both to the hand and to the purse.
“I have resolved,” Aldus wrote in 1490, “to devote my life to the cause of
scholarship. I have chosen, in place of a life of ease and freedom, an anxious
and toilsome career. A man has higher responsibilities than the seeking of his
own enjoyment; he should devote himself to honorable labor. Living that is a
mere existence can be left to men who are content to be animals. Cato
compared human existence to iron. When nothing is done with it, it rusts; it is
only through constant activity that polish or brilliancy is secured.”
GROLIER IN THE PRINTING OFFICE OF ALDUS
After Painting by François Flameng
Courtesy The Grolier Club, New York City
The weight of responsibility felt by Aldus in becoming a printer may be

better appreciated when one realizes that this profession then included the
duties of editor and publisher. The publisher of today accepts or declines
manuscripts submitted by their authors, and the editing of such manuscripts, if
considered at all, is placed in the hands of his editorial department. Then the
“copy” is turned over to the printer for manufacture. In the olden days the
printer was obliged to search out his manuscripts, to supervise their editing—
not from previously printed editions, but from copies transcribed by hand,
frequently by careless scribes. Thus his reputation depended not only on his
skill as a printer, but also upon his sagacity as a publisher, and his scholarship
as shown in his text. In addition to all this, the printer had to create the
demand for his product and arrange for its distribution because there were no
established bookstores.
The great scheme that Aldus conceived was the publication of the Greek
classics. Until then only four of the Greek authors, Æsop, Theocritus, Homer,
and Isocrates, had been published in the original. Aldus gave to the world, for
the first time in printed form, Aristotle, Plato, Thucydides, Xenophon,
Herodotus, Aristophanes, Euripides, Sophocles, Demosthenes, Lysias,
Æschines, Plutarch, and Pindar. Except for what Aldus did at this time, most
of these texts would have been irrevocably lost to posterity.
When you next see Italic type you will be interested to know that it was
first cut by Aldus, said to be inspired by the thin, inclined, cursive handwriting
of Petrarch; when you admire the beauty added to the page by the use of small
capitals, you should give Aldus credit for having been the first to use this
attractive form of typography. Even in that early day Aldus objected to the
inartistic, square ending of a chapter occupying but a portion of the page, and
devised all kinds of type arrangements, half-diamond, goblet, and bowl, to
satisfy the eye.
To me, the most interesting book that Aldus produced was the
Hypnerotomachia Poliphili,—“Poliphilo’s Strife of Love in a Dream.” It stands as
one of the most celebrated in the annals of Venetian printing, being the only
illustrated volume issued by the Aldine Press. This work was undertaken at the
very close of the fifteenth century at the expense of one Leonardo Crasso of
Verona, who dedicated the book to Guidobaldo, Duke of Urbino. It was
written by a Dominican friar, Francesco Colonna, who adopted an ingenious
method of arranging his chapters so that the successive initial letters compose
a complete sentence which, when translated, read, “Brother Francesco
Colonna greatly loved Polia.” Polia has been identified as one Lucrezia Lelio,
daughter of a jurisconsult of Treviso, who later entered a convent.
Text Page from Aldus’ Hypnerotomachia Poliphili, Venice, 1499 (11 × 7 inches).
It is on this model that the type used in this volume is based
Illustrated Page of Aldus’ Hypnerotomachia Poliphili, Venice, 1499 (11 × 7 inches)
GROLIER BINDING
Castiglione: Cortegiano. Aldine Press, 1518
Laurenziana Library, Florence
The volume displays a pretentious effort to get away from the

commonplace. On every page Aldus expended his utmost ingenuity in the
arrangement of the type,—the use of capitals and small capitals, and unusual
type formations. In many cases the type balances the illustrations in such a way
as to become a part of them. Based on the typographical standards of today,
some of these experiments are indefensible, but in a volume issued in 1499
they stand as an extraordinary exhibit of what an artistic, ingenious printer can
accomplish within the rigid limitations of metal type. The illustrations
themselves, one hundred and fifty-eight in number, run from rigid
architectural lines to fanciful portrayals of incidents in the story. Giovanni
Bellini is supposed to have been the artist, but there is no absolute evidence to
confirm this supposition.
Some years ago the Grolier Club of New York issued an etching entitled,
Grolier in the Printing Office of Aldus (page 208). I wish I might believe that this
great printer was fortunate enough to have possessed such an office! In spite
of valuable concessions he received from the Republic, and the success
accorded to him as a printer, he was able to eke out but a bare existence, and
died a poor man. The etching, however, is important as emphasizing the close
relation which exited between the famous ambassador of François I at the
Court of Pope Clement VII, at Rome, and the family of Aldus, to which
association booklovers owe an eternal debt of gratitude. At one time the
Aldine Press was in danger of bankruptcy, and Grolier not only came to its
rescue with his purse but also with his personal services. Without these
tangible expressions of his innate love for the book, collectors today would be
deprived of some of the most interesting examples of printing and binding
that they count among their richest treasures.
The general conception that Jean Grolier was a binder is quite erroneous;
he was as zealous a patron of the printed book as of the binder’s art. His great
intimacy in Venice was with Andrea Torresani (through whose efforts the
Jenson and the Aldus offices were finally combined), and his two sons,
Francesco and Federico, the father-in-law and brothers-in-law of the famous
Aldus. No clearer idea can be gained of Grolier’s relations at Casa Aldo than
the splendid letter which he sent to Francesco in 1519, intrusting to his hands
the making of Budé’s book, De Asse:
GROLIER BINDING
Capella: L’Anthropologia Digaleazzo. Aldine Press, 1533
From which the Cover Design of this Volume was adapted
(Laurenziana Library, Florence. 7½ × 4¼ inches)
You will care with all diligence, he writes, O most beloved Francesco, that this
work, when it leaves your printing shop to pass into the hands of learned men, may be
as correct as it is possible to render it. I heartily beg and beseech this of you. The book,
too, should be decent and elegant; and to this will contribute the choice of the paper, the
excellence of the type, which should have been but little used, and the width of the
margins. To speak more exactly, I should wish it were set up with the same type with
which you printed your Poliziano. And if this decency and elegance shall increase your
expenses, I will refund you entirely. Lastly, I should wish that nothing be added to the
original or taken from it.
What better conception of a book, or of the responsibility to be assumed
toward that book, both by the printer and by the publisher, could be expressed
today!
The early sixteenth century marked a crisis in the world in which the book
played a vital part. When Luther, at Wittenberg, burned the papal bull and
started the Reformation, an overwhelming demand on the part of the people
was created for information and instruction. For the first time the world
realized that the printing press was a weapon placed in the hands of the masses
for defence against oppression by Church or State. François I was King of
France; Charles V, Emperor of the Holy Roman Empire; and Henry VIII,
King of England. Italy had something to think about beyond magnificently
decorated volumes, and printing as an art was for the time forgotten in
supplying the people with books at low cost.
François I, undismayed by the downfall of the Italian patrons, believed that
he could gain for himself and for France the prestige which had been Italy’s
through the patronage of learning and culture. What a pity that he had not
been King of France when Jenson returned from Mayence! He was confident
that he could become the Mæcenas of the arts and the father of letters, and
still control the insistence of the people, which increased steadily with their
growing familiarity with their new-found weapon. He determined to have his
own printer, and was eager to eclipse even the high Standard the Italian
master-printers had established.
ROBERT ÉTIENNE, 1503–1559
Royal Printer to François I
From Engraving by Étienne Johandier Desrochers (c. 1661–1741)
Robert Étienne (or Stephens), who in 1540 succeeded Néobar as “Printer

in Greek to the King,” while not wholly accomplishing his monarch’s
ambitions, was the great master-printer of his age. He came from a family of
printers, and received his education and inspiration largely from the learned
men who served as correctors in his father’s office. François proved himself
genuinely interested in the productions of his Imprimerie Royale, frequently
visiting Étienne at the Press, and encouraging him by expending vast sums for
specially designed types, particularly in Greek. The story goes that on one
occasion the King found Étienne engaged in correcting a proof sheet, and
refused to permit the printer to be disturbed, insisting on waiting until the
work was completed.
For my own collection of great typographical monuments I would select
for this period the Royal Greeks of Robert Étienne. A comparison between the
text page, so exquisitely balanced (page 222), and the title page (page 220), where
the arrangement of type and printer’s mark could scarcely be worse, gives
evidence enough that even the artist-printer of that time had not yet grasped
the wonderful opportunity a title page offers for self-expression. Probably
Étienne regarded it more as a chance to pay his sovereign the compliment of
calling him “A wise king and a valiant warrior.” But are not the Greek
characters marvelously beautiful! They were rightly called the Royal Greeks! The
drawings were made by the celebrated calligrapher Angelos Vergetios, of
Candia, who was employed by François to make transcripts of Greek texts for
the Royal Collection, and whose manuscript volumes may still be seen in the
Bibliothèque Nationale in Paris. Earlier fonts had been based upon this same
principle of making the Greek letters reproductions as closely as possible of
the elaborate, involved, current writing hand of the day; but these new designs
carried out the principle to a degree until then unattained. The real success of
the undertaking was due to the skill of Claude Garamond, the famous French
punchcutter and typefounder. Pierre Victoire quaintly comments:
Besides gathering from all quarters the remains of Hellenic literature, François I
added another benefit, itself most valuable, to the adornment of this same honorable
craft of printing; for he provided by the offer of large moneys for the making of
extremely graceful letters, both of Greek and Latin. In this also he was fortunate, for
they were so nimbly and so delicately devised that it can scarce be conceived that human
wit may compass anything more dainty and exquisite; so that books printed from these
types do not merely invite the reader,—they draw him, so to say, by an irresistible
attraction.
ÉTIENNE’S ROYAL GREEKS, Paris, 1550
Title Page (10¼ × 6 inches)
Page showing Étienne’s Roman Face (Exact size)

Imaging Anatomy Ultrasound 2Nd Edition Paula J Woodward Full Chapter

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Imaging Anatomy Ultrasound 2Nd Edition Paula J Woodward Full Chapter

Uploaded by

Copyright:

Available Formats

Imaging Anatomy.

James F. Griffith, MD, MRCP, FRCR K. T. Wong, MBChB, FRCR, FHKCR,

IMAGING ANATOMY: ULTRASOUND, SECOND EDITION ISBN: 978-0-323-54800-7

Copyright © 2018 by Elsevier. All rights reserved.

Publisher Cataloging-in-Publication Data

Names: Woodward, Paula J.

International Standard Book Number: 978-0-323-54800-7

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Bryan R. Foster, MD Yolanda Y. P. Lee, MBChB, FRCR, FHKCR,

Chander Lulla, MD, DMRD

Deyond Y. W. Siu, MBChB, FRCR

Art Direction and Design

124 Lower Cervical Level and Supraclavicular Fossa

SECTION 8: OBSTETRICS AND

Brain and Spine

Scalp and Calvarial Vault 4

○ Inner tables often slightly irregular (convolutional

Brain and Spine

Posterolateral/mastoid fontanelle Mendosal suture

Sweat gland and duct

Subcutaneous fibroadipose tissue

US AND T2WI MR, SCALP

Outer table of calvarium

Periosteum covering calvarium

Inner table of calvarium

Superior sagittal sinus

Inner table of calvarium

Cortical v. in subarachnoid space

Scalp Outer table of calvarium

Superior sagittal sinus Inner table of calvarium

Brain and Spine

Suture Outer table of calvarium

Cortical vv. in subarachnoid space

Inner table of calvarium

Brain and Spine

GYRI AND SULCI

Superior frontal gyrus

Superior temporal gyrus Sylvian fissure

Superior frontal gyrus

Middle frontal gyrus

Inferior frontal gyrus

Inferior parietal lobule

Brain and Spine

Medial frontal gyrus

Genu of corpus callosum Septum pellucidum

Splenium of corpus callosum

Cistern of velum interpositum

Suprasellar cistern Superior cerebellar cistern

Brain and Spine

CORONAL US VIA ANTERIOR FONTANELLE

Superior frontal gyrus

Genu, corpus callosum

Insula Temporal lobe

Middle cranial fossa

Brain and Spine

Falx Superior frontal gyrus

Middle frontal gyrus

Superior frontal gyrus

Inferior frontal gyrus

Superior frontal gyrus

Middle frontal gyrus

CORONAL US VIA ANTERIOR FONTANELLE

Cavum septi pellucidi