Applied Radiological Anatomy

399 Pages·2012·48.85 MB·English

by  Paul Butler

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Pearls and Pitfalls in e
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best possible anatomic examples currently available Fergus V. Coakley Anatomy
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American Journal of Radiology
Cover designed by Zoe Naylor
Applied Radiological Anatomy
Second Edition

Applied Radiological Anatomy
Second Edition
Edited by:
Paul Butler
Consultant Neuroradiologist, The Royal London Hospital, London, UK
Adam W. M. Mitchell
Consultant Radiologist, Chelsea and Westminster Hospital, London;
Honorary Senior Lecturer at Imperial College London, UK
Jeremiah C. Healy
Consultant Radiologist, Chelsea and Westminster Hospital, London;
Honorary Senior Lecturer at Imperial College London, UK
cambridge university press
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Cambridge University Press
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Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521766661
First edition © Cambridge University Press 1999
Second edition © Cambridge University Press 2012
Th is publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First edition published 1999
Second edition published 2012
Printed in the United Kingdom at the University Press, Cambridge
A catalogue record for this publication is available from the British Library
Library of Congress Cataloguing in Publication data
Applied radiological anatomy / edited by Paul Butler, Adam Mitchell,
Jeremiah C. Healy. – 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-521-76666-1 (hardback)
1. Radiography, Medical. 2. Human anatomy. 3. Human
anatomy–Atlases. I. Butler, Paul, 1954 June 4– II. Mitchell,
Adam W. M. III. Ellis, Harold, 1926– IV. Title.
RC78.A675 2011
616.07'572–dc22 2011007348
ISBN 978-0-521-76666-1 Hardback
Cambridge University Press has no responsibility for the
persistence or accuracy of URLs for external or third-party
internet websites referred to in this publication, and does not
guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Every eff ort has been made in preparing this book to provide
accurate and up-to-date information which is in accord with
accepted standards and practice at the time of publication.
Although case histories are drawn from actual cases, every eff ort
has been made to disguise the identities of the individuals involved.
Nevertheless, the authors, editors and publishers can make no
warranties that the information contained herein is totally free from
error, not least because clinical standards are constantly changing
through research and regulation. Th e authors, editors and publishers
therefore disclaim all liability for direct or consequential damages
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Contents
List of contributors ix
Section 1 – Central Nervous System Section 3 – Upper and Lower Limb
1 The skull and brain 1 15 The upper limb 278
Kieran M. Hogarth, Jozef Jarosz and Paul Butler Gajan Rajeswaran and Justin Lee
2 The orbit and visual pathway 35 16 The lower limb 319
Indran Davagnanam and Jonathan L. Hart Gonzalo Ansede , Adam W. M. Mitchell and
Jeremiah C. Healy
3 The petrous temporal bone 47
Tim Beale and Simon Morley
Section 4 – Obstetrics and Neonatology
4 The extracranial head and neck 56
Tim Beale 17 Obstetrical imaging 366
Ian Suchet
5 The vertebral column and spinal cord 75
Asif Saifuddin
Section 2 – Thorax, abdomen and Pelvis
Index 383
6 The chest 91
Sheila Rankin
7 The heart and great vessels 109
Simon Padley and Narayan Karunanithy
8 The Breast 126
Steven D. Allen
9 The anterior abdominal wall and peritoneum 134
Nishat Bharwani and Rodney H. Reznek
10 The abdomen and retroperitoneum 150
Navin Ramachandran and Aslam Sohaib
11 The gastrointestinal tract 181
Nasir Khan
12 The kidney and adrenal gland 213
Uday Patel and Hema Verma
13 The male pelvis 230
Nevin T. Wijesekera, Michael Gonsalves and Uday Patel
14 The female pelvis 247
Catriona L. Davies
v

Contributors

Steven D. Allen , BSc, MBBS, MRCS, FRCR Kieran M. Hogarth, BSC, MBBS, FRCR
Consultant Radiologist, Consultant Neuroradiologist,
Royal Marsden Hospital, John Radcliff e Hospital, Oxford, UK
Sutton, Surrey, UK
Josef Jarosz
Gonzalo Ansede Consultant Neuroradiologist,
Specialist Registrar in Radiology, King’s College Hospital, London, UK
Royal Brompton Hospital,
Narayan Karunanithy , MRCS, FRCR
London, UK
Consultant Radiologist,
Tim Beale Guy’s and St Th omas’ NHS Foundation Trust, and Honorary
Consultant Radiologist, Clinical Lecturer King’s College, London, UK
University College London Hospitals and
Nasir Khan , MBBS, MRCP, FRCR
Royal National Th roat, Nose and Ear Hospital,
Consultant Radiologist,
London, UK
Chelsea and Westminster Hospital, London, UK
Nishat Bharwani , BSc, MBBS, MRCP, FRCR
Justin Lee
Consultant Radiologist,
Consultant Radiologist,
Imperial College Healthcare NHS Trust, London, UK
Chelsea and Westminster Hospital,
Paul B utler , MRCP, FRCR London, UK
Consultant Neuroradiologist,
Adam W. M. Mitchel
Th e Royal London Hospital, London, UK
Consultant Radiologist,
Indran Davagnanam , MB, BCh, BAO, BMedSci, FRCR Chelsea, and Westminster Hospital, London; Honorary Senior
Neuroradiology Specialist Registrar, Lecturer, at Imperial College London, UK
National Hospital for Neurology and Neurosurgery,
Simon Morley
Queen Square, London, UK
Consultant Radiologist,
Catriona L. D avies , MBBS, MRCP, FRCR University College London Hospitals,
Consultant Radiologist, London, UK
Chelsea and Westminster Hospital, London, UK
S imon P adley, BSc, MBBS, FRCP, FRCR
Michael Gonsalves Consultant Radiologist,
Radiology Registrar, Chelsea and Westminster and
St George’s Hospital, London, UK Royal Brompton Hospitals and
Honorary Senior Lecturer,
Jonathan L. Hart , MA (Oxon), BMBCh, MRCS, FRCR
Imperial College London, UK
Specialist Registrar, Neuroradiology,
National Hospital for Neurology and Neurosurgery, Uday Patel
Queen Square, London, UK Consultant Radiologist,
St George’s Hospital, London, UK
Jeremiah C. Healy
Consultant Radiologist, Chelsea and Westminster Gajan Rajeswaran, FRCR
Hospital, London; Consultant Radiologist,
Honorary Senior Lecturer, at Imperial College London, UK Chelsea and Westminster Hospital, London, UK
vii
Contributors
Navin Ramachandran , BSc, MBBS, MRCP, FRCR Aslam Sohaib , MRCP, FRCR
Consultant Radiologist, Consultant Radiologist,
University College London Hospitals, Royal Marsden Hospital,
London, UK London, UK
S heila R ankin Ian Suchet
Radiology Department, Department of Medical Imaging,
Guy’s Hospital, London, UK University of Saskatchewan, Saskatoon,
Saskatchewan, Canada
Rodney H. Rezrek, MA, FRANZCR (hon), FFR RCSI (hon),
FRCP, FRCR Hema Verma , MRCP, FRCR
Emeritus Professor of Diagnostic Imaging, Specialist Registrar in Radiology,
St. Bartholomew’s Cancer Institute, St George’s Hospital,
St. Bartholomew’s and the London School of Medicine and London, UK
Dentistry, Queen Mary University of London, UK
Nevin T. Wijesekera
Asif Saifuddin Specialist Registrar in Radiology,
Consultant Musculoskeletal Radiologist, Royal Brompton Hospital,
Th e Royal National Orthopaedic Hospital NHS Trust, London, UK
Stanmore, Middlesex, UK
viii
Central Nervous System
Section 1
Chapter The skull and brain
1
Kieran M. Hogarth , Jozef Jarosz and Paul Butler
Introduction and imaging methods
Computed tomography ( CT) and magnetic resonance imaging
( MRI) are the mainstays of cerebral imaging. Skull radiography Frontal grey
matter
now plays very little part in diagnosis, being largely replaced by
multislice C T.
Frontal white
N on- or minimally invasive angiography performed using matter
CT (C T angiography) or MRI (m agnetic resonance angiog-
raphy) has resulted in invasive catheter angiography being Insula
reserved for a few special diagnostic indications or as part of an
interventional, (therapeutic), procedure.
A natomical detail is far better displayed by MRI than by
CT, although both are valuable in clinical practice.
With T1-weighted (T1W) MR images, grey matter is of
lower signal intensity (darker) than white matter (Fig. 1 .1) . On
T2-weighted (T2W) images, including T2-FLAIR sequences,
the reverse is true ( Fig. 1.2 ).
W ith C T, somewhat paradoxically, white matter is depicted
as darker grey than grey matter (Fig. 1 .3) . Th e explanation is
Superior
sagittal sinus
Fig. 1.2 T2W MRI. ‘Mid-axial’ section of the brain. Note the signal void due to
Frontal grey blood fl owing rapidly.
matter
Frontal white
matter
that CT is an X-ray investigation. White matter contains lipid
as part of myelin, which is relatively radiolucent.
Head of the
Th e appearance of myelinated tracts on MRI is rather
caudate
nucleus more variable and will be infl uenced by the pulse sequence
Lentiform used. In perhaps its simplest form, the lipid in subcutaneous
nucleus
fat is typically high signal (white) on both T1 and T2 MR
Thalamus
sequences.
C onversely, lipid is extremely radiolucent and appears
Splenium of
the corpus black on CT.
callosum
Dense bone contains few free protons on which MRI is
based and therefore appears as a signal void (black) on MR.
On CT, bone, which is radio-opaque, appears white.
Air in the paranasal sinuses appears black on both CT
and  MRI.
Superior Besides compact bone and air, hypointensity on MRI occurs
sagittal sinus
also with iron deposition in the globus pallidus and substantia
Fig. 1.1 T1W MRI. ‘Mid-axial’ section of the brain. nigra and as a feature of rapid blood or CSF fl ow (see below).
Applied Radiological Anatomy, 2nd Edition ed. Paul Butler, Adam W.M. Mitchell and Jeremiah C. Healy. Published by Cambridge University Press.
© Cambridge University Press 2011.
1