Brain anatomy in MRI image. Shoulder Joint MRI Anatomy Normal Coronal Shoulder Anatomy and Checklist

The shoulder joint has the greatest range of motion than any other joint in the human body. The small size of the glenoid cavity of the scapula and the relatively weak tension of the joint capsule create conditions for relative instability and a tendency to subluxation and dislocation. MRI examination is the best modality for examining patients with pain syndrome and instability of the shoulder joint. In the first part of the article, we will focus on the normal anatomy of the shoulder joint and anatomical variants that can simulate pathology. In part two we will discuss shoulder instability. In part 2 we will look at impingement syndrome and rotator cuff injury.

translation of the article by Robin Smithuis and Henk Jan van der Woude on Radiology Assistant

Radiology department of the Rijnland hospital, Leiderdorp and the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

Introduction

The supporting apparatus of the shoulder joint consists of the following structures:

upper
- coracoacromial arch
- coracoacromial ligament
- tendon of the long head of the biceps brachii muscle
- supraspinatus tendon
front
- anterior parts of the labrum
- shoulder-scapular ligaments (glenohumeral ligaments, or articular-humeral ligaments) - upper, middle and anterior bundle of the lower ligament
- subscapularis tendon
rear
- posterior parts of the labrum
- posterior bundle of the inferior glenohumeral ligament
- tendons of the infraspinatus and teres minor muscles

Image of the anterior sections of the shoulder joint.

The subscapularis tendon attaches to both the lesser tuberosity and the greater tuberosity, giving support to the long head of the biceps muscle in the biceps groove. Dislocation of the long head of the biceps brachii muscle will inevitably lead to a rupture of part of the subscapularis tendon. The rotator cuff consists of the subscapularis, supraspinatus, infraspinatus, and teres minor tendons.

Image of the posterior sections of the shoulder joint.

The supraspinatus, infraspinatus, and teres minor muscles and their tendons are depicted. They all attach to the greater tubercle humerus. The rotator cuff tendons and muscles are involved in stabilizing the shoulder joint during movement. Without the rotator cuff, the humeral head would be partially displaced from the socket, reducing the force of abduction of the deltoid muscle (the rotator cuff muscle coordinates the forces of the deltoid muscle). Injury to the rotator cuff can cause the humeral head to be displaced superiorly, resulting in a high erect humeral head.

Normal anatomy

Normal shoulder anatomy in axial images and checklist.

look for the os acromiale, the acromial bone (the accessory bone located at the acromion)
note that the course of the supraspinatus tendon is parallel to the axis of the muscle (this is not always the case)
Please note that the course of the tendon of the long head of the biceps muscle in the area of attachment is directed at 12 o'clock. The attachment area can be of different widths.
note the superior portions of the labrum and the attachment of the superior glenohumeral ligament. At this level, we look for SLAP damage (Superior Labrum Anterior to Posterior) and structural variants in the form of a hole under the glenoid lip (sublabral foramen - sublabial hole). At the same level, a Hill-Sachs injury is visualized along the posterolateral surface of the humeral head.
the fibers of the subscapularis tendon, creating the bicipital groove, hold the tendon of the long head of the biceps muscle. Study cartilage.
level of the middle glenohumeral ligament and anterior parts of the labrum. Look for the Bufford complex. Study cartilage.
concavity of the posterolateral edge of the humeral head should not be confused with a Hill-Sachs lesion because it is normal form for this level. Hill-Sachs lesions are visualized only at the level of the coracoid process. In the anterior sections we are now at the 3-6 o'clock level. Bankart damage and its variants are visualized here.
note the fibers of the inferior glenohumeral ligament. At this level, Bankart damage is also looked for.

Supraspinatus tendon axis

Subject to tendinopathy and injury, the supraspinatus tendon is a critical part of the rotator cuff. Injuries to the supraspinatus tendon are best seen in the oblique coronal plane and in abduction external rotation (ABER). In most cases, the axis of the supraspinatus tendon (arrowhead) is deviated anteriorly to the axis of the muscle (yellow arrow). When planning an oblique coronal projection, it is better to focus on the axis of the supraspinatus tendon.

Normal Coronal Shoulder Anatomy and Checklist

note the coracoclavicular ligament and short head of the biceps.
note the coracoacromial ligament.
pay attention to the suprascapular nerve and vessels
look for impingement of the supraspinatus muscle due to osteophytes in the acromioclavicular joint or due to thickening of the coracoacromial ligament.
examine the superior biceps labrum complex, look for the sublabial recess or SLAP injury
look for fluid collection in the subacromial bursa and damage to the supraspinatus tendon
look for it partial rupture supraspinatus tendon at the site of its insertion in the form of a ring-shaped increase in signal
examine the area of attachment of the inferior glenohumeral ligament. Examine the inferior labrum and ligament complex. Look for a HAGL lesion (humeral avulsion of the glenohumeral ligament).
look for damage to the infraspinatus tendon
note slight Hill-Sachs damage

Normal sagittal anatomy and checklist

pay attention to the rotator cuff muscles and look for atrophy
note the middle glenohumeral ligament, which has an oblique direction in the joint cavity, and study the relationship to the subscapularis tendon
at this level, damage to the labrum is sometimes visible in the 3-6 o'clock direction
examine the place of attachment of the long head of the biceps brachii muscle to the articular labrum (biceps anchor)
note the shape of the acromion
look for impingement at the acromioclavicular joint. Note the interval between the rotator cuff and the coracohumeral ligament.
look for damage to the infraspinatus muscle

Injuries to the labrum
Imaging in shoulder abduction and external rotation is best for assessing the anterioinferior labrum at the 3-6 o'clock position, where most labral injuries are located. In the position of abduction and external rotation of the shoulder, the articular-brachial ligament is stretched, straining the anterior-inferior parts of the articular labrum, allowing intraarticular contrast to get between the labrum damage and the glenoid cavity.

Rotator cuff injury
Images in shoulder abduction and external rotation are also very useful in visualizing both partial and complete rotator cuff injuries. Abduction and external rotation of the limb releases the tensioned cuff more than with conventional oblique coronal images in the adducted position of the limb. As a result, small partial damage to the fibers of the articular surface of the cuff is not adjacent to either the intact bundles or the head of the humerus, and intra-articular contrast improves visualization of the damage (3).

Shoulder abduction and external rotation (ABER) view

Shoulder abduction and external rotation images are obtained in the axial plane by deviating 45 degrees from the corotal plane (see illustration).
In this position, the 3-6 o'clock area is oriented perpendicularly.
Note the red arrow indicating a small Perthes lesion that was not visualized in standard axial orientation.

Anatomy of shoulder abduction and external rotation

Note the insertion of the long biceps tendon. The inferior edge of the supraspinatus tendon should be smooth.
Look for discontinuity of the supraspinatus tendon.
Examine the labrum in the 3-6 o'clock area. Due to the tension of the anterior bands in the lower parts of the labrum, damage will be easier to detect.
Note the smooth inferior edge of the supraspinatus tendon

Variants of the structure of the articular labrum

There are many variations in the structure of the labrum.
These variable norms are localized in the 11-3 o'clock area.

It is important to be able to recognize these variants because they can simulate SLAP injuries.
These normal variants are usually not accepted as a Bankart lesion, since it is localized in the 3-6 o’clock position, where anatomical variants do not occur.
However, damage to the labrum can occur in the 3-6 o'clock region and extend to the upper parts.

Sublabial recess

There are 3 types of attachment of the upper parts of the labrum at the 12 o'clock area, at the site of attachment of the tendon of the long head of the biceps brachii muscle.

Type I - there is no depression between the articular cartilage of the glenoid cavity of the scapula and the articular lip
Type II - there is a small depression
Type III - there is a large depression
This sublabial depression is difficult to distinguish from a SLAP lesion or sublabial foramen.

This illustration shows the difference between a sublabial recess and a SLAP injury.
A depression greater than 3-5 mm is always not normal and should be treated as a SLAP injury.

Sublabial hole

Sublabial foramen - absence of attachment of the anterosuperior parts of the articular labrum in the area of 1-3 o'clock.
Determined in 11% of the population.
With MR arthrography, the sublabial foramen should not be mistaken for a sublabial recess or SLAP lesion, which are also localized in this area.
The sublabial recess is located in the area of attachment of the biceps brachii tendon at 12 o'clock and does not extend to the area 1-3 o'clock.
A SLAP injury can extend to the 1-3 o'clock area, but should always involve the biceps tendon insertion.

MAGNETIC RESONANCE TOMOGRAPHIC ANATOMY

CEREBELLA

S. S. Kazakova

Ryazan State Medical University named after Academician I. P. Pavlov.

The paper presents the results of studying the anatomical picture of the cerebellum based on magnetic resonance imaging in axial, sagittal and frontal projections in T1 and T2-weighted images of 40 patients without pathological changes in the structures of the brain.

Key words: anatomy of the cerebellum, magnetic resonance imaging, brain.

Currently, the leading method (“gold standard”) for recognizing diseases of the brain, in particular the cerebellum, is magnetic resonance imaging (MRI). Analysis of MRI symptoms requires knowledge of the anatomical features of the organ being studied. However, in the MRI literature, the anatomy of the cerebellum is not fully represented and is sometimes contradictory.

Designations of anatomical structures are given in accordance with the International Anatomical Nomenclature. At the same time, terms that are widely used in the daily practice of specialists involved in MRI are also given.

Results and its discussion

The cerebellum (small brain) on MRI scans is determined under the occipital lobes of the hemispheres big brain, dorsal to the pons and medulla oblongata, and fulfills almost the entire posterior cranial fossa. Participates in the formation of the roof (posterior wall) of the fourth ventricle. Its lateral parts are represented by two hemispheres (right and left), between them there is a narrow part - the cerebellar vermis. Shallow grooves divide the hemispheres and the vermis into lobules. The diameter of the cerebellum is significantly larger than it anterior-posterior size(9-10 and 3-4 cm respectively). The cerebellum is separated from the cerebrum by a deep transverse fissure, into which a process of the dura mater (cerebellar tent) is wedged. The right and left hemispheres of the cerebellum are separated by two notches (anterior and posterior), located on the anterior and posterior edges, forming angles. IN

The cerebellar vermis is divided into an upper part - the superior vermis and bottom part-inferior vermis, separated from the cerebral hemispheres by grooves.

According to MRI data, it is possible to differentiate gray matter from white matter. The gray matter, located in the superficial layer, forms the cerebellar cortex, and the accumulations of gray matter in its depths form the central nucleus. The white matter (brain body) of the cerebellum lies in the thickness of the cerebellum and, through 3 pairs of legs, connects the gray matter of the cerebellum with the brain and spinal cord: the lower ones go from the medulla oblongata to the cerebellum, the middle ones from the cerebellum to the pons and the upper ones from the cerebellum to the cerebellum. roof of the midbrain.

The surfaces of the hemispheres and the cerebellar vermis are divided by fissures into sheets. Groups of convolutions form separate lobules, which are combined into lobes (superior, posterior and inferior).

The cerebellar nuclei, which represent accumulations of gray matter in the thickness of the brain body, are not differentiated on MRI scans.

The amygdala is located at the inferior medullary velum. It corresponds to the tongue of the worm. Its short convolutions follow from front to back.

Thus, most anatomical formations identified on sections of the cerebellum are also reflected in MRI.

Analysis of MRI data showed the dependence of the size of the cerebellum on age, gender and craniometric parameters, which confirms the information given in the literature.

A comparison of anatomical data and data obtained from MR studies is presented in Figures 1-2.

Anatomical section of the brain along the midline in the sagittal projection (according to R.D. Sinelnikov).

Designations: 1 - superior medullary velum, 2 - IV ventricle, 3 - inferior medullary velum, 4 - pons, 5 - medulla, 6 - superior vermis of the cerebellum, 7 - tent, 8 - medullary body of the vermis, 9 - deep horizontal fissure of the cerebellum, 10 - inferior vermis, 11 - cerebellar amygdala.

Patient D., 55 years old. MRI of the brain in a sagittal projection along the midline, T1-weighted image.

The designations are the same as in Fig. 1a.

Fig.2a. Anatomical horizontal section of the cerebellum (according to R. D. Sinelnikov).

Designations: 1 - pons, 2 - superior cerebellar peduncle, 3 - IV ventricle, 4 - dentate nucleus, 5 - cortical nucleus, 6 - tent nucleus, 7 - globular nucleus, 8 - cerebellar medulla, 9 - vermis, 10 - right cerebellar hemisphere, 11 - left cerebellar hemisphere.

gag*-/gch i

Patient 10

years. MRI of the brain in axial projection, T2-weighted image.

The designations are the same as in Fig. 2a.

MRI is a non-invasive and highly informative method of brain imaging. The MRI picture of the cerebellum is quite demonstrative and reflects the main anatomical structures of this part of the brain. These features should be taken into account in clinical practice and serve as a guideline when analyzing pathological changes in the cerebellum.

LITERATURE

1. Duus Peter. Topical diagnosis in neurology. Anatomy. Physiology. Clinic / Peter Duus; under. ed. prof. L. Likhterman. - M.: IPC "VASAR-FERRO", 1995. - 400 p.

2. Konovalov A.N. Magnetic resonance imaging in neurosurgery / A.N. Konovalov, V.N. Kornienko, I.N. Pronin. - M.: Vidar, 1997. - 472 p.

3. Magnetic resonance imaging of the brain. Normal anatomy / A. A. Baev [etc.]. - M.: Medicine, 2000. - 128 p.

4. Sapin M.R. Human anatomy M.R. Sapin, T. A. Bilich. - M.: GEOTARMED., 2002. - T.2 - 335 p.

5. Sinelnikov R.D. Atlas of human anatomy R.D. Sinelnikov, Ya.R. Sinelnikov. - M.: Medicine, 1994. - T.4. - 71 s.

6. Solovyov S.V. Dimensions of the human cerebellum according to MRI data by S.V. Solovyov // Vestn. radiology and radiology. - 2006. - No. 1. - P. 19-22.

7. Kholin A.V. Magnetic resonance imaging for diseases of the central nervous system/ A.V. Choline. - St. Petersburg: Hippocrates, 2000. - 192 p.

MAGNETIC-REZONANCE-TOMOGRAPHIC ANATOMY OF CEREBELLUM

The work presents investigation results of anatomical picture of cerebellum on the basis of magnetic-resonance tomography in axial, sagittal and front views in T1 and T2 weighted images of 40 patients who have no pathological changes in brain structures.

In an adult, the spinal cord begins at the level of the foramen magnum and ends approximately at the level of intervertebral disc between L, and Ln (Fig. 3.14, see Fig. 3.9). From each segment spinal cord the anterior and posterior roots of the spinal nerves depart (Fig. 3.12, 3.13). The roots are directed to the corresponding intervertebral

Rice. 3.12. Lumbar spine

brain and cauda equina [F.Kishsh, J.Sentogothai].

I - intumescentia lumbalis; 2 - radix n. spinalis (Th. XII); 3 - costaXII; 4 - conus medullaris; 5 - vertebra L. I; 6 - radix; 7 - ramus ventralis n.spinalis (L. I); 8 - ramus dorsalis n.spinalis (L. I); 9 - filum terminale; 10 - ganglion spinale (L.III);

I1 - vertebra L V; 12 - ganglion spinale (L.V); 13-os sacrum; 14 - N. S. IV; 15-N. S. V; 16 - N. coccygeus; 17 - filum terminale; 18 - os coccyges.

Rice. 3.13. Cervical spinal cord [F.Kishsh, J.Sentogothai].

1 - fossa rhomboidea; 2 - pedunculus cerebellaris sup.; 3 - pedunculus cerebellaris medius; 4 - n. trigeminus; 5 - n. facialis; 6 - n. vestibulocochlearis; 7 - margo sup. partis petrosae; 8 - pedunculus cerebellaris inf.; 9 - tuberculi nuclei cuneati; 10 - tuberculi nuclei gracilis; 11 - sinus sigmoideus; 12 - n. glossopharyngeus; 13 - n. vagus; 14 - n. accessories; 15 - n. hupoglossus; 16 - processus mastoideus; 17 - N.C. I; 18 - intumescentia cervicalis; 19 - radix dors.; 20 - ramus ventr. n. spinalis IV; 21 - ramus dors. n. spinalis IV; 22 - fasciculus gracilis; 23 - fasciculus cuneatus; 24 - ganglion spinale (Th. I).

hole (see Fig. 3.14, Fig. 3.15 a, 3.16, 3.17). Here the dorsal root forms the spinal ganglion (local thickening - ganglion). The anterior and posterior roots unite immediately after the ganglion, forming the trunk of the spinal nerve (Fig. 3.18, 3.19). The uppermost pair of spinal nerves leaves the spinal canal at the level between the occipital bone and Cj, the lowest - between S and Sn. There are 31 pairs of spinal nerves.

In newborns, the end of the spinal cord (conus medullaris) is located lower than in adults, at the level of Lm. Up to 3 months, the spinal cord roots are located directly opposite the corresponding vertebrae. More begins next fast growth spine than the spinal cord. In accordance with this, the roots become longer and longer towards the conus of the spinal cord and go obliquely downwards towards their intervertebral foramina. By 3 years of age, the conus spinal cord occupies its usual adult location.

The blood supply to the spinal cord is carried out by the anterior and paired posterior spinal arteries, and similarly by the radicular-spinal arteries. The spinal arteries arising from the vertebral arteries (Fig. 3.20) supply blood to only 2-3 upper cervical segments.

Rice. 3.14. MRI. Midsagittal image of the cervical spine.

a-T2-VI; b-T1-VI.

1 - spinal cord; 2 - subarachnoid space; 3 - dural sac ( back wall); 4 - epidural space; 5 - anterior arch C1; 6 - posterior arch C1; 7 - body C2; 8 - intervertebral disc; 9 - hyaline plate; 10 - image artifact; 11 - spinous processes of the vertebrae; 12 - trachea; 13 - esophagus.

Rice. 3.15. MRI. Parasagittal image of the lumbosacral spine.

a-T2-VI; b-T1-VI.

1 - epidural space; 2 - subarachnoidal space; 3 - spinal nerve roots; 4 - plates of vertebral arches.

Rice. 3.16. MRI. Parasagittal image of the thoracic spine, T2-weighted image.

1 - intervertebral foramen; 2 - spinal nerve; 3 - vertebral arches; 4 - articular processes of the vertebrae; 5 - intervertebral disc; 6 - hyaline plate; 7 - thoracic aorta.

Rice. 3.17. MRI. Parasagittal image of the lumbosacral spine.

a-T2-VI; b-T1-VI.

1 - spinal nerve roots; 2 - epidural space; 3 - posterior parts of the vertebral arches; 4 - body Sr; 5 - intervertebral foramen Ln-Lin.

ment, throughout the rest of the length the spinal cord is supplied by the radicular-spinal arteries. Blood from the anterior radicular arteries enters the anterior spinal artery, and from the posterior ones - into the posterior spinal artery. The radicular arteries receive blood from the vertebral arteries in the neck, subclavian arteries, segmental intercostal and lumbar arteries. It is important to note that each segment of the spinal cord has its own pair of radicular arteries. There are fewer anterior radicular arteries than the posterior ones, but they are larger. The largest of them (about 2 mm in diameter) is the artery of the lumbar enlargement - the large radicular artery of Adamkiewicz, which enters the spinal canal usually with one of the roots at the level from Thv||1 to LIV. The anterior spinal artery supplies approximately 4/5 of the diameter of the spinal cord. Both posterior spinal arteries are connected to each other and to the anterior spinal artery using a horizontal arterial trunk; the circumflex branches of the arteries anastomose with each other, forming the vascular crown (vasa corona).

Venous drainage is carried out into the looping longitudinal collector veins, the anterior and posterior spinal veins. Posterior vein larger, it increases in diameter along the direction

to the conus spinal cord. Most of the blood through the intervertebral veins through the intervertebral foramina enters the external vertebral venous plexus, a smaller part of the collector veins flows into the internal vertebral venous plexus, which is located in the epidural space and, in fact, is an analogue of the cranial sinuses.

The spinal cord is covered by three meninges: the hard (dura mater spinalis), the arachnoid (arachnoidea spinalis) and the soft (pia mater spinalis). The arachnoid and pia mater taken together are similarly called leptomeningeal (see Fig. 3.18).

The dura mater consists of two layers. At the level of the foramen magnum, both layers completely diverge. Outer layer tightly adjacent to the bone and, in fact, is the periosteum. The inner layer is actually meningeal and forms the dural sac of the spinal cord. The space between the layers is called epidural (cavitas epiduralis), peridural or extradural, although it would be more correct to call it intradural (see Fig. 3.18, 3.14 a, 3.9 a;

Rice. 3.18. Schematic representation of the membranes of the spinal cord and spinal roots [P. Duus].

1 - epidural fiber; 2 - dura mater; 3 - arachnoid mater; 4 - subarachnoid space; 5 - pia mater; 6 - posterior root of the spinal nerve; 7 - dentate ligament; 8 - anterior root of the spinal nerve; 9 - gray matter; 10 - white matter.

Rice. 3.19. MRI. Transverse section at the level of the intervertebral disc Clv_v. T2-VI.

1 - gray matter of the spinal cord; 2 - white matter of the spinal cord; 3 - subarachnoid space; 4 - posterior root of the spinal nerve; 5 - anterior root of the spinal nerve; 6 - spinal nerve; 7 - vertebral artery; 8 - uncinate process; 9 - facets of the articular processes; 10 - trachea; 11 - jugular vein; 12 - carotid artery.

rice. 3.21). The epidural space contains loose connective tissue And venous plexuses. Both layers of the dura mater are joined together as the spinal roots pass through the intervertebral foramina (see Fig. 3.19; Fig. 3.22, 3.23). The dural sac ends at the level of S2-S3. Its caudal part continues in the form of a terminal filament, which is attached to the periosteum of the coccyx.

The arachnoid mater consists of a cell membrane to which a network of trabeculae is attached. This network, like a web, weaves around the subarachnoid space. The arachnoid membrane is not fixed to the hard meninges. The subarachnoid space is filled with circulating cerebrospinal fluid and extends from the parietal parts of the brain to the end of the cauda equina at the level of the coccyx, where the dural sac ends (see Fig. 3.18, 3.19, 3.9; Fig. 3.24).

The pia mater lines all surfaces of the spinal cord and brain. The trabeculae of the arachnoid membrane are attached to the pia mater.

Rice. 3.20. MRI. Parasagittal image of the cervical spine.

a-T2-VI; b-T1-VI.

1 - lateral mass C,; 2 - rear arc C,; 3 - body Sp; 4 - arc Ssh; 5 - vertebral artery at the level of segment V2; 6 - spinal nerve; 7 - epidural fatty tissue; 8 - Th body; 9 - arch leg Thn; 10 - aorta; eleven - subclavian artery.

Rice. 3.21. MRI. Midsagittal image of the thoracic spine.

a-T2-VI; b-T1-VI.

1 - spinal cord; 2 - subarachnoid space; 3 - dural sac; 4 - epidural space; 5 - body of ThXI1; 6 - intervertebral disc; 7 - hyaline plate; 8 - course of the vertebral vein; 9 - spinous process.

When performing MRI, there are no topographical landmarks familiar in radiology for assessing the relative position of the spine and spinal cord. The most accurate reference point is the body and tooth Cp; less reliable are the body Lv and S (see Fig. 3.14, 3.9). Localization by the location of the conus spinal cord is not a reliable guide, due to the individual variable location (see Fig. 3.9).

Anatomical features spinal cord (shape, location, size) are better visible on T1-WI. The spinal cord on MRI images has smooth, clear contours and occupies a mid-position in the spinal canal. The dimensions of the spinal cord are not the same along its entire length; its thickness is greater in the area of the cervical and lumbar thickening. The intact spinal cord is characterized by an isointense signal on MRI images. On images in the axial plane, the boundary between white and gray matter is differentiated.
Concept and types, 2018.
White matter is located on the periphery, gray matter is located in the middle of the spinal cord. The anterior and posterior roots of the spinal cords emerge from the lateral parts of the spinal cord.

Rice. 3.22. MPT. Transverse section at the Lv-S1 level. a-T2-VI; b-T1-VI.

1 - spinal nerve Lv; 2 - roots of spinal nerves S; 3 - roots of the sacral and coccygeal spinal nerves; 4 - subarachnoid space; 5 - epidural fiber; 6 - intervertebral foramen; 7 - lateral mass of the sacrum; 8 - lower articular process of Lv; 9 - superior articular process S^ 10 - spinous process of Lv.

Rice. 3.23. MPT. Transverse section at the Liv-Lv level.

a-T2-VI; b-T1-VI.

1 - spinal nerve L1V; 2 - spinal nerve roots; 3 - subarachnoid space; 4 - epidural fiber; 5 - intervertebral foramen; 6 - yellow ligaments; 7 - lower articular process L|V; 8 - superior articular process of Lv; 9 - spinous process L|V; 10 - lumbar muscle.

Rice. 3.24. MRI. Parasagittal image of the cervical spine.

a-T2-VI; b-T1-VI.

1 - spinal cord; 2 - subarachnoid space; 3 - front arc C,; 4 - rear arc C,; 5 - body Sp; 6 - tooth Sp; 7 - intervertebral disc; 8 - vertebral arches; 9 - hyaline plate; 10 - large tank.

nerves (see Fig. 3.19). The anterior and posterior roots of the spinal nerves located intradularly are clearly visible on transverse T2-WI (see Fig. 3.22 b, 3.23 b). The spinal nerve formed after the connection of the roots is located in the epidural tissue, characterized by a hyperintense signal on T1 and T2-weighted images (see Fig. 3.22).

Cerebrospinal fluid, contained in the dural sac, gives a signal characteristic of fluid, hyperintense on T2-weighted images and hypointense on T1-weighted images (see Fig. 3.21). The presence of pulsation of cerebrospinal fluid in the subarachnoid space creates characteristic image artifacts, which are more pronounced on T2-weighted images (see Fig. 3.14 a). Artifacts are most often located in the thoracic spine in the posterior subarachnoid space.

Epidural fatty tissue is more developed in the chest and lumbar regions, is better visualized on T1-WI in the sagittal and axial planes (see Fig. 3.21 b; Fig. 3.25 b, 3.26). Fat fiber in the anterior epidural space it is most pronounced at the level of the intervertebral disc between Lv and S, body S, (see Fig. 3.22). This is due to the cone-shaped narrowing of the dural sac at this level. IN cervical spine epidural tissue is poorly expressed and is not visible on MRI images in all cases.

Rice. 3.25. MPT. Parasagittal image of the thoracic spine.

a-T2-VI; b-T1-VI.

1 - spinal cord; 2 - subarachnoid space; 3 - dural sac; 4 - epidural space; 5 - body Thxl]; 6 - hyaline plate; 7 - intervertebral disc; 8 - spinous process.

Rice. 3.26. MRI. Cross section at the Th]X-Thx level. T2-VI.

1 - spinal cord; 2 - subarachnoid space; 3 - epidural space; 4 - intervertebral disc; 5 - vertebral arch ThIX; 6 - spinous process Th|X; 7 - rib head; 8 - rib neck; 9 - costal fossa.

Literature

1. Kholin A.V., Makarov A.Yu., Mazurkevich E.A. Magnetic resonance imaging of the spine and spinal cord. - St. Petersburg: Institute of Traumatol. and orthopedist, 1995.- 135 p.

2. Akhadov T.A., Panov V.O., Eichoff U. Magnetic resonance imaging of the spine and spinal cord. - M., 2000. - 748 p.

3. Konovalov A.N., Kornienko V.N., Pronin I.N. Neuroradiology of childhood. - M.: Antidor, 2001. - 456 p.

4. Zozulya Yu.A., Slynko E.I. Spinal vascular tumors and malformations. - Kyiv: UVPK EksOb, 2000. - 379 p.

5. Barkovich A.J. Pediatricneororadiology-Philadelphia, NY: Lippinkott-Raven Publishers, 1996. - 668 p.

6. Haaga J.R. Computed tomography and magnetic-resonance imaging of the whole body. - Mosby, 2003. - 2229 p.

MRI of the brain. T2-weighted axial MRI. Color processing of the image.

Knowledge of brain anatomy is very important for correct localization pathological processes. It is even more important for studying the brain itself using modern “functional” methods such as functional magnetic resonance imaging (fMRI) and positron emission tomography. We become acquainted with the anatomy of the brain from our student days and there are many anatomical atlases, including cross sections. It would seem, why another one? In fact, comparing MRI slices with anatomical ones leads to many errors. This is related to both specific features obtaining MRI images, and with the fact that the structure of the brain is very individual.

MRI of the brain. Volumetric representation of the surface of the cortex. Color processing of the image.

List of abbreviations

Furrows

Interlobar and median

SC – central sulcus

FS – Sylvian fissure (lateral fissure)

FSasc – ascending branch of the Sylvian fissure

FShor – transverse fissure of Sylvian fissure

SPO – parieto-occipital sulcus

STO – temporo-occipital sulcus

SCasc – ascending branch of the cingulate sulcus

SsubP – subparietal sulcus

SCing – cingulate sulcus

SCirc – circular sulcus (islet)

Frontal lobe

SpreC – precentral sulcus

SparaC – paracentral sulcus

SFS – superior frontal sulcus

FFM – frontal-marginal fissure

SOrbL – lateral orbital sulcus

SOrbT – transverse orbital sulcus

SOrbM – medial orbital sulcus

SsOrb – infraorbital groove

SCM – sulcus callosumarginalis

Parietal lobe

SpostC – postcentral sulcus

SIP – intraparietal sulcus

Temporal lobe

STS – superior temporal sulcus

STT – transverse temporal sulcus

SCirc – circular sulcus

Occipital lobe

SCalc – calcarine groove

SOL – lateral occipital sulcus

SOT – transverse occipital sulcus

SOA - anterior occipital sulcus

Convolutions and lobes

PF – frontal pole

GFS - superior frontal gyrus

GFM – middle frontal gyrus

GpreC – precentral gyrus

GpostC – postcentral gyrus

GMS – supramarginal gyrus

GCing – cingulate gyrus

GOrb – orbital gyrus

GA – angular gyrus

LPC – paracentral lobule

LPI – inferior parietal lobule

LPS – superior parietal lobule

PO – occipital pole

Cun – wedge

PreCun – precuneus

GR – gyrus rectus

PT – pole of the temporal lobe

Median structures

Pons – Varoliev Bridge

CH – cerebellar hemisphere

CV – cerebellar vermis

CP – cerebral peduncle

To – cerebellar amygdala

Mes – midbrain

Mo – medulla oblongata

Am – amygdala

Hip - hippocampus

LQ – quadrigeminal plate

csLQ – superior colliculus

cp – pineal gland

CC – corpus callosum

GCC – genu corpus callosum

SCC – splenium of the corpus callosum

F – vault of the brain

cF – vault column

comA – anterior commissure

comP – posterior commissure

Cext – external capsule

Hyp – pituitary gland

Ch – optic chiasm

no – optic nerve

Inf – funnel (pedicle) of the pituitary gland

TuC – gray tubercle

Cm – papillary body

Subcortical nuclei

Th – thalamus

nTha – anterior nucleus of the thalamus opticus

nThL – lateral nucleus of the thalamus opticus

nThM – medial nucleus of the thalamus optic

pul – pad

subTh – subthalamus (inferior nuclei of the thalamus opticum)

NL – lenticular nucleus

Pu – shell of the lenticular kernel

Clau – fence

GP – globus pallidus

NC – caudate nucleus

caNC – head of the caudate nucleus

coNC – body of the caudate nucleus

CSF pathways and associated structures

VL – lateral ventricle

caVL – anterior horn lateral ventricle

cpVL – posterior horn lateral ventricle

sp – transparent partition

pch – choroid plexus of the lateral ventricles

V3 – third ventricle

V4 – fourth ventricle

Aq – cerebral aqueduct

CiCM – cerebellomedullary (large) tank

CiIP – interpeduncular cistern

Vessels

ACI – internal carotid artery

aOph – ophthalmic artery

A1 – first segment of the anterior cerebral artery

A2 – second segment of the anterior cerebral artery

aca – anterior communicating artery

AB – basilar artery

P1 – first segment of the posterior cerebral artery

P2 – second segment of the posterior cerebral artery

аcp – posterior communicating artery

Transverse (axial) MRI sections of the brain

MRI of the brain. Three-dimensional reconstruction of the cortical surface.

Sagittal MRI slices of the brain

MRI of the brain. Three-dimensional reconstruction of the lateral surface of the cortex.

1.1. PREPARATION FOR THE STUDY

Special preparation of the patient for the study is usually not required. Before the study, the patient is asked to find out possible contraindications for MRI or injection contrast agent, explain the research procedure and provide instructions.

1.2. RESEARCH METHODOLOGY

Approaches to performing MRI of the brain are standard. The examination is performed with the subject lying on his back. As a rule, sections are made in the transverse and sagittal planes. If necessary, coronal planes can be used (studies of the pituitary gland, brainstem structures, temporal lobes).

Tilting transverse sections along the orbitomeatal line is not usually used in MRI. The slice plane can be tilted for better visualization of the structures being studied (for example, along the optic nerves).

In most cases, MRI of the brain uses a slice thickness of 3-5 mm. During research

small structures (pituitary gland, optic nerves and chiasm, middle and inner ear) it is reduced to 1-3 mm.

Typically T1- and T2-weighted sequences are used. To reduce examination time, the most practical approach is to perform T2-weighted slices in the transverse plane and T1-weighted slices in the sagittal plane. Typical echo time (TE) and repetition time (TR) values for a T1-weighted sequence are 15–30 and 300–500 ms, and for a T2-weighted sequence 60–120 and 1600–2500 ms, respectively. The use of the “turbo spin echo” technique can significantly reduce the examination time when obtaining T2-weighted images.

It is advisable to include the FLAIR sequence (T2-weighted sequence with liquid signal suppression) in the set of standard sequences. Typically, 3-dimensional MR angiography (3D TOF) is performed during brain MRI.

Other types of pulse sequences (for example, 3-dimensional thin-section gradient sequences, diffusion-weighted (DWI) and perfusion programs, and a number of others) are used for special indications.

Sequences with three-dimensional data assembly make it possible to perform reconstructions in any plane after the end of the study. In addition, they can produce thinner sections than with 2D sequences. It should be noted that most 3D sequences are T1-weighted.

Like CT, MRI enhances brain structures with missing or damaged blood-brain barrier (BBB).

Water-soluble paramagnetic gadolinium complexes are currently used for contrast enhancement. They are administered intravenously at a dose of 0.1 mmol/kg. Since paramagnetic substances predominantly influence T1 relaxation, their contrast effect is clearly evident on T1-weighted MR images, such as spin echo images with short TR and TE times or gradient images with short TR and deflection angles of the order of 50-90°. Their contrast effect is significantly reduced on T2-weighted images, and in some cases is completely lost. The contrasting effect of MR drugs begins to appear from the first minutes and reaches its maximum in 5-15 minutes. It is advisable to complete the examination within 40-50 minutes.

LIST OF FIGURES

1.1. Transverse sections, T2-weighted images.

1.2. Sagittal sections, T1-weighted images.

1.3. Frontal sections, T1-weighted images.

1.4. MR angiography of intracranial arteries.

1.5. MR angiography of the extracranial sections of the main arteries of the head.

1.6. MR phlebography.

CAPTIONS FOR FIGURES

BRAIN

1) III ventricle (ventriculus tertius); 2) IV ventricle (ventriculus quartus); 3) globus pallidus (globus pallidus); 4) lateral ventricle, central part (ventriculus lateralis, pars centralis); 5) lateral ventricle, posterior horn (ventriculus lateralis, cornu post.); 6) lateral ventricle, inferior horn (ventriculus latera-lis, cornu inf.); 7) lateral ventricle, anterior horn (ventriculus lateralis, cornu ant.); 8) pons (pons); 9) maxillary sinus (sinus maxillaris);

10) superior cerebellar vermis (vermis cerebelli superior);

11) top cerebellar cistern (cisterna cerebelli superior); 12) superior cerebellar peduncle (pedunculus cerebellaris superior); 13) temporal lobe (lobus temporalis); 14) temporal gyrus, superior (gyrus temporalis superior); 15) temporal gyrus, inferior (gyrus temporalis inferior); 16) temporal gyrus, middle (gyrus temporalis medius); 17) internal auditory canal (meatus acus-ticus internus); 18) brain aqueduct (aqueductus cerebri); 19) pituitary funnel (infundibulum); 20) hypothalamus (hypothalamus); 21) pituitary gland (hypophysis); 22) hippocampal gyrus (gyrus hyppocampi); 23) eyeball (bulbus oculi); 24) head of the lower jaw (caput mandibu-lae); 25) head of the caudate nucleus (caput nuclei caudati); 26) masseter muscle (m. masseter); 27) posterior leg of the internal capsule (capsula interna, crus posterius); 28) occipital lobe (lobus occipitalis); 29) occipital gyri (gyri occipitales); 30) optic nerve (nervus

opticus); 31) optic chiasm (chiasma opticum); 32) optic tract (tractus opticus); 33) rocky part (pyramid) temporal bone (pars petrosa ossae temporalis); 34) sphenoid sinus (sinus sphenoidalis);

35) knee of the internal capsule (capsula interna, genu);

36) pterygopalatine fossa (fossa pterygopalatina); 37) lateral (Sylvian) fissure (fissura lateralis); 38) lateral pterygoid muscle (m. pterygoideus lateralis); 39) frontal lobe (lobus frontalis); 40) frontal gyrus, superior (gyrus frontalis superior); 41) frontal gyrus, inferior (gyrus frontalis inferior); 42) frontal gyrus, middle (gyrus frontalis medius); 43) frontal sinus (sinus frontalis); 44) medial pterygoid muscle (m. pterygoideus medialis); 45) interventricular foramen (foramen ventriculare); 46) interpeduncular cistern (cisterna interpeduncularis); 47) cerebellar amygdala (tonsilla cerebelli); 48) cerebellocerebral (large) tank (cisterna magna); 49) corpus callosum, splenium (corpus callosum, splenium); 50) corpus callosum, knee (corpus callosum, genu); 51) corpus callosum, trunk (corpus callosum, truncus);

52) cerebellopontine angle (angulus pontocerebellaris);

53) tentorium cerebellum (tentorium cerebelli); 54) outer capsule (capsula externa); 55) external auditory canal (meatus acusticus externus); 56) inferior cerebellar vermis (vermis cerebelli inferior); 57) inferior cerebellar peduncle (pedunculus cerebellaris inferior); 58) lower jaw (mandibula); 59) cerebral peduncle (pedunculus cerebri); 60) nasal septum (septum nasi); 61) turbinates (conchae nasales); 62) olfactory bulb (bulbus olfactorius); 63) olfactory tract (tractus olfactorius); 64) bypass tank (cisterna ambiens);

65) fence (claustrum); 66) parotid salivary gland (glandula parotis); 67) orbital convolutions (gyri orbita-les); 68) island (insula); 69) anterior sphenoid process (processus clinoideus anterior); 70) anterior leg of the internal capsule (capsula interna, crus ante-rius); 71) cavernous sinus (sinus cavernosus); 72) submandibular salivary gland (glandula submandibularis); 73) sublingual salivary gland (glandula sublingua-lis); 74) nasal cavity (cavum nasi); 75) semicircular canal (canalis semicircularis); 76) cerebellar hemisphere (hemispherium cerebelli); 77) postcentral gyrus (gyrus postcentralis); 78) cingulate gyrus (gyrus cinguli); 79) vestibulocochlear nerve (VIII pair);

80) precentral gyrus (sulcus precentralis);

81) medulla oblongata (medulla oblongata); 82) longitudinal fissure of the brain (fissura longitudinalis cerebri); 83) transparent partition (septum pellucidum); 84) straight gyrus (gyrus rectus); 85) lattice cells (cellulae ethmoidales); 86) vault (fornix); 87) sickle brain (falxcerebri); 88) ramp (clivus); 89) shell (putamen); 90) choroid plexus of the lateral ventricle (plexus choroideus ventriculi lateralis); 91) mastoid body (corpus mammillare); 92) mastoid cells (cellulae mastoideae); 93) midbrain (mesencephalon); 94) middle cerebellar peduncle (pedunculus cerebellaris medius); 95) suprasellar cistern (cisterna suprasellaris); 96) thalamus (thalamus); 97) parietal lobe (lobusparietalis); 98) parieto-occipital sulcus (sulcus parietooccipitalis); 99) snail (cochlea); 100) quadrigeminal colliculi, superior (colliculus superior); 101) colliculi of the quadrigeminal, lower (colliculus inferior); 102) central sulcus (sulcus centralis); 103) tank-

on the bridge (cisterna pontis); 104) four-hill cistern (cisterna quadrigemina); 105) pineal body, pineal gland (corpus pineale, epiphysis); 106) calcarine groove (sulcus calcarinus)

ARTERIES OF THE NECK AND BRAIN

107) bifurcation of the carotid arteries (bifurcatio carotica); 108) vertebral artery (a. vertebralis); 109) superior cerebellar artery (a. superior cer-ebelli); 110) internal carotid artery (a. carotis int.); 111) ophthalmic artery (a. ophthalmica); 112) posterior cerebral artery (a. cerebri posterior); 113) posterior communicating artery (a. communucans posterior); 114) cavernous part of the inner carotid artery (pars cavernosa); 115) stony part of the internal carotid artery (pars petrosa); 116) external carotid artery (a. carotis ext.); 117) common carotid artery (a. carotis communis); 118) main artery (a. basilaris);

119) anterior cerebral artery (a. cerebri anterior);

120) anterior inferior cerebellar artery (a. anterior inferior cerebelli); 121) anterior communicating artery (a. communucans anterior); 122) middle cerebral artery (a. cerebri media); 123) supraclinoid part of the internal carotid artery (pars supraclinoidea)

VEINS AND SINES OF THE BRAIN

124) great cerebral vein, vein of Galen (v. magna cerebri); 125) superior sagittal sinus (superior sagittal sinus); 126) internal jugular vein (v. jugularis int.); 127) external jugular vein (v. jugularis ext.);

128) inferior petrosal sinus (inferior petrosal sinus);

129) inferior sagittal sinus (inferior sagittal sinus);

130) cavernous sinus (sinus cavernosus); 131) superficial veins brain (vv. superiores cerebri); 132) transverse sinus (sinus transversus); 133) straight sine (sinus rectus); 134) sigmoid sinus (sinus sigmoideus); 135) sine drain (confluence sinum)

Rice. 1.1.1