Anatomy for Diagnostic Imaging

347 Pages·2010·45.42 MB·English

by  Stephanie Ryan

Anatomy
for
Diagnostic Imaging
Dedication
This book is dedicated to:
Tom, Stephen, Ellen and Niamh (SR)
Billy, Barry, Jack, Sam and Michael (MMcN)
Nicola, Sarah, Emma, Jack and Nick (SE)
Commissioning Editor: Timothy Horne
Development Editor: Lulu Stader
Project Manager: Elouise Ball
Cover Design: Charles Gray
Text Design: Stewart Larking
Illustration Manager: Merlyn Harvey
Illustrator: Amanda William
Anatomy
for
Diagnostic Imaging
T H I R D E D I T I O N
Stephanie Ryan
FRCSI FFR(RCSI)
Consultant Paediatric Radiologist, Children’s University Hospital, Temple Street,
Dublin, Ireland
Michelle McNicholas
MRCPI FFR(RCSI) FRCR
Consultant Radiologist, Mater Misericordiae Hospital, Dublin, Ireland
Stephen Eustace
MSc(RadSci) MRCPI FFR(RCSI) FRCR
Consultant Radiologist, Mater Misericordiae & Cappagh National Orthopaedic Hospitals,
Dublin, Ireland
Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto  2011
An imprint of Elsevier Ltd
First Edition © Saunders 1994
Second Edition © Elsevier Limited 2004
Third Edition © 2011, Elsevier Limited. All rights reserved.
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ISBN 978-0-7020-2971-4
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Notice
Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods,
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Contents
Preface vii The pleura 119
The trachea and bronchi 122
Acknowledgements viii
The lungs 125
The mediastinal divisions 130
 1 Head and neck .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1 The heart 131
The skull and facial bones 1 The great vessels 140
The nasal cavity and paranasal sinuses 13 The oesophagus 144
The mandible and teeth 16 The thoracic duct and mediastinal lymphatics 146
The oral cavity and salivary glands 19 The thymus 147
The orbital contents 24 The azygos system 147
The ear 28 Important nerves of the mediastinum 149
The pharynx and related spaces 32 The mediastinum on the chest radiograph 150
The nasopharynx and related spaces 32 Cross-sectional anatomy 152
The larynx 38
The thyroid and parathyroid glands 40  5 The abdomen  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 157
The neck vessels 43 Anterior abdominal wall 157
The stomach 158
 2 The central nervous system .  .  .  .  .  .  .  .  .  .  .  .52 The duodenum 164
Cerebral hemispheres 52 The small intestine 167
Cerebral cortex 52 The ileocaecal valve 169
White matter of the hemispheres 54 The appendix 169
Basal ganglia 60 The large intestine 170
Thalamus, hypothalamus and pineal gland 63 The liver 175
Pituitary gland 65 The biliary system 182
Limbic lobe 66 The pancreas 187
The brainstem 67 The spleen 192
Cerebellum 70 The portal venous system 193
Ventricles, cisterns, CSF production and flow The kidneys 196
ventricles 73 The ureter 202
Meninges 79 The adrenal glands 203
Arterial supply of the CNS 80 The abdominal aorta 204
Internal carotid artery 80 The inferior vena cava 205
Venous drainage of the brain 87 Veins of the posterior abdominal wall 206
The peritoneal spaces of the abdomen 208
 3 The spinal column and its contents  .  .  .  .  .  .  .91 Cross-sectional anatomy of the upper abdomen 212
The vertebral column 91
Joints of the vertebral column 100  6 The pelvis  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 218
Ligaments of the vertebral column 102 The bony pelvis, muscles and ligaments 218
The intervertebral discs 102 The pelvic floor 221
Blood supply of the vertebral column 105 The sigmoid colon, rectum and anal canal 222
The spinal cord 106 Blood vessels, lymphatics and nerves of the pelvis 226
The spinal meninges 108 The lower urinary tract 230
Blood supply of the spinal cord 108 The male urethra 232
The female urethra 233
 4 The thorax  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 113 The male reproductive organs 233
The thoracic cage 113 The female reproductive tract 239
The diaphragm 117 Cross-sectional anatomy 247
Contents
 7 The upper limb .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   . 251  9 The breast   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   . 313
The bones of the upper limb 251 General anatomy 313
The joints of the upper limb 257 Lobular structure 313
The muscles of the upper limb 275 Blood supply 313
The arterial supply of the upper limb 276 Lymphatic drainage 313
The veins of the upper limb 278 Radiology of the breast 314
Age changes in the breast 321
Radiological signifi cance of breast density and
 8 The lower limb   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   . 280
parenchymal pattern 321
The bones of the lower limb 280
The joints of the lower limb 287 Index 325
The muscles of the lower limb 305
The arteries of the lower limb 306
The veins of the lower limb 310
vi
Preface
The fi rst edition of this book was published 15 years ago and the book, with an initial traditional anatomical description of
was welcomed by radiologists and other clinicians, but particu- each organ or system followed by the radiological anatomy of
larly by radiologists in training who sought to learn the ana- that part of the body using all the relevant imaging modalities
tomical basis of radiological imaging – usually early in their We have included a series of ‘ radiology pearls ’ with most
radiological training sections to underscore clinically and radiologically important
Over these years the anatomy of the human body remained points Each chapter is illustrated, as before, with line dia-
unchanged of course, but the techniques used to image it have grams, radiographs, angiograms, ultrasound, CT or MR images,
changed immeasurably Bronchography and lymphography as appropriate We have completely revised the text We have,
have long since gone Diagnostic cardiac catheterization and despite all this, succeeded in keeping the size of the book
diagnostic angiography have been largely replaced by CT and manageable, especially with the exam candidate in mind We
MR angio graphy CT has changed from being an axial imaging have also kept the cost of the book as low as was reasonably
technique to being a rapid and powerful 3D imaging technique achievable!
MR imaging techniques allow not only multiplanar and 3D The authors have immense clinical experience as radiologists
views of anatomy but visualization of arterial and venous each in different subspecialties We all teach regularly and
anatomy and, by tractography, direct imaging of the neural remain in contact with the needs of the examination candi-
tracts in the brain Rapid advances in interventional radiological dates in a wide variety of medical disciplines We hope that
techniques guided by ultrasound, CT, MR and angiography this clinical experience is refl ected in the content of the text
require a new understanding of age-old anatomy and the choice of images in this new edition
In this third edition we have therefore addressed these new We trust that this third edition continues to be of use to
techniques, explored some areas in much greater detail than radiologists and radiographers both in training and in practice,
before and added over 140 new images including some colour and to medical students, physicians and surgeons and all who
images Such is the anatomical detail that can now be demon- use imaging as a vital part of patient care This third edition
strated by imaging that some diagrams can now be replaced by brings the basics of radiological anatomy to a new generation
those images We have retained the successful organization of of radiologists in an ever-changing world of imaging
Acknowledgements
As for the first and second editions, we acknowledge the help Most of all, we thank our families for bearing with us as
of very many people in the amassing of radiological material hours on end were spent with the computer rewriting the
for this book We have received much positive and some dreaded book, yet again
critical feedback from many people all over the world We We are extremely fortunate to have the approval of the
have incorporated suggestions for improvement that we have late Professor J B Coakley, Professor Emeritus of Anatomy at
received into each edition University College Hospital, Dublin, to use many of his excel-
We are grateful to all our colleagues for their patience with lent line drawings (Figs 1 43, 1 46, 1 49; 4 5A and B, 4 19,
our constant searches for the perfect image for ‘the book’ We 4 21, 4 22, 4 35, 4 39) These have been appreciated by gen-
are very grateful for the help of radiographers including Andrea erations of medical students
Craddock and James Bisset at the Mater Hospital, Annette Fig 3 21A is reproduced with permission from Sheehy N,
White at Cappagh Hospital and Sarah McGeough, Liliana Boyle G, Meaney JFM 2005 High-resolution 3D contrast-
Barreira and Martina Bonnar at the Children’s Hospital, enhanced MRA of the normal anterior spinal arteries within
Temple Street We acknowledge the help of Dr Leo Lawler, the cervical region Radiology 236(2): 637–641
Dr Darra Murphy and Dr Martin Shelly at the Mater Hospital Fig 5 19B is courtesy of Siemens
and Dr Aimen Quateen at Beaumont Hospital Fig 5 27 is adapted with permission from Covey AM et al
We are grateful to Timothy Horne of Elsevier who has 2004 Anatomic variations in portal vein anatomy American
spearheaded the production of a second and third edition of Journal of Radiology 183: 1055–1065
this book and to Lulu Stader, our editor, who tried to be
patient with deadlines stretched and extended well beyond
original plans
1
Head and neck
CHAPTER CONTENTS which is continuous with the fibrous tissue in the sutures The
periosteum is called the pericranium externally and on the
The skull and facial bones  . . . . . . . . . . . . . . . . . . . . . . . . . . .1
deep surface of the skull is called endosteum The endosteum
The nasal cavity and paranasal sinuses  . . . . . . . . . . . . . . .13
is the outer layer of the dura The diploic veins within the skull
The mandible and teeth  . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 are large, valveless vessels with thin walls They communicate
with the meningeal veins, the dural sinuses and the scalp veins
The oral cavity and salivary glands . . . . . . . . . . . . . . . . . . .19
The paired parietal bones form much of the side and the
The orbital contents  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 roof of the skull and are joined in the midline at the sagittal
The ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 suture Parietal foramina are paired foramina or areas of thin
bone close to the midline in the parietal bones They are often
The pharynx and related spaces . . . . . . . . . . . . . . . . . . . . .32
visible on a radiograph, may be big and may even be palpable
The nasopharynx and related spaces . . . . . . . . . . . . . . . . .32 They may transmit emissary veins from the sagittal sinus The
frontal bone forms the front of the skull vault It is formed by
The larynx  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
two frontal bones that unite at the metopic suture The frontal
The thyroid and parathyroid glands  . . . . . . . . . . . . . . . . . .40
bones join the parietal bones at the coronal suture The junc-
The neck vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 tion of coronal and sagittal sutures is known as the bregma
The occipital bone forms the back of the skull vault and is
joined to the parietal bones at the lambdoid suture The lamb-
The skull and facial bones
doid and sagittal sutures join at a point known as the lambda
The greater wing of sphenoid and the squamous part of
The skull consists of the calvarium, facial bones and mandible the temporal bone form the side of the skull vault below the
The calvarium is the brain case and comprises the skull vault frontal and parietal bones The sutures formed here are: (i) the
and skull base The bones of the calvarium and face are joined sphenosquamosal suture between the sphenoid and temporal
at immovable fibrous joints, except for the temporomandibular bones; (ii) the sphenofrontal and sphenoparietal sutures
joint, which is a movable cartilaginous joint between greater wing of sphenoid and frontal and parietal
bones; and (iii) the squamosal suture between temporal and
parietal bones The sphenofrontal, sphenoparietal and squa-
The skull vault
(Figs 1 1–1 4) mosal sutures form a continuous curved line (Fig 1 1) The
intersection of the sutures between the frontal, sphenoidal,
The skull vault is made up of several flat bones, joined at parietal and temporal bones is termed the pterion and provides
sutures, which can be recognized on skull radiographs The a surface marking for the anterior branch of the middle menin-
bones consist of the diploic space – a cancellous layer contain- geal artery on the lateral skull radiograph The asterion is
ing vascular spaces – sandwiched between the inner and outer the point where the squamosal suture meets the lambdoid
tables of cortical bone The skull is covered by periosteum, suture
© 2011, Elsevier Ltd
DOI: 10.1016/B978-0-7020-2971-4.00006-X