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MRI Normal Variants and Pitfalls MRI Normal Variants and Pitfalls Laura W. Bancroft, MD AssociateProfessor MayoClinicFlorida Jacksonville,Florida Mellena D. Bridges, MD AssistantProfessor MayoClinicFlorida Jacksonville,Florida AcquisitionsEditor:LisaMcAllister ManagingEditor:KerryBarrett ProjectManager:NicoleWalz ManufacturingCoordinator:KathleenBrown MarketingManager:AngelaPanetta CreativeDirector:DougSmock CoverDesigner:ItzhackShelomi ProductionServices:LaserwordsPrivateLimited,Chennai,India 2009byLIPPINCOTTWILLIAMS&WILKINS,aWoltersKluwerbusiness 530WalnutStreet Philadelphia,PA19106USA LWW.com All rightsreserved. This book is protected by copyright. No part of this book may be reproduced in anyformorbyanymeans,includingphotocopying,orutilizedbyanyinformationstorageandretrieval systemwithoutwrittenpermissionfromthecopyrightowner,exceptforbriefquotationsembodiedin critical articles and reviews. Materials appearing in this book prepared by individuals as part of their officialdutiesasU.S.governmentemployeesarenotcoveredbytheabove-mentionedcopyright. PrintedintheUSA LibraryofCongressCataloging-in-PublicationData MRInormalvariantsandpitfalls/editedbyLauraW.BancroftandMellenaD.Bridges. p.;cm. Includesbibliographicalreferencesandindex. ISBN-13:978-0-7817-8314-9 ISBN-10:0-7817-8314-3 1.Magneticresonanceimaging.I.Bancroft,LauraW.II.Bridges,MellenaD.,M.D. III.Title:Magneticresonanceimagingnormalvariantsandpitfalls. [DNLM:1. MagneticResonanceImaging—methods.2. Artifacts.3.DiagnosticErrors—prevention &control.4. ImageInterpretation,Computer-Assisted.WN185M93952009] RC78.7.N83M7592009 (cid:1) 616.07548—dc22 2008009240 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty,expressedorimplied,withrespecttothecurrency,completeness,oraccuracyofthecontents of the publication. Application of this information in a particular situation remains the professional responsibilityofthepractitioner. Theauthors,editors,andpublisherhaveexertedeveryefforttoensurethatdrugselectionanddosageset forthinthistextareinaccordancewithcurrentrecommendationsandpracticeatthetimeofpublication. However, in view of ongoing research, changes in government regulations, and the constant flow of informationrelatingtodrugtherapyanddrugreactions,thereaderisurgedtocheckthepackageinsert foreachdrugforanychangeinindicationsanddosageandforaddedwarningsandprecautions.Thisis particularlyimportantwhentherecommendedagentisaneworinfrequentlyemployeddrug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of health care providerstoascertaintheFDAstatusofeachdrugordeviceplannedforuseintheirclinicalpractice. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)638-3030or faxordersto(301)223-2320.Internationalcustomersshouldcall(301)223-2300. Visit Lippincott Williams & Wilkins on the Internet: at www.LWW.com. Lippincott Williams & Wilkinscustomerservicerepresentativesareavailablefrom8:30AMto6PM,EST. 10 9 8 7 6 5 4 3 2 1 L.W.B. To my extremely wonderful husband, Joe. My parents, JoAnn and Bob, who have always given me love and support. And my children Ashley, Walker, and Jack who can really make me laugh. M.D.B. To Gregory, Zoe, and Hannah for their support and, above all, for their sublime tolerance. C o n t e n t s ListofContributors ix 7. Wrist/Hand 127 Preface xi LauraW.Bancroft,MarkJ.Kransdorf, andThomasH.Berquist Acknowledgments xiii III ■ Chest 139 I ■ Head and Neck 1 8. Breast 141 1. The Head 3 ElizabethR.DePeri DavidA.Miller,DebbieJ.Merinbaum, andJohnE.Kirsch 9. Thoracic Spine 162 BrainParenchyma 4 LauraW.BancroftandDebbieJ.Merinbaum 10. Intrathoracic 174 Ventricles 15 LauraW.Bancroft,RonaldS.Kuzo, Cisterns 22 andJ.MarkMcKinney Fissures 27 Vascular 175 Arteries 28 Cardiac 183 Veins 39 Other 186 Orbits 43 Calvarium 46 IV ■ Abdomen 193 Face 57 11. Liver and Biliary System 195 2. The Neck 66 MellenaD.Bridges DavidA.Miller,RobertA.Pooley, andLauraW.Bancroft Liver 196 Neck 67 Biliary 253 BrachialPlexus 74 12. Gallbladder 268 3. Cervical Spine 77 MellenaD.Bridges DavidA.MillerandLauraW.Bancroft 13. Pancreas 282 MellenaD.Bridges II ■ The Upper Extremity 85 14. Kidneys and Adrenals 304 MellenaD.BridgesandJosephG.Cernigliaro 4. Shoulder/Arm 87 Kidneys 305 LauraW.Bancroft,JeffreyJ.Peterson, Ureters 322 andJohnE.Kirsch 5. Elbow 107 Adrenals 324 LauraW.Bancroft,ThomasH.Berquist, 15. Spleen 334 andDebbieJ.Merinbaum MellenaD.Bridges 6. Forearm 121 16. Vasculature 350 LauraW.Bancroft,ThomasH.Berquist, MellenaD.Bridges,J.MarkMcKinney, andDebbieJ.Merinbaum andEricM.Walser vii Contents 17. Lumbar Spine 377 21. Musculoskeletal 486 LauraW.BancroftandDebbieJ.Merinbaum LauraW.BancroftandJohnE.Kirsch Pelvis/Hip 487 V ■ Pelvis 395 Thigh 508 18. Female 397 VI ■ The Lower Extremity 511 MellenaD.Bridges UterusandCervix 398 22. Knee 513 OvariesandAdnexa 423 LauraW.BancroftandPatrickT.Liu VaginaandPerineum 441 23. Calf 543 19. Male 450 LauraW.BancroftandRobertA.Pooley MellenaD.Bridges 24. Ankle/Foot 550 20. Unisex 468 LauraW.BancroftandWilliamB.Morrison MellenaD.BridgesandRobertA.Pooley Bladder 469 Index 579 VascularandArtifacts 480 viii L i s t o f C o n t r i b u t o r s LAURAW.BANCROFT,MD PATRICKT.LIU,MD AssociateProfessorofRadiology AssociateProfessorofRadiology DepartmentofRadiology DepartmentofRadiology MayoClinicFlorida MayoClinicArizona Jacksonville,Florida Scottsdale,Arizona THOMASH.BERQUIST,MD,FACR J.MARKMCKINNEY,MD ProfessorofRadiology AssistantProfessorofRadiology DepartmentofRadiology DepartmentofRadiology MayoClinicFlorida MayoClinicFlorida Jacksonville,Florida Jacksonville,Florida MELLENAD.BRIDGES,MD DEBBIEJ.MERINBAUM,MD AssistantProfessorofRadiology ChairmanandMedicalDirectorofImaging DepartmentofRadiology DepartmentofRadiology MayoClinicFlorida WolfsonChildren’sHospital Jacksonville,Florida Jacksonville,Florida JOSEPHG.CERNIGLIARO,MD DAVIDA.MILLER,MD AssistantProfessorofRadiology AssistantProfessorofRadiology DepartmentofRadiology DepartmentofRadiology MayoClinicFlorida MayoClinicFlorida Jacksonville,Florida Jacksonville,Florida ELIZABETHR.DEPERI,MD WILLIAMB.MORRISON,MD AssistantProfessorofRadiology AssociateProfessorofRadiology DepartmentofRadiology DepartmentofRadiology MayoClinicFlorida ThomasJeffersonUniversity Jacksonville,Florida Philadelphia,Pennsylvania JOHNE.KIRSCH,PhD JEFFREYJ.PETERSON,MD SeniorScientist AssociateProfessorofRadiology MagneticResonanceDivision DepartmentofRadiology SiemensMedicalSolutions,Inc. MayoClinicFlorida Cary,NorthCarolina Jacksonville,Florida MARKJ.KRANSDORF,MD,FACR ROBERTA.POOLEY,PhD ProfessorofRadiology AssistantProfessorofRadiology DepartmentofRadiology DepartmentofRadiology MayoClinicFlorida MayoClinicFlorida Jacksonville,Florida Jacksonville,Florida RONALDS.KUZO,MD ERICM.WALSER,MD AssociateProfessorofRadiology ProfessorofRadiology DepartmentofRadiology DepartmentofRadiology MayoClinic MayoClinicFlorida Rochester,Minnesota Jacksonville,Florida ix

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