Principal Imaging Atlas of Human Anatomy

Imaging Atlas of Human Anatomy

, , ,

Imaging Atlas of Human Anatomy, 4th Edition provides a solid foundation for understanding human anatomy. Jamie Weir, Peter Abrahams, Jonathan D. Spratt, and Lonie Salkowski offer a complete and 3-dimensional view of the structures and relationships within the body through a variety of imaging modalities. Over 60% new images-showing cross-sectional views in CT and MRI, nuclear medicine imaging, and more-along with revised legends and labels ensure that you have the best and most up-to-date visual resource. In addition, you’ll get online access to 10 pathology tutorials (with another 24 available for sale) linking to additional images for even more complete coverage than ever before. In print and online, this atlas will widen your applied and clinical knowledge of human anatomy.

  • Features orientation drawings that support your understanding of different views and orientations in images with tables of ossification dates for bone development.
  • Presents the images with number labeling to keep them clean and help with self-testing.
  • Features completely revised legends and labels and over 60% new images-cross-sectional views in CT and MRI, angiography, ultrasound, fetal anatomy, plain film anatomy, nuclear medicine imaging, and more-with better resolution for the most current anatomical views.
  • Reflects current radiological and anatomical practice through reorganized chapters on the abdomen and pelvis, including a new chapter on cross-sectional imaging.
  • Covers a variety of common and up-to-date modern imaging-including a completely new section on Nuclear Medicine-for a view of living anatomical structures that enhance your artwork and dissection-based comprehension.
  • Includes stills of 3-D images to provide a visual understanding of moving images.
  • Provides free online access to 10 pathology tutorials - designed with the help of a recent medical student - illustrated with hundreds of pathological images to further develop your visual memory of anatomical structures and positions..
Año:
2010
Edición:
4
Editorial:
Mosby
Idioma:
english
Páginas:
264
ISBN 10:
0723434573
ISBN 13:
9780723434573
File:
PDF, 113.83 MB
Descarga (pdf, 113.83 MB)

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Commissioning Editor: Madelene Hyde
Development Editor: Sharon Nash
Project Manager: Frances Affleck
Design: Kirsteen Wright
Marketing Managers: Jason Oberacker (US) and Ian Jordan (UK)

Jamie Weir MBBS, DMRD, FRCP(Ed), FRANZCR(Hon), FRCR
Emeritus Professor of Radiology
University of Aberdeen
Aberdeen, UK

Peter H Abrahams MBBS, FRCS(Ed), FRCR, DO(Hon)
Professor of Clinical Anatomy, Warwick Medical School, UK
Professor of Clinical Anatomy, St George’s University, Grenada, West Indies
Extraordinary Professor, Department of Anatomy, University of Pretoria, South Africa
Fellow, Girton College, Cambridge, UK
Examiner, MRCS, Royal College of Surgeons, UK
Family Practitioner, Brent, London, UK

Jonathan D Spratt MBBChir, MA(Cantab), FRCS(Eng), FRCS(Glasg), FRCR
Chief Radiologist, County Durham and Darlington NHS Foundation Trust
Examiner in Anatomy, Royal College of Radiologists, UK
Examiner, MRCS, Royal College of Surgeons, UK
Fellow in Anatomical Radiology, Northumbria University, UK
Visiting Professor of Anatomy, St George’s School of Medicine, Grenada and St Vincent

Lonie R Salkowski

MD

Associate Professor of Radiology and Anatomy
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, USA
Clinical Professor, College of Health Sciences
University of Wisconsin-Milwaukee
Milwaukee, Wisconsin, USA

An imprint of Elsevier Limited
¹2011, Elsevier Limited. All rights reserved.
First edition 1992
Second edition 1997
Third edition 2003
The right of Jamie Weir, Peter H Abrahams, Jonathan D Spratt and
Lonie R Salkowski to be identified as authors of this work has been asserted by
them in accordance with the Copyright, Designs and Patents Act 1988.
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. Permissions may be sought directly from Elsevier’s Rights
Department: phone: (+1) 215 239 3804 ; (US) or (+44) 1865 843830 (UK); fax:
(+44) 1865 853333; e-mail: healthpermissions@elsevier.com. You may also
complete your request on-line via the Elsevier website at
http://www.elsevier.com/permissions.
ISBN: 978-0-7234-3457-3
International Edition ISBN: 978-0-8089-2388-6
British Library Cataloguing in Publication Data

Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notice
Medical knowledge is constantly changing. Standard safety precautions must be
followed, but as new research and clinical experience broaden our knowledge,
changes in treatment and drug therapy may become necessary or appropriate.
Readers are advised to check the most current product information provided by
the manufacturer of each drug to be administered to verify the recommended
dose, the method and duration of administration, and contraindications. It is
the responsibility of the practitioner, relying on experience and knowledge of the
patient, to determine dosages and the best treatment for each individual patient.
Neither the Publisher nor the authors assume any liability for any injury and/or
damage to persons or property arising from this publication.
The Publisher

Typeset by IMH(Cartrif), Loanhead, Scotland
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contents
Preface to the Fourth edition

vii

Preface to the First edition

vii

Acknowledgements and Dedication

viii

Introduction

ix

1. Head, neck and brain

1

2. Vertebral column and spinal cord

55

3. Upper limb

67

4. Thorax

89

5. Abdomen and pelvis – Cross-sectional

123

6. Abdomen and pelvis – Non cross-sectional

171

7. Lower limb

207

8. Nuclear medicine

235

Index

241

This page intentionally left blank

vii

Preface to the four th edition
There is increasing importance placed on the interpretation of
radiological anatomy in a world that has seen considerable changes in
medical student training programmes over the last decade, combined
with the reduction in cadaver dissection.
We have updated and revised this atlas, by the addition of new images
and techniques, to reflect these trends. The ‘Author’ team has also
changed. We wish to record our sincere thanks to Drs Hourihan, Belli,
Moore and Owen for their previous contributions and introduce you
to our two new co-authors, Dr Jonathan Spratt from Durham, UK and
Dr Lonie Salkowski from Madison, WI, USA. Both are radiological
anatomists of high repute and most of the new material emanates
from their work.
The format for this fourth edition remains the same but the layout of
the chapters on the abdomen and pelvis has been revised to reflect
current radiological and anatomical practice; the new chapters being
cross-sectional imaging of the abdomen and pelvis and non crosssectional imaging of the abdomen and pelvis.
A new section on nuclear medicine, by Dr Salkowski, has also been
added.
We are adding for the first time, a website of pathology to complement
this radiological atlas. It consists of a series of 34 PowerPoint tutorials
related to the eight anatomical chapters and based on nine ‘concepts’.
These ‘concepts’ have been designed to help you understand the
relationship between normal anatomy and altered, abnormal anatomy
that is the discipline of pathology. This material has been produced
with the help of Dr Jennifer Allison who started this project as a
medical student. A selection of these tutorials is available free with

the atlas (please see inside front cover for access details) and the
remainder will be available for a small charge from the same site.
The nine concepts are as follows:
1.
2.
3.
4.
5.
6.
7.

‘things pushed’
‘things pulled’
‘things added’
‘things missing’
‘things larger than normal’
‘things smaller than normal’
‘things that have an abnormal structure, either locally or
diffusely’
8. ‘things that have an abnormal shape, either locally or generally'
9. ‘things you cannot see despite knowing they are present
pathologically, i.e. you are either using the wrong imaging
technique or you will never see any abnormality because the
disease is only microscopic and has not induced any visible
anatomical (or physiological) change’.

Further explanations together with numerous examples to demonstrate
these ‘concepts’ are on the website. We believe the ongoing reliance
placed by clinicians on the imaging of pathological processes will be
facilitated by this novel and exciting approach and the addition of
pathology combined with this extensively revised radiological anatomy
text will enhance the understanding of imaging to the benefit of both
you, the reader, and your patient. As this book and accompanying
website are for you, the student, we encourage and welcome
corrections or suggestions and ideas for future editions.
Jamie Weir, Peter H Abrahams, Jonathan Spratt and Lonie Salkowski
January 2010

Preface to the first edition
Imaging methods used to display normal human anatomy have
improved dramatically over the last few decades. The ability to
demonstrate the soft tissues by using the modern technologies
of magnetic resonance imaging, X-ray computed tomography, and
ultrasound has greatly facilitated our understanding of the link
between anatomy as shown in the dissecting room and that necessary
for clinical practice. This atlas has been produced because of the
new technology and the fundamental changes that are occurring in
the teaching of anatomy. It enables the preclinical medical student
to relate to basic anatomy while, at the same time, providing a
comprehensive study guide for the clinical interpretation of imaging,
applicable for all undergraduate and postgraduate levels.
Several distinguished authors, experts in their fields of imaging, have
contributed to this book, which has benefited from editorial integration
to ensure balance and cohesion. The atlas is designed to complement
and supplement the McMinn's Clinical Atlas of Human Anatomy 6th
edition.

Duplication of images occurs only where it is necessary to demonstrate
anatomical points of interest or difficulty. Similarly, examples of
different imaging modalities of the same anatomical region are only
included if they contribute to a better understanding of the region
shown. Radiographs that show important landmarks in limb ossification
centre development, together with examples of some common
congenital anomalies, are also documented. In certain sections,
notably MR and CT, the legends may cover more than one page, so
that a specific structure can be followed in continuity through various
levels and planes.
Human anatomy does not alter, but our methods of demonstrating it
have changed significantly. Modern imaging allows certain structures
and their relationships to be seen for the first time, and this has aided
us in their interpretation. Knowledge and understanding of radiological
anatomy are fundamental to all those involved in patient care, from the
nurse and the paramedic to medical students and clinicians.
Jamie Weir and Peter H Abrahams
February 1992

viii

Acknowledgements
Thank you to all of our previous contributors of images to the previous
editions of this atlas and to Dr Alison Murray who has kindly granted
permission for use of images used in the online pathology tutorials.
New material and labelling have been added by Dr Richard Wellings,

University Hospital, Coventry and Warwickshire and Dr Andrew Hine,
N.W. London Hospitals and we are very grateful for their help. The two
images in the introduction, the body MRA and the MR tractography,
were kindly supplied by Toshiba Medical Systems.

Dedication
To our students – past, present and future

ix

Introduction
Guide to ossification tables
Ossification tables, such as the one shown on the right, appear
throughout this book.
The key to these tables is as follows:
(c) = cartilage
(m) = membrane
miu = months of intrauterine life
wiu = weeks of intrauterine life
mths = months
yrs = years

CLAVICLE (m)
Lateral end
Medial end

Appears
5 wiu
15 yrs

Fused
20+ yrs
20+ yrs

SCAPULA (c)
Body
Coracoid
Coracoid base
Acromion

8 wiu
<1 yr
Puberty
Puberty

15 yrs
20 yrs
15–20 yrs
15–20 yrs

at the forefront of research, namely MRS, fMRI and mMRI, the latter
taking on a new direction since the description of the human genome.

And the rule to remember is: girls before boys.

Magnetic resonance imaging

Magnetic resonance spectroscopic imaging (MRS) assesses function
within the living brain. MRS takes advantage of the fact that protons

Magnetic resonance imaging (MRI) produces images by magnetising
the patient in the bore of a powerful magnet and broadcasting short
pulses of radiofrequency (RF) energy at 46 MHz to resonate mobile
protons (hydrogen nuclei) in fat, protein and water. The protons
produce RF echoes when their resonant energy is released and their
density and location can be exactly correlated by complex mathematical
algorithms into an image matrix.
The spinning proton of the hydrogen nucleus acts like a tiny bar
magnet, aligning either with or against the magnetic field producing
a small net magnetic vector. RF energy is used to generate a second
magnetic field, perpendicular to the static magnetic field, which rotate
or ‘flip’ the protons away from the static magnetic field. Once the RF
pulse is switched off, the protons flip back to their original position of
equilibrium (‘relaxation’), emitting the RF energy they had acquired into
the antenna around the patient, which is then digitised, amplified and,
finally, spatially encoded by the array processor.
MRI systems are graded according to the strength of the magnetic
field they produce. Routine high-field systems are those capable
of producing a magnetic field strength of 1.5–3 T (Tesla) using a
superconducting electromagnet immersed in liquid helium. Open
magnets for claustrophobic patients and limb scanners use permanent
magnets between 0.2 and 0.75 T. For comparison, earth’s magnetic
field varies from 30 to 60 uT. MRI does not present any recognised
biological hazard. Patients who have any form of pacemaker or
implanted electro-inductive device must not be examined. Other
prohibited items include ferromagnetic intracranial aneurysm slips,
certain types of cardiac valve replacement and intra-ocular metallic
foreign bodies. Many extra cranial vascular clips and orthopaedic
prostheses are now 'MRI friendly', but these may cause local artefacts.
Loose metal items must be excluded from the examination room
– pillows containing metallic coiled springs have been known to near
suffocate patients!
Although beyond the remit of the current edition of this book, new
methods of analysing normal and pathologic brain anatomy are now

Body MRA.

x

MR tractography.
residing in differing chemical environments possess slightly different
resonant properties (chemical shift). For a given volume of brain
the distribution of these proton resonances can be displayed as a
spectrum. Discernible peaks can be seen for certain neurotransmitters:
N-acetylaspartate varies in multiple sclerosis, stroke and schizophrenia
while choline and lactate levels have been used to evaluate certain
brain tumours.

at 8 T of the microvasculature of the live human brain allowing close
comparison to histology, having significant implications in the treatment
of reperfusion injury and in the physiology of solid tumours and
angiogenesis. There is every reason to believe that continued efforts
to push the envelope of high-field-strength applications will open new
vistas in what appears to be a never-ending array of potential clinical
applications.

Functional MRI (fMRI) depends on the fact that haemoglobin is
diamagnetic when oxygenated but paramagnetic when deoxygenated.
These different signals can be weighted to the smaller vessels, and
hence closer to the active neurons, by using larger magnetic fields.
In molecular imaging (mMRI) biomarkers interact chemically with their
surroundings and alter the image according to molecular changes
occurring within the area of interest, potentially enabling early detection
and treatment of disease and basic pharmaceutical development, also
allowing for quantitative testing.

Ultrasound

High-field-strength magnets of course give significant improvement
in spatial resolution and contrast. MR images have been acquired

In contrast with the other images in this book, ultrasound images
do not depend on the use of electromagnetic wave forms. It is the
properties of high-frequency sound waves (longitudinal waves) and their
interaction with biological tissues that go to form these ‘echograms’.
A sound wave of appropriate frequency (diagnostic range 3.5–20 MHz)
is produced by piezo-electric principles, namely that certain crystals
can change their shape and produce a voltage potential, and vice
versa. As the beam passes through tissues, two important effects
determine image production: attenuation and reflection. Attenuation is
caused by the loss of energy due to absorption, reflection, refraction

xi

out of the capture of the receiver with resulting reduction in signal
intensity. Reflection of sound waves within the range of the receiver
produces the image, the texture of which is dependent upon tiny
differences in acoustic impedance between different tissues. Blood
flow and velocity can be measured (using the Doppler principle) in
duplex mode.
Techniques such as harmonic imaging and the use of ultrasound
contrast agents (stabilised microbubbles) have enabled non-invasive
determination of myocardial perfusion to be recently discovered. These
contrast agents clearly improve the detection of metastases in the liver
and spleen. Ultrasound is the most common medical imaging technique
for producing elastograms in which stiffness or strain images of soft
tissue are used to detect or classify tumours. Cancer is 5–28 times
stiffer than the background of normal soft tissue. When a mechanical
compression or vibration is applied, the tumour deforms less than the
surrounding tissue. Elastography can be used for example to measure
the stiffness of the liver in vivo or in the detection of breast or thyroid
tumours. A correlation between liver elasticity and the cirrhosis score
has been shown.
Only a handful of key ultrasound images have been included in the
book to illustrate a particular point or area, as the real-time nature of
ultrasound precludes further coverage. Interpretation of the anatomy
from static ultrasound images is more difficult than that from other
imaging modalities because the technique is highly operator-dependent
and provides information on tissue structure and form different from
that of other imaging techniques.

Nuclear medicine
Historically the field of nuclear medicine began in 1946 when
radioactive iodine was administered as an ‘atomic cocktail’ to treat
thyroid cancer. Since that time, nuclear medicine has advanced and
was recognized by the American Medical Association as a medical
specialty in 1971.
Diagnostic radiology creates an image by passing radiation through
the body from an external source. Nuclear medicine, unlike diagnostic
radiology, creates an image by measuring the radiation emitted from
tracers taken internally. Thus the image is created from the radiation
emitted from the patient. Overall the radiation dosages are comparable
and vary depending on the examination.
Nuclear medicine also differs from most other imaging modalities in
that the tests demonstrate the physiological function of a specific area
of the body. In some instances this physiological information can be
fused with more anatomical imaging of CT or MRI thus combining the
strengths of anatomy and function for diagnosis.
Rather than a contrast media for imaging, nuclear medicine uses
radiopharmaceuticals, which are pharmaceuticals that have been
labelled with a radionuclide. These radiopharmaceuticals are
administered to patients by intravenous injection, ingestion, or
inhalation. The method of administration depends on the type of
examination and the organ or organ process to be imaged. By
definition, all these radiopharmaceuticals emit radiation. This emitted
radiation is detected and imaged with specialised equipment such
as gamma cameras, positron emission tomography (PET), and single

photon emission computed tomography (SPECT). Radiation in certain
tests can be measured from parts of the body by the use of probes, or
samples can be taken from patients and measured in counters.
The premise of nuclear medicine imaging involves functional biology,
thereby not only can studies be done to image a disease process
but they can also be used to treat diseases. Radiopharmaceuticals
that are used for imaging emit a gamma ray (a) and those used for
treatment emit a beta (`) particle. Gamma rays are of higher energy
to pass through the body and be detected by a detection camera,
whereas beta particles travel only short distances and emit their
radiation dose to the target organ. For example, technetium-99m
or iodine-123 may be used to detect thyroid disease, but certain
thyroid diseases or thyroid cancer may be treated solely or in part by
treatment with iodine-131. The difference in the agent used depends
on the type and energy levels of the radiation particle that the
radioisotope emits.
Radionuclides, or the radioactive particle, used in nuclear medicine
are often chemically bound to a complex called a tracer so that when
administered it acts in a characteristic way in the body. The way the
body handles this tracer can differ in disease or pathologic processes
and thus demonstrate images different from normal in disease
states. For example, the tracer used in bone imaging is methylenediphosphonate (MDP). MDP is bound to technetium-99m for bone
imaging. MDP attaches to hydroxyapatite in the bone. If there is a
physiological change in the bone from a fracture, metastatic bone
disease or arthritic change, there will be an increase in bone activity
and thus more accumulation of the tracer in this region compared
with the normal bone. This will result in a focal ‘hot spot’ of the
radiopharmaceutical on a bone scan.
Technetium-99m is the major workhorse radioisotope of nuclear
medicine. It can be eluted from a molybdenum/technetium generator
stored within a nuclear medicine department allowing for easy access.
It has a short half-life (6-hours), which allows for ease of medical
imaging and disposal. Its pharmacological properties allow it to be
easily bound to various tracers and it emits gamma rays that are of
suitable energy for medical imaging.
In addition to technetium-99m, the most common intravenous
radionuclides used in nuclear medicine are iodine-123 and 131,
thallium-201, gallium-67, 18-fluorodeoxyglucose (FDG) and indium-111
labeled leukocytes. The most common gaseous/aerosol radionuclides
used are xenon-133, krypton-81m, technetium-99m (Technegas) and
technetium-99m DTPA.
The images obtained from nuclear medicine imaging can be in the
form of one or many images. Image sets can be represented as time
sequence imaging (e.g. cine) such as dynamic imaging or cardiac gated
sequences, or by spatial sequence imaging where the gamma camera
is moved relative to the patient such as in SPECT imaging. Spatial
sequence imaging allows the images to be presented as a slice-stack
of images much like CT or MRI images are displayed. Spatial sequence
imaging can also be fused with concomitant CT or MR imaging to
provide combined physiologic and anatomical imaging. Time and
spatial sequence imaging offer a unique perspective and information of
physiological processes in the body.

xii

A PET (positron emission tomography) scan is a specialised type of
nuclear medicine imaging that measures important body functions,
such as blood flow, oxygen use, and sugar (glucose) metabolism to
evaluate how well organs and tissues are functioning. PET imaging
involves short-lived radioactive tracer isotopes that are chemically
incorporated into biologically active molecules. The most common
molecule used is fluorodeoxyglucose (FDG), which is a sugar. After
injection into the body, these active molecules become concentrated
into the tissues of interest. After this waiting time, which is about
an hour for FDG, imaging can proceed. Imaging of FDG occurs as the
isotope decays. The isotope undergoes positron emission decay. As
the positron is emitted, it travels only a few millimeters and annihilates
with an electron and in so doing produce a pair of gamma photons
moving in opposite directions. The PET scan detectors process only
those photon pairs that are detected simultaneously (coincident
detection). This data is then processed to create an image of tissue
activity with respect to that particular isotope. These images can then
be fused with CT or MR images.
A limitation of PET imaging is the short half-life of the isotopes. Thus
close access to a cyclotron for generation of the isotopes plays an
important role in the feasible location of PET imaging. Typical isotopes
used in medical imaging and their half-lives are: carbon-11 (~20 min),
nitrogen-13 (~10 min), oxygen-13 (~2 min) and fluorine-18 (~110 min).

Angiography/Interventional radiology
Angiographic imaging began in 1927 by Egas Moniz, a physician and
neurologist, with the introduction of contrast X-ray cerebral angiography.
In 1949 he was awarded the Nobel Prize for his work. The field
of angiography however was revolutionised with the advent of the
Seldinger technique in 1953, in which no sharp needles remained
inside the vascular lumen during imaging.
Although the field of angiography began with X-ray and fluoroscopic
imaging of blood vessels and organs of the body by injecting radioopaque contrast agents in to the blood, it has evolved to so much
more. Many of the procedures performed by angiography can be
diagnostic, as newer techniques arose, it has allowed for the advent
of minimally invasive procedures performed with image guidance and
thus the name change of the discipline to Interventional radiology (or
vascular and interventional radiology).
Angiograms are typically performed by gaining access to the blood
vessels, whether this is through the femoral artery, femoral vein or
jugular vein depends on the area of interest to be imaged. Angiograms
can be obtained of the brain as cerebral angiograms, of the heart as
coronary angiograms, of the lungs as pulmonary angiograms, and so
on. Imaging of the arterial and venous circulation of the arms and legs
can demonstrate peripheral vascular disease. Once vascular access is
made, then catheters are directed to the specific location to be imaged
in the body by the use of guide wires. Contrast agents are injected
through these catheters to visualise the vessels or the organ with X-ray
imaging.
In addition to diagnostic imaging, treatment and/or interventions can
often be performed through similar catheter based examinations. Such
procedures might involve angioplasties where a balloon mechanism is
placed across an area of narrowing, or stenosis, in a vessel or lumen.

With controlled inflation of the balloon, the area of narrowing can be
widened. Often to keep these areas from narrowing again, stents can
be placed within the lumen of the vessel or even in the trachea or
oesophagus.
Imaging in diagnostic or interventional procedures can be still images
or motion (cine) images. The technique often used is called digital
subtraction angiography (DSA). In this type of imaging, images are
taken at 2–30 frames per second to allow imaging of the flow of blood
through vessels. A preliminary image of the area is taken before the
contrast is injected. This ‘mask’ image is then electronically subtracted
from all the images leaving behind only the vessels filled with contrast.
This technique requires the patient to remain motionless for optimal
subtraction.
Angiograms can be performed of the heart to visualise the size and
contractility of the chambers and anatomy of the coronary vessels.
The thorax can also be studied to evaluate the pulmonary arteries
and veins for vascular malformations, blood clots and possible
origins of hemoptysis. The neck is often imaged to visualise the
vessels that supply the brain as they arise from the aortic arch to
the cerebral vessels, in the investigation of atherosclerotic disease,
vascular malformations and tumoral blood supplies. Renal artery
imaging can elucidate the cause of hypertension in selected patients,
as can imaging of the mesenteric vessels discover the origin of
gastrointestinal bleeding or mesenteric angina.
In addition to angiograms and venograms, the field of interventional
radiology also performs such procedures as coil-embolisation of
aneurysms and vascular malformations, balloon angioplasty and
stent placement, chemoembolisation directly into tumours, drainage
catheter insertions, embolisations (e.g. uterine artery embolisation
for treatment of uterine fibroids), thrombolysis to dissolve blood
clots, tissue biopsy (percutaneous or transvascular), radiofrequency
ablation and cryoablation of tumours, line insertions for specialised
vascular access, inferior vena cava filter placements, vertebroplasty,
nephrostomy placement, gastrostomy tube placement for feeding,
dialysis access, TIPS (transjugular intrahepatic porto-systemic shunt)
placement, biliary interventions, and, most recently, endovenous laser
ablation of varicose veins.

Computed tomography
The limitation of all plain radiographic techniques is the two
dimensional representation of three dimensional structures: the linear
attenuation co-efficient of all the tissues in the path of the X-ray beam
form the image.
Computed tomography (CT) obtains a series of different angular X-ray
projections that are processed by a computer to give a section of
specified thickness. The CT image comprises a regular matrix of picture
elements (pixels). All of the tissues contained within the pixel attenuate
the X-ray projections and result in a mean attenuation value for the
pixel. This value is compared with the attenuation value of water and is
displayed on a scale (the Hounsfield Scale). Water is said to have an
attenuation of 0 Hounsfield units (HU); air typically has an HU number
of –1000; fat is approximately –100 HU; soft tissues are in the range
+20 to +70 HU; and bone is usually greater than +400 HU.

xiii

Modern multislice helical CT scanners can obtain images in subsecond times and imaging of the whole body from the top of the head
to the thighs can take as little as a single breath hold of only a few
seconds. The fast scan times allow dynamic imaging of arteries and
veins at different times after the injection of intravenous contrast
agents. The continuous acquisition of data from a helical CT scanner
allows reconstruction of an image in any plane, commonly sagittal
and coronal, as displayed in many of the forthcoming chapters. This
orthogonal imaging greatly improves the understanding of the three
dimensional aspects of radiological anatomy and now forms part of the
standard practice of assessing disease.

No specific preparation is required for CT examinations of the brain,
spine or musculoskeletal system. Studies of the chest, abdomen
and pelvis usually require intravenous contrast medium that contains
iodine, so enhancing the arteries and veins and defining their
relationships to a greater extent. Opacification of the bowel in CT
studies of the abdomen and pelvis can be accomplished by oral
ingestion of a water-soluble contrast medium from 24 hours prior to
the examination to show the colon, combined with further oral intake
0–60 minutes prior to the scan, for outlining the stomach and small
bowel. Occasionally, direct insertion of rectal contrast to show the
distal large bowel may be required.

Digital images are stored in an archive and form part of an electronic
storage record that is becoming commonplace throughout the world,
namely a PACS (Picture Archiving and Communication System). PACS
allows interrogation of images via an electronic network so that those
images (and reports) may be visualised at a distance, for example,
on the wards or at another hospital. The Electronic Patient Record
(EPR), where all patient information is stored, is developing rapidly and
gaining acceptance allowing a marked improvement in data handling.

Generally all studies are performed with the patient supine and images
are obtained in the transverse or axial plain. Modern CT scanners allow
up to 25 degrees of gantry angulation, which is particularly valuable
in spinal imaging. Occasionally, direct coronal images are obtained in
the investigation of cranial and maxillofacial abnormalities; in these
cases the patient lies prone with the neck extended and the gantry
appropriately angled, but this technique has largely been superseded
by the orthogonal imaging described above.

3
2
4

6

1

4

12
3 5

8

2
1
10

5
10

7
8

9

8
11

Right ventricular angiogram (p. 112).

Inferior mesenteric arteriogram (p. 186).

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1

1

Head, neck and brain

2

Skull

21

12
8
25

3
14

11

22

24
9

4

2
6

(a) Skull, occipitofrontal projection.
(b) Skull, demonstrating the foramina rotunda,
occipitofrontal projection.

16

7

19

23
17

10
15

1
5

18

13
20

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Basi-occiput
Body of sphenoid
Crista galli
Ethmoidal air cells
Floor of maxillary sinus (antrum)
Floor of pituitary fossa
Foramen rotundum
Frontal sinus
Greater wing of sphenoid
Inferior turbinate
Internal acoustic meatus
Lambdoid suture
Lateral mass of atlas (first cervical vertebra)
Lesser wing of sphenoid
Mastoid process
Middle turbinate
Nasal septum
Odontoid process (dens) of axis
(second cervical vertebra)
Petrous part of temporal bone
Ramus of mandible
Sagittal suture
Planum sphenoidale
Sphenoid air sinus
Superior orbital fissure
Temporal surface of greater wing of sphenoid

a

2

9
24

7

b

Skull

3

12

10

20
19
28

32
33

13

34

17
18

26

16

14
30

8

15

9

3

4

(a) Skull, lateral projection.

11

22
29
24

21

1

Pituitary fossa (sella turcica), (b) of a 7-year-old
child, (c) of a 23-year-old woman, lateral
projections.

25

a

3535

1 Anterior arch of atlas (first cervical
vertebra)
2 Anterior clinoid process
3 Arch of zygoma
4 Articular tubercle for temporomandibular
joint
5 Basilar part of occipital bone
6 Basisphenoid/basi-occiput synchondrosis
7 Carotid sulcus
8 Clivus
9 Condyle of mandible
10 Coronal suture
11 Coronoid process of mandible

12
13
14
15
16
17
18
19
20
21
22
23

24 Odontoid process (dens) of axis (second
cervical vertebra)
25 Palatine process of maxilla
26 Pituitary fossa (sella turcica)
27 Planum sphenoidale
28 Posterior clinoid process
29 Ramus of mandible
30 Sphenoidal sinus
31 Tuberculum sellae
32 Pinna of ear
33 Inion
34 External occipital protruberance
35 Soft palate

Diploë
Dorsum sellae
Ethmoidal air cells
External acoustic meatus
Frontal process of zygoma
Frontal sinus
Greater wing of sphenoid
Grooves for middle meningeal
vessels
Lambdoid suture
Malar process of maxilla
Mastoid air cells
Middle clinoid process

28
28
13

2

13

27
31

26
30

23
8

5
6

b

2

c

7

Skull

4

10

3

7

13

14
2
11
5

6

4

8
1

9

12
15

16

Skull, 30° fronto-occipital (Townes') projection.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Arch of atlas (first cervical vertebra)
Arcuate eminence of temporal bone
Coronal suture
Dorsum sellae
Foramen magnum
Internal acoustic meatus
Lambdoid suture
Mandibular condyle
Odontoid process (dens) of axis (second cervical vertebra)
Sagittal suture
Superior semicircular canal
Zygomatic arch
Groove for transverse sinus
Squamous occipital bone
Mandible
Nasal septum

Skull

5

15
17

3
20

16

9
10

18

7
5

8

2

11
4
1

6

12

(a) Skull, submentovertical projection.
(b) Skull, with additional angulation for
zygomatic arches, submentovertical
projection.

14
13

a

22
19

21

23
b

1 Anterior arch of atlas (first cervical
vertebra)
2 Auditory (Eustachian) tube
3 Body of mandible
4 Carotid canal
5 Foramen lacerum
6 Foramen magnum
7 Foramen ovale
8 Foramen spinosum
9 Greater palatine foramen
10 Greater wing of sphenoid
11 Head of mandible
12 Jugular foramen
13 Occipital condyle
14 Odontoid process (dens) of axis
(second cervical vertebra)
15 Perpendicular plate of ethmoid
16 Posterior margin of orbit
17 Posterior wall of maxillary sinus
(antrum)
18 Sphenoidal sinus
19 Temporal process of zygomatic bone
20 Vomer
21 Zygomatic arch
22 Zygomatic bone
23 Zygomatic process of temporal bone

Facial bones and paranasal sinuses

6

6
28

14

6

10
23

11

4
7

21

8
19
12

9

5

29

14

3

11
20
2

25

24

29

25
24

a
b

(a) Modified occipito frontal projection.
(b) Occipito mental projection.

28
27
17

22
18
5
16
1

13
15

9
c

15

26
d

(c) Lateral nasal bones projection.
(d) Lateral sinus projection.
1
2
3
4
5
6
7
8
9
10

Anterior wall of maxillary sinus (antrum)
Condyle of mandible
Coronoid process of mandible
Ethmoidal sinuses
Frontal process of zygomatic bone
Frontal sinuses
Frontozygomatic suture
Greater wing of sphenoid
Horizontal plate of palatine bone
Infra-orbital foramen

11
12
13
14
15
16
17
18
19
20

Left maxillary sinus (antrum)
Lesser wing of sphenoid
Malar process of maxilla
Nasal septum
Palatine process of maxilla
Posterior wall of maxillary sinus (antrum)
Sella turcica
Sphenoidal sinus
Superior orbital fissure
Temporal process of zygomatic bone

21
22
23
24
25
26
27
28
29

Zygomatic arch
Zygomatic process of frontal bone
Zygomatic process of temporal bone
Mastoid process
Odontoid peg
Soft palate
Floor of anterior cranial fossa
Nasal bones
Mandible

Temporomandibular joints

7

9
6
9

10
7

4

5

1

6

8

3
2

10

7

4

5
3

8

1
2

b

(b) Temporomandibular joint MR: open.
MR of the temporomandibular joint with the subject looking to
the left.

a

(a) Temporomandibular joint MR: closed.

1
2
3
4
5
6
7
8

11
12
13
14
16
7

6
1

0
5

15

2

9
10
11
12
13
14
15
16

Condylar head
Condylar neck
Anterior band of disc
Posterior band of disc
Articular eminence
Mandibular fossa
External auditory canal
Mastoid process of temporal
bone
Temporal lobe of brain
Temporalis muscle
Pinna of ear
Greater wing of sphenoid
Tegmen tympani
Malleus
Zygomatic process of temporal
bone
Sinus plate

c

(c) Radiograph of temporomandibular joint:
closed.

Radiographs of the temporomandibular joint with the subject looking to the right.

12
13

1
14

7

6

5
1
2

d

(d) Radiograph of temporomandibular joint:
open.

Paranasal sinuses

8

1

3

10
11

2

12
3
5

17

5
6

6
4

14 13

4
16

7

25

25

9
8

18

a

b

19

30
20

21

21

29

11

11
30

32

22
15

14

20

12

31

15

28

5
5

13 14

26

16

16

26

27

23

33
9

24

24
9

18

34
35

c

d

Facial bones and paranasal sinuses, axial CT images demonstrated at the following levels: (a) alveolar process of the maxilla,
(b) hard palate, (c) nares, (d) maxillary sinus, (e) middle turbinate, (f) zygomatic arch, (g) sphenoid sinus, (h) ethmoid sinus.
1
2
3
4
5
6
7
8
9
10
11
12
13

Incisive canal
Alveolar rim
Alveolar recess
Medial pterygoid muscle
Masseter muscle
Ramus of mandible
Oropharynx
Body of C2
Styloid process
Hard palate
Maxillary sinus (antrum)
Lateral wall of maxillary sinus (antrum)
Lateral pterygoid plate

14
15
16
17
18
19
20
21
22
23
24

Medial pterygoid plate
Pterygoid fossa
Nasopharynx
Vomer
Odontoid process (dens)
Nares
Nasal septum
Inferior turbinate
Coronoid process of mandible
Condylar neck of mandible
Anterior arch of atlas (first cervical
vertebra)
25 Parapharyngeal space

26 Lateral pyterygoid muscle
27 Torus tubarius
28 Inferior meatus (at location of
nasolacrimal opening)
29 Zygoma
30 Nasal cavity
31 Medial wall of maxillary sinus (antrum)
32 Temporalis muscle
33 Condylar head of mandible
34 Mastoid air cells
35 Occipital condyle
36 Middle turbinate
37 Middle meatus

Paranasal sinuses

9

39
38

39
11

37
36

11
32

20
32

40

47
48

42

49
42

66
33

51

33

62

45

41

50

46
34

f

e

63
63

52

52
53

43
32

58
70

56

54

57

44

68

g

38
39
40
41
42
43
44
45

Superior turbinate
Nasolacrimal duct
Zygomatic arch
Clivus
Foramen spinosum
Greater wing of sphenoid
Cavernous internal carotid artery
Horizontal petrous internal carotid artery
canal
46 Vertical petrous internal carotid artery
canal
47 Pterygopalatine fossa

64
34

61

54

65

69
67

43

60

55

57

59

68

h

48
49
50
51
52
53
54
55
56
57
58
59

Foramen rotundum
Vidian canal
Middle ear cavity
Eustachian tube
Globe of eye
Optic nerve
Sphenoid sinus (antrum)
Inferior orbital fissure
Superior orbital fissure
Temporal lobe
Anterior ethmoidal air cells
Middle ethmoidal air cells

Posterior ethmoidal air cells
Internal auditory canal
External auditory canal
Nasal bone
Petrous apex
Floor of sella
Foramen lacerum
Ossicles of middle ear (incus and
malleus)
68 Semicircular canals of inner ear
69 Cochlea of inner ear
70 Lamina papyracea
60
61
62
63
64
65
66
67

Paranasal sinuses

10

1

1
2
3

2

4
6

16
5

21

10
9
11

11

b

a

25
26

27
7

6

28

28

18 13

30

15

31
10

17

23

12
9

20

19
12 10

22

9

14
11
24
8

8
c

d

29

Paranasal sinuses, coronal CT images demonstrated at the following levels: (a) frontal sinuses, (b) nasolacrimal duct, (c)
cribriform plate, (d) anterior ethmoids, (e) middle ethmoids, (f) pterygopalatine fossa, (g) sphenoid sinus, (h) nasopharynx.

1
2
3
4
5
6
7
8
9
10

Frontal bone
Frontal sinus (antrum)
Nasal bone
Upper eyelid
Lower eyelid
Globe of eye
Crista galli
Hard palate
Maxillary sinus (antrum)
Nasal septum

11
12
13
14
15
16
17
18
19
20

Inferior turbinate (concha)
Middle turbinate (concha)
Superior turbinate (concha)
Inferior meatus
Lamina papyracea
Air in nasolacrimal sac
Inferior orbital canal
Anterior ethmoid air cells
Middle meatus
Superior meatus

Paranasal sinuses

11

34
47

50 37

39
40
45 37

10

32
9

50

12

32

9
11

11
51

52

51 33
e

f

38

46
39

36

46
41

42
36

37

32

32

50
35
49

49
44

g

35

43

51

h

48

48

Paranasal sinuses, coronal CT images demonstrated at the following levels: (a) frontal sinuses, (b) nasolacrimal duct, (c) cribriform
plate, (d) anterior ethmoids, (e) middle ethmoids, (f) pterygopalatine fossa, (g) sphenoid sinus, (h) nasopharynx.

21
22
23
24
25
26
27
28
29
30
31

Nasolacrimal duct
Maxilla
Zygoma
Lateral wall of maxillary sinus
Orbital roof, frontal bone
Cribriform plate, ethmoid bone
Perpendicular plate, ethmoid bone
Fovea ethmoidalis, frontal bone
Upper alveolar ridge of maxilla
Lateral orbital wall, zygomatic bone
Orbital floor, maxillary bone

32
33
34
35
36
37
38
39
40
41
42

Zygomatic arch
Ramus of mandible
Greater wing of sphenoid
Nasopharynx
Sphenoid sinus (antrum)
Pterygopalatine fossa
Optic canal
Superior orbital fissure
Inferior orbital fissure
Foramen rotundum
Vidian canal

43
44
45
46
47
48
49
50
51
52

Lateral pterygoid plate
Medial pterygoid plate
Sphenopalatine foramen
Anterior clinoid process
Lesser wing of sphenoid
Medial pterygoid muscle
Lateral pterygoid muscle
Temporalis muscle
Masseter muscle
Greater palatine foramen

Paranasal sinuses

12

4

5
9
3

12

2
1
11

10

6

8

14
7

a

b

16

53

5

5
44
13

45
17

15

10

13

15

10

31
32

42
c

d

(a)–(h) Paranasal sinuses, sagittal CT images, from lateral to midline.

1
2
3
4
5
6
7
8
9
10
11
12
13
14

Condyle of mandible
Articular eminence
Zygomatic arch
Zygoma
Globe of eye
Lateral pterygoid muscle
Styloid process
Coronoid process of mandible
Middle ear
Maxillary sinus (antrum)
Masseter muscle
Inner ear
Pterygopalatine fossa
Transverse process of C1

15
16
17
18
19
20
21
22
23
24
25
26
27
28

Horizontal petrous internal carotid artery canal
Frontal bone, orbital roof
Maxillary bone, orbital floor
Hard palate
Soft palate
Tongue
Oropharynx
Nasopharynx
Sphenoid sinus (antrum)
Frontal sinus (antrum)
Posterior ethmoid air cells
Anterior ethmoid air cells
Greater palatine foramen
Inferior turbinate (concha)

43

Paranasal sinuses

13

40
24

41
26

53

25
23

13

51

10
31
22

28

32
27
e

30

f

39
47
46

25
38

38
23

23

48
52

29

50
49

28

37

34

18
18

19

22
h

g

20

(a)–(h) Paranasal sinuses, sagittal CT images, from lateral to midline.

29
30
31
32
33
34
35
36
37
38
39
40

Middle turbinate (concha)
Base of C2
Occipital condyle
Lateral mass of C1
Anterior arch of C1
Dens (odontoid process)
Posterior arch of C1
Incisive foramen (contains nasopalatine nerve – V2 sensory
branch)
Anterior nasal spine of maxillae
Nasal bone
Cribriform plate
Optic canal

41
42
43
44
45
46
47
48
49
50
51
52
53

33

36

Anterior clinoid
Tubercles of transverse process of C1
Transverse foramen of C2
Internal auditory canal
Inferior orbital fissure
Hypophyseal fossa
Dorsum sellae
Clivus
Vomer
Pharyngeal tonsil
Nasolacrimal duct
Basion
Superior orbital fissure

21

35

14

Temporal bone and ear

11
13
1

1

5

6

6

a

b

13

12

c

9

8

2

2
7

3

10

7

3

d

4

4

(a)–(h) Coronal CT images, from anterior to posterior.

1
2
3
4
5
6
7
8

Sphenoid body
Condylar fossa of temporomandibular joint
Mandibular condyle head
Styloid process
Zygomatic arch
Mandibular ramus
Horizontal petrous internal carotid artery
Hypotympanum

9
10
11
12
13
14
15
16

Epitympanum
Basi-occiput (lower clivus)
Dorsum sellae
Foramen lacerum
Location of vertical portion of internal carotid artery
Anterior arch of C1
Dens (odontoid process)
Body of C2

Temporal bone and ear

26

15

29

19
7
24
30
14

14

27

4

4
16

f

e

20

22

19

20

22
21

24
10

23
28

4

15

17
17

25 31

15
18

16

g

h

16

(a)–(h) Coronal CT images, from anterior to posterior.

17
18
19
20
21
22
23
24

Transverse process of C1
Lateral mass of C1
Cochlea
Semicircular canal
Jugular foramen
Internal acoustic canal
Mastoid air cells
External auditory canal

25
26
27
28
29
30
31

Stylomastoid foramen (location of mastoid segment of CN7)
Incus
Malleus
Tendon of tensor tympani muscle
Scutum
Tympanic annulus
Mastoid tip

Posterior fossa and midbrain

16

2

3

10

20
8

2

11

22
9

4
1

18

6
5 19

7

5
12
24

a

b

10

10
13

21

13 17

25

21

16

16
9
5

15

15

18
18

14

5

23
c

d

(a)–(h) Axial MR images, from inferior to superior.

1
2
3
4

Glossopharyngeal nerve (CN9)
Basilar artery
Jugular foramen
Medulla

5
6
7
8

Fourth ventricle
Vagus nerve (CN10)
Cerebellar hemisphere
Internal carotid artery

9
10
11
12

The legends for pages 16–19 are common for all 4 pages.

Pons
Abducens nerve (CN6)
Facial nerve (CN7)
Vestibulocochlear nerve (CN8)

Posterior fossa and midbrain

17

2
17

28

27
9
5
26

32

23
f

e

35
35

31

35

30
47

33
29
34

36

33

23
h

g

(a)–(h) Axial MR images, from inferior to superior.
13
14
15
16

Cochlear nerve
Vestibular nerve
Semicircular canals
Cochlea

17
18
19
20

Meckel's cave
Middle cerebellar peduncle
Foramen of Luschka
Anterior inferior cerebellar artery

21
22
23
24

The legends for pages 16–19 are common for all 4 pages.

Clivus
Facial nerve in stylomastoid foramen
Superior sagittal sinus
Vermis

Cranial ner ves

18

35

35
46

38

40

41
42

2
10

39
45

37
43

9
44

a

b

2

17
33

17

27
9

9

5

d

c

Cranial nerves, MR images of (a) olfactory and optic nerves, (b) oculomotor nerve, (c) trochlear nerve, (d) trigeminal nerve,
(e) and (f) abducens, facial and auditory nerves, (g) glossopharyngeal nerve, (h) hypoglossal nerve.

25
26
27
28
29
30

Internal auditory canal
Superior cerebellar peduncle
Preganglionic segment of CN5 (trigeminal)
CN5 enters Meckel's cave
Oculomotor nerve (CN3)
CN3 in oculomotor cistern

31
32
33
34
35
36

Pituitary
Ambient cistern
Trochlear nerve (CN4)
Interpenduncular cistern
Globe of eye
Midbrain

The legends for pages 16–19 are common for all 4 pages.

Cranial ner ves

25
11

2
10

11
9

9

12

12
18

18

24

e

f

21

8

21
2

20
9

4

9

3
1

4
6

7

h

g

Cranial nerves, MR images of (a) olfactory and optic nerves, (b) oculomotor nerve, (c) trochlear nerve, (d) trigeminal nerve,
(e) and (f) abducens, facial and auditory nerves, (g) glossopharyngeal nerve, (h) hypoglossal nerve.
37
38
39
40
41
42

Mammillary body
Infundibulum
Optic chiasm
Optic nerve, intracranial portion
Optic nerve, intra-ocular segment
Optic nerve, intracanalicular segment

43
44
45
46
47

Red nucleus of midbrain
Substantia nigra
Cerebral peduncle
Olfactory tract and bulb (CN1)
Posterior cerebral artery

The legends for pages 16–19 are common for all 4 pages.

19

Orbit

20

2

1

1

3
4

8

7

2
4

6

7
5

5

a

b

1

2

9
3
10

10

4
5

d

c

(a)–(d) Coronal MR images, from posterior to anterior.
1
2
3
4
5

Levator palpebrae superioris muscle
Superior rectus muscle
Superior oblique muscle
Medial rectus muscle
Inferior rectus muscle

6
7
8
9
10

Lateral rectus muscle
Optic nerve/sheath complex
Superior ophthalmic vein
Lacrimal gland
Globe of eye

6

Orbit

3

21

3

4

4
1
5

1
7

8

5 19
9
10

27
15

15

6

7

20

28

11

17

12
14

13

31
a

b

18

2
1

1

26

26 8 6 19
5

25

21
16
23
22

16

24

17

22
29
30

31

31
c

d

(a)–(d) Orbit, axial MR images, from inferior to superior.

1
2
3
4
5
6
7
8
9
10
11

Vitreous chamber of globe
Lens
Anterior chamber of globe
Ciliary body
Lateral rectus muscle
Medial rectus muscle
Superior rectus muscle
Ethmoid air cells
Sphenoid sinus (antrum)
Basilar artery
Pons

12
13
14
15
16
17
18
19
20
21
22

Midbrain
Superior recess fourth ventricle
Cerebral aqueduct
Internal carotid artery
Middle cerebral artery
Posterior cerebral artery
Crista galli
Optic nerve (intra-orbital segment)
Optic nerve (intracanalicular segment)
Optic nerve (intracranial segment)
Optic tract

23
24
25
26
27
28
29
30
31

Optic chiasm
Anterior commissure
Gyrus rectus
Olfactory nerve (CN1)
Anterior clinoid process
Dorsum sellae
Cerebral peduncle
Medial and lateral geniculate bodies
Visual (calcarine) cortex

Orbit

22

1

4

17

5
14

2

12

3

2

15

13

16

11

9

9

6
19

6
18

19
18
8

7

a

b

1

1

14
10
6
6
19

1

d

c

(a)–(d) Orbit, sagittal MR images, from medial to lateral.
1
2
3
4
5
6
7
8
9
10

Orbicularis oculi muscle
Globe
Optic nerve, intraocular segment
Levator palpebrae superioris
Superior rectus muscle
Maxillary sinus (antrum)
Dens (odontoid process)
Anterior arch of C1
Clivus
Internal carotid artery

11
12
13
14
15
16
17
18
19

Pons
Basilar artery
Inferior rectus muscle
Retrobulbar fat
Sella turcica/pituitary
Dorsum sellae
Optic nerve, intracranial segment
Pterygopalatine fossa
Inferior oblique muscle

Orbit and eye

23

5
11

10
4
8
12

2

7

9

1
6

4

3

7

1

8
3 5
6

2

a

b

(a) Orbital venogram.
1
2
3
4
5
6
7
8
9
10
11
12

(b) Macrodacryocystogram.

.

Angular veins
Anterior collateral vein
Cavernous sinus
First part of superior ophthalmic vein
Frontal veins
Inferior ophthalmic vein
Internal carotid artery
Medial collateral vein
Second part of superior ophthalmic vein
Superficial connecting vein
Supraorbital vein
Third part of superior ophthalmic vein

1
2
3
4

.
5
6
7
8

Common canaliculus
Hard palate
Inferior canaliculus
Lacrimal catheters

Lacrimal sac
Nasolacrimal duct
Site of lacrimal punctum
Superior canaliculus

5
3
2
7

4

1

14
13

16
15
11
8

1
2
3
4
5
6
7
8
9

Anterior chamber
Aqueous humour
Cornea
Ethmoidal sinuses
Eyelid
Lateral rectus muscle
Lens
Medial rectus muscle
Ophthalmic artery

Optic nerve
Retina and choroid
Retro-orbital fat
Sclera
Suspensory ligament of the
lens
15 Temporalis muscle
16 Vitreous

10

10
11
12
13
14

6
12

0

9

c

(c) Globe, axial MR image.

Phar ynx

24

2

35

35

36
1
6
6

8
10
5

9

8

12 3

3

10
5

37

9
14

25
11

26

11

14

38
27

33

33

24
30

32

30

31

31
34

a

b

36

4

9

4

13

14
27

37

5

11

38

5

28
26

30

32

32
31

34

39

31

34

c

30
39

d

(a)–(h) Nasopharynx and oropharynx, axial CT images.

1
2
3
4
5
6
7

Genioglossus muscle
Body of mandible
Uvula
Oropharynx
Internal jugular vein
Masseter muscle
Submandibular gland

8
9
10
11
12
13
14

Medial pterygoid muscle
Parotid gland
Styloid process
Sternocleidomastoid muscle
Palatine tonsil
Posterior belly of digastric muscle
Retromandibular vein

15
16
17
18
19
20
21

External jugular vein
Anterior belly of digastric muscle
Epiglottis
Vallecula
Hypopharynx
Mylohyoid muscle
Platysma muscle

Phar ynx

2

2

16

40

40

16
21

7

7

4

4
5

5

11

25

41

29
41

32
31

34
32

39

31

f

e

20

21

21
18
17
19

15

7
7
5

11

5

23

22
18
17
19
5

15

29
41

41

34
31

42

42

33

31
32
34

g

h

(a)–(h) Nasopharynx and oropharynx, axial CT images.

22
23
24
25
26
27
28
29

Hyoid body
Greater horn of hyoid
Posterior arch of C1
Dens (odontoid process)
Spinal cord
Body of C2
Body of C3
Body of C4

30
31
32
33
34
35
36
37

Obliquus capitis inferior muscle
Semispinalis capitis muscle
Splenius capitis muscle
Longissimus capitis muscle
Trapezius muscle
Orbicularis oris muscle
Levator anguli oris muscle
Longus capitis muscle

38
39
40
41
42

Longus colli muscle
Nuchal ligament
Superior constrictor muscle of pharynx
Levator scapulae muscle
Spinalis capitis muscle and multifidus
muscle

26

Lar ynx and hypophar ynx

4
11
25

4

5
6

8

7
9

2
1

6

11

25

9

10
10

3
13

1

13
12
12
21

21

23
22

23
22
16

a

b

4
30

30
2 9
1
3

10
14
15

11 20
25

25
14

12

1 2
3

19
18
10

12

15
21

23
22
16

24
16

c

d

(a)–(l) Larynx and hypopharynx, axial CT images.

1
2
3
4
5
6
7

11

Internal jugular vein
External carotid artery
Internal carotid artery
Platysma muscle
Geniohyoid muscle
Submandibular gland
Epiglottis

8
9
10
11
12
13
14

Vallecula
Hypopharynx
External jugular vein
Anterior jugular vein
Levator scapulae muscle
Longus capitus and colli muscles
Longus capitus muscle

The legends for pages 26–28 are common for all 3 pages.

Lar ynx and hypophar ynx

27

39

25

4

11

11 30
34

20 35

1

10

10

1

29
12

12
16

40
11
25

24
16

f

e

11

30
20 34
32

25
4
29

11

25

31

34

1
29

32

1

36
12

16
2322

12

16
31

g

h

(a)–(l) Larynx and hypopharynx, axial CT images.

15
16
17
18
19
20
21

Longus colli muscle
Trapezius muscle
Clavicle
Aryepiglottic fold
Laryngeal vestibule
Thyroid cartilage lamina
Spinalis cervicis muscle

22
23
24
25
26
27
28

Splenius capitis muscle
Semispinalis capitis muscle
Semispinalis cervicis muscle
Sternocleidomastoid muscle
Sternohyoid muscle
Thyroid gland
Oesophagus

The legends for pages 26–28 are common for all 3 pages.

Lar ynx and hypophar ynx

28

11
10

11

26 25

25
27
1

27

33

33

29

1

29

28
15

15
16

27

12
12
16

i

j

25

17

27
33
36
37

10

26

29
15

17

25

1

1

28

36

37

38

38
12

12
16

16

k

l

(a)–(l) Larynx and hypopharynx, axial CT images.
29
30
31
32
33
34

Common carotid artery
Infrahyoid strap muscle
Vertebral artery
Cricoid cartilage
Trachea
Larynx

26
27
33
29
28

35
36
37
38
39
40

Glottis
Anterior scalene muscle
Middle scalene muscle
Posterior scalene muscle
Arytenoid cartilage
Vocalis muscle

The legends for pages 26–28 are common for all 3 pages.

Lar ynx and hypophar ynx

1
2
3
4
5
6
7
8

1

Nasopharynx
Soft palate
Base of tongue
Oropharynx
Retropharyngeal soft tissues
Body of hyoid
Greater horn of hyoid
Epiglottis

9
10
11
12
13
14
15

29

Vallecula
Thyroid cartilage
Cricoid cartilage
Larygneal space
Trachea
Entrance to oesophagus
Hypopharynx

1
2

4
3

5

3

9
1
2
3
4

7

6

5

8
15 14

4
1

10
12

6

10

1

Deltoid insertion of levator muscle
Mandible
Nose
Pars marginalis of orbicularis oris
muscle
5 Pars peripheralis of orbicularis oris
muscle
6 Tongue

11

11

2
13

a

(a) Soft tissues of the neck, lateral projection.

c

b

(b) The kiss, sagittal MR image.

d

(c) and (d) Thyroid ultrasound, axial projection.
1
2
3
4
5
6
7
8

Thyroid gland lobe
Thyroid gland isthmus
Trachea
Common carotid artery
Internal jugular vein
Infrahyoid strap muscle
Sternocleidomastoid muscle
Prevertebral muscle

Phar ynx

30

43
42
48
47
28

50

28

47

50

49

51

45

44
45

45

46

a

b

40

32

24

40

23

23
28
52

28

41

52

13
29

51

51

34
44
44

d

c

(a)–(l) Coronal MR images of pharynx, from posterior to anterior.
1
2
3
4
5
6
7

Maxillary sinus (antrum)
Hard palate
Mandible
Alveolar ridge of maxilla
Oral cavity
Inferior turbinate
Middle turbinate

8
9
10
11
12
13
14

Nasal septum
Genioglossus muscle
Geniohyoid muscle
Anterior belly of digastric muscle
Lingual septum
Platysmus muscle
Hypoglossus muscle

The legends for pages 30–32 are common for all 3 pages.

Phar ynx

31

27

27
17

17
32

24

24

33

33

53
28

53
22

23

28

31

28

20

30

23

31

30

13
29

29

13

39
34

38

34

35

36

36
37

e

f

27
17

21
1

26

7

8

22

17

6

6
25
25

28

23

20

20
9

3

3

14

14
15

29 13

13

10

g

h

(a)–(l) Coronal MR images of pharynx, from posterior to anterior.

15
16
17
18
19
20
21
22
23

Mylohyoid muscle
Zygomatic bone
Zygomatic arch
Transverse muscle of tongue
Longitudinal muscle of tongue
Masseter muscle
Temporal muscle
Ramus of mandible
Medial pterygoid muscle

24
25
26
27
28
29
30
31
32

Lateral pterygoid muscle
Soft palate
Vomer
Sphenoid sinus (antrum)
Parotid gland
Submandibular gland
Uvula
Palatopharyngeus muscle
Pharyngeal tonsils

The legends for pages 30–32 are common for all 3 pages.

10 11

Phar ynx

32

21
7
17

1

7

8

16

1

6
2
5

6
2

5
20

19

4

18
14
9
12
11

10

9

3

15

3

13

10

13

11

j

i

7
8

8
1
16

1

6

6

2

2

13

9

10

5

4

4

9

3

3

11
l

k

11
13

(a)–(l) Coronal MR images of pharynx, from posterior to anterior.

33
34
35
36
37
38
39
40
41
42
43

Levator veli palatini muscle
Vestibular fold
Larygneal ventricle
Vocalis muscle
Cricoid cartilage
Thyrohyoid muscle
Vallecula
Eustachian tubes
Oropharynx
Mandibular condyles
Temporomandibular joint

44
45
46
47
48
49
50
51
52
53

Thyroid gland
Sternocleidomastoid muscle
Trachea
Internal carotid artery
External auditory canal
Retromandibular vein
Anterior arch of C1
Epiglottis
Palatine tonsils
Nasopharynx

The legends for pages 30–32 are common for all 3 pages.

Vessels of the neck

33

17

10

12

6
9

11

13

17

3
7

2

12

9

1

4

3

11
2

4
4

21

8

20
16

5

8 21
a

23

14
b

18

18

22

Digitally subtracted arteriograms of the external carotid artery, (a) anteroposterior
projection, (b) lateral projection. (c) Thyroid arteriogram.
1 Ascending cervical artery
2 Ascending pharyngeal
artery
3 Endotracheal tube
4 Facial artery
5 Inferior thyroid artery
6 Infra-orbital artery
7 Labial branch of facial
artery
8 Lingual artery
9 Maxillary artery

10
11
12
13
14
15
16
17

Middle meningeal artery
Occipital artery
Posterior auricular artery
Posterior superior
alveolar artery
Reflux of contrast into
vertebral artery
Subclavian artery
Submental artery
Superficial temporal
artery

6

1

7

8

15 19

18 Superior thyroid artery
19 Suprascapular artery
20 Thyroid branches of
inferior thyroid artery
21 Tip of catheter in
external carotid artery
22 Tip of catheter in
thyrocervical trunk
23 Transverse cervical
artery

1 Left brachiocephalic
vein
2 Trachea
3 Inferior thyroid vein
4 Transverse process
of C7

c

Internal jugular vein
Lingual vein
Superior thyroid vein
Tip of catheter in
middle thyroid vein
9 Right first rib

16

20

17

5
6
7
8

22

20 17
10
12

14

5

4
9
2

3

d

1

(d) Neck venogram.
(e) MR angiogram of neck vessels.

1 Aortic arch
2 Brachiocephalic
artery
3 Left common carotid
artery
4 Left subclavian
artery
5 Left internal thoracic
artery
6 Right internal
thoracic artery
7 Right brachiocephalic vein
8 Right lobe of the
thyroid gland
9 Costocervical trunk
10 Right vertebral
artery

11 Right common
carotid artery
12 Left vertebral artery
13 Superior vena cava
14 External carotid
artery
15 Internal carotid
artery
16 Basilar artery
17 Sigmoid sinus
18 Internal jugular vein
19 Right subclavian
vein
20 Petrous portion of
the internal carotid
artery
21 Right subclavian
artery
22 Jugular bulb

14 15
15

0

18
12
3

11
10
8

9

9
4
21
19

5

6
7

3 4
2
1

e

13

34

Teeth

4
2

1

5
3

6
19
27

25
23
12 20
13

26

17

22

21

18
9

15

16
8

14

24

10

10

a

7

1

4
2
5

3

11
19

18
12 13 14 15 16

17

6

23
19
18
12
28

13

17

14 15 16

7

28

28

9
8
10

10

b

Dental panoramic tomogram (orthopantomogram) of (a) a 6-year-old child, (b) an adult.
1
2
3
4
5
6
7

Nasal septum
Maxillary sinus (antrum)
Coronoid process of mandible
Mandibular condylar head
Mandibular condylar neck
Mandibular ramus
Angle of mandible

8
9
10
11
12
13
14

Mandibular body
Mandibular canal
Mental tubercle
Anterior nasal spine
Medial incisor
Lateral incisor
Canine tooth

15
16
17
18
19
20
21

Anterior premolar
Posterior premolar
First molar
Second molar
Third molar (wisdom tooth)
Deciduous canine tooth
Deciduous anterior premolar

22
23
24
25
26
27
28

Deciduous posterior premolar
Bite block
Hyoid bone
Crown of tooth
Root of tooth
Pulp chamber of tooth
Alveolar bone

Salivar y glands

35

5
6

2

1
4

2
7

6

1

7

7
3

4

a

b

(a) Parotid sialogram.
1
2
3
4

(b) Parotid sialogram, submentovertical projection.
5 Mastoid process
6 Parotid (Stensen's) duct
7 Secondary ductules

Catheter
Coronoid process of mandible
Hyoid bone
Mandible

3

1
2
3
4
4

c

(c) Submandibular sialogram.

1
2
3
4

Catheter
Main submandibular (Wharton's) duct
Mandible
Secondary ductules

Vessels of the brain

36

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

15
5
17

13

1

8
4

10
16
2

11

Angular branches of middle cerebral artery
Anterior cerebral artery
Anterior temporal branches of middle cerebral artery
Branches (in insula) of middle cerebral artery
Callosomarginal artery
Cavernous portion of internal carotid artery
Cervical portion of internal carotid artery
Frontopolar artery
Genu of middle cerebral artery
Lenticulostriate arteries
Middle cerebral artery
Orbitofrontal branch of pericallosal artery
Pericallosal artery
Petrous portion of internal carotid artery
Posterior parietal branches of middle cerebral artery
Recurrent artery of Heubner
Sylvian point

9
12

3
6
14

7

26

6

a

Digitally subtracted arterial phase of carotid arteriograms,
(a) anteroposterior projection, (b) lateral projection, (c) oblique
projection.

3

15

17

2

30

27

4
11

7
20
10

28
12

25
9

22
1
13

23

8

19

24

6
2 17

11

3
14

26

29

27

21
20

c

1
2
3
4
5
6
7
8
9

7
5

10

25

11
12
13

9
b

16

14

18

Angular artery
Anterior cerebral artery
Anterior choroidal artery
Anterior communicating artery
Anterior temporal artery
Callosomarginal artery
Cavernous portion of internal
carotid artery
Central sulcus artery
Cervical portion of internal
carotid artery
Ethmoidal branch of
ophthalmic artery
Frontopolar artery
Inferior internal parietal artery
Internal frontal branch of
anterior cerebral artery
Intracranial (supraclinoid)
internal carotid artery

15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Lenticulostriate artery
Maxillary artery
Middle cerebral artery
Occipital artery
Operculofrontal artery
Ophthalmic artery
Orbitofrontal artery
Paracentral artery
Pericallosal artery
Pericallosal artery extending
around corpus callosum
Petrous portion of internal
carotid artery
Posterior cerebral artery
Posterior communicating
artery
Posterior parietal artery
Posterior temporal artery
Recurrent artery of Heubner

Vessels of the brain

37

(a) Digitally subtracted venous phase of carotid arteriogram,
anteroposterior projection.

7

1
2
3
4
5
6
7
8
9

8
8
2

9
7

Basal vein of Rosenthal
Inferior sagittal sinus
Internal cerebral vein
Internal jugular vein
Jugular bulb
Right transverse sinus
Superficial cortical veins
Superior sagittal sinus
Thalamostriate vein

3
1

6
1

5
4

a

(b) Digitally subtracted venous phase of carotid arteriogram,
lateral projection.

13
12

17

6

1

14
18
11

7 5
2
10

11
16

15

3

9
8
b

4

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Anterior caudate vein
Basal vein of Rosenthal
Cavernous sinus
Confluence of venous sinuses (torcular Herophili)
Great cerebral vein of Galen
Inferior sagittal sinus
Internal cerebral vein
Internal jugular vein
Sigmoid sinus
Sphenoparietal sinus
Straight sinus
Superficial cerebral veins
Superior sagittal sinus
Thalamostriate vein
Transverse sinus
Vein of Labbé
Vein of Trolard
Venous angle

Vessels of the brain

38

(a) Digitally subtracted arterial phase of vertebral arteriogram,
anteroposterior projection.
4

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

8
17
12
14

6
9

16

5

10

13
15
3

1

7
2

11

Anterior inferior cerebellar artery
Anterior spinal artery
Basilar artery
Calcarine artery
Hemispheric branch of superior cerebellar artery
Inferior temporal artery
Medullary segment of posterior inferior cerebellar artery
Parieto-occipital artery
Posterior cerebral artery in ambient cistern
Posterior cerebral artery in interpeduncular cistern
Posterior inferior cerebellar artery
Quadrigeminal portion of posterior cerebral artery
Site of junction with posterior communicating artery
Superior cerebellar arteries behind brainstem
Superior cerebellar artery
Thalamoperforating branches of superior cerebellar artery
Vermian branch of superior cerebellar artery
Vertebral artery exiting transverse foramen of atlas
(first cervical vertebra)

18
a

(b) Digitally subtracted arterial phase of vertebral arteriogram,
lateral projection.

16
10

12

4

19
11

11
14
17

3
18

1

15

20

6

2
9

13

5

7
8
21
b

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21

Anterior inferior cerebellar artery
Anterior medullary segment of posterior inferior cerebellar artery
Basilar artery
Calcarine artery
Hemispheric branches of posterior inferior cerebellar artery
Inferior vermian segment of posterior inferior cerebellar artery
Lateral medullary segment of posterior inferior cerebellar artery
Meningeal branch of vertebral artery
Origin of posterior inferior cerebellar artery
Parieto-occipital artery
Posterior cerebral artery
Posterior choroidal branches of posterior cerebral artery
Posterior medullary segment of posterior inferior cerebellar
artery
Posterior temporal artery
Retrotonsillar segment of posterior inferior cerebellar artery
Splenial branches of posterior cerebral artery
Superior cerebellar artery
Supratonsillar segment of posterior inferior cerebellar artery
Thalamoperforate branches of posterior cerebral artery
Vertebral artery
Vertebral artery exiting transverse foramen of atlas
(first cervical vertebra)

Vessels of the brain

39

(a) Digitally subtracted venous phase of vertebral arteriogram,
anteroposterior projection.

10

9

6

11

2

8
3

7
12
12

1
2
3
4
5
6
7
8
9
10
11
12

Anterior pontomesencephalic vein
Inferior hemispheric vein
Inferior vermian vein
Internal jugular vein
Jugular bulb
Left transverse sinus
Petrosal vein
Posterior mesencephalic vein
Right transverse sinus
Straight sinus
Superior hemispheric vein
Superior petrosal sinus

5
1
4

a

(b) Digitally subtracted venous phase of vertebral arteriogram,
lateral projection.

3 12
13

15
14

9 8 10
1
18
17

7
6
b

11

2
5
4

16

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Anterior pontomesencephalic vein
Confluence of venous sinuses (torcular Herophili)
Great cerebral vein of Galen
Inferior hemispheric vein
Inferior vermian vein
Internal jugular vein
Jugular bulb
Lateral mesencephalic vein
Posterior mesencephalic vein
Precentral cerebellar vein
Sigmoid sinus
Straight sinus
Superior choroidal vein
Superior hemispheric vein
Superior vermian vein
Tonsillar vein
Transverse sinus
Vein of the great horizontal fissure

Vessels of the brain

40

4
3
2

7 5
10

4
3

9

6

8

2

7 5

8

12

1
a

14
b

14

4
6

7

7

3

3
1

2

5

7

11
1

12

1

8
9 13

5

6

8
11

12

7

2

12

9

11

10
10

d

c
MR angiograms of the Circle of Willis, (a) and (b) coronal, (c) and (d) axial.

1
2
3
4
5
6
7

Internal carotid artery
Horizontal (A1) anterior cerebral artery (ACA) segment
Vertical (A2) ACA segment
Anterior communicating artery
Horizontal (M1) middle cerebral artery (MCA) segment
Insular (M2) MCA segment
MCA genu (bifurcation)

8
9
10
11
12
13
14

Precommunicating (P1) posterior cerebral artery (PCA) segment
Ambient (P2) PCA segment
Quadrigeminal (P3) PCA segment
Posterior communicating artery
Basilar artery
Superior cerebellar artery
Vertebral artery

Vessels of the brain

41

1
2
2

1

11
11

5

5

3
4

4
6
6

8

7

7
9
10
9
b

a

1

2

1

11

11
5

3

3
4

6

8

5

4

5

6

6
7

7

10

10
9

9

d

c

MR images of the venous circulation, (a) lateral view, (b) frontal view, (c) left posterior oblique view, (d) right posterior oblique view.

1
2
3
4
5
6

Superior sagittal sinus
Superficial cerebral veins
Vein of Galen
Straight sinus
Vein of Labbe’
Transverse sinus

7
8
9
10
11

Sigmoid sinus
Sinus confluence (torcular Herophilli)
Internal jugular vein
Jugular bulb
Internal cerebral vein

Brain

42

21
22
15

1

23

27
28

2
34

18
19 20

8
5

13

6

3

3

24

4

16

11

35

9

12

25

16

10

26

16

14

29

30

7
17

a

b

31

48
49

32
39

18
50
33

37
36
37

40

57

51

42
43

44

59 60

41

54
47

38

52
58

53
55

45

56
46

d

c

(a)–(n) Brain axial T2 images, from inferior to superior.
1
2
3
4
5
6
7
8

Parotid duct
Masseter muscle
Parotid gland (superficial lobe)
Ramus of mandible
Pinna of ear
Retromandibular vein
Sternocleidomastoid muscle
Parotid gland (deep lobe)

9
10
11
12
13
14
15
16

Internal jugular vein
Mastoid process
Internal carotid artery
Occipital condyle
Longus capitis muscle
Foramen magnum
Hard palate
Vertebral artery

17
18
19
20
21

Occipital vessels
Medial pterygoid muscle
Lateral pterygoid muscle
Lateral pterygoid plate
Levator labii superioris
alaeque nasi muscle
22 Inferior turbinate
23 Nasal septum

Numbers 1–161 are common to pages 42–45.

24
25
26
27
28
29
30

Nasopharynx
Medulla oblongata
Cerebellar tonsil
Coronoid process of mandible
Temporalis muscle
Folia of cerebellar hemisphere
Foramen of Magendie

Brain

43

76

61
62

77

68

48

63 64

75

78

65
50
66 67

79 80

51
74

43

84

82
83

81
70

69

86

85

29

71

87
72
88

73

e

f

90
91

103

102

104

89
92 97
75
93
94

95

95

107

98
96

81
85

99 101

113

106

105

108
161
109
111

100

85
110

112
87
114

h

g

(a)–(n) Brain axial T2 images, from inferior to superior.
31
32
33
34
35
36
37
38
39

Nasolacrimal duct
Zygomatic arch
Head of mandible
Medial pterygoid plate
Jugular foramen
Petrous temporal bone
Internal carotid artery
Mastoid air cells
Maxillary sinus (antrum)

40
41
42
43
44
45
46

Cochlear
Posterior semicircular canal
Clivus
Basilar artery
Labyrinthine artery
Inferior cerebellar vermis
Inion (internal occipital
protuberance)
47 Foramen of Lushka

48
49
50
51
52
53
54

Ethmoid air cells
Inferior rectus muscle
Sphenoid sinus
Temporal lobe
Pons
Middle cerebellar peduncle
Flocculonodular lobe of
cerebellum
55 Fourth ventricle

Numbers 1–161 are common to pages 42–45.

56 Cisterna magna
57 Facial nerve (seventh cranial
nerve)
58 Vestibulocochlear nerve
(eighth cranial nerve)
59 Internal auditory meatus
60 Cerebellopontine angle

Brain

44

90
103

127

104
65

126
125
129

95
116

105

113

115
118
120

119

121

123

124

122

130
131

115

132

117

128

51

118
133
134
135

136

87
114
103
137

88
j

i

88

103

144
138

142

145

139
140

146
122

118

133

151

133

141
143

k

l

(a)–(n) Brain axial T2 images, from inferior to superior.
61
62
63
64
65
66

Lens
Vitreous humour
Lateral rectus muscle
Retro-orbital fat
Temporalis muscle
Internal carotid artery
(cavernous part)

67
68
69
70
71
72

Body of sphenoid
Medial rectus muscle
Superior cerebellar peduncle
Superior semicircular canal
Superior cerebellar vermis
Calcarine cortex of occipital
lobe

73 Torcula herophili (confluence of
venous sinuses)
74 Petroclinoid ligament
75 Optic nerve (second cranial
nerve)
76 Infundibulum of frontal sinus
77 Lacrimal gland

Numbers 1–161 are common to pages 42–45.

78 Superior ophthalmic vein
79 Pituitary gland
80 Internal carotid artery
(supraclinoid part)
81 Temporal horn of lateral
ventricle
82 Uncus of temporal lobe

Brain

45

147
148

157
158
159

95

154

138

95
153

149
150
151

152
113

151
103

154

156

155

85
88

160
m

n

(a)–(n) Brain axial T2 images, from inferior to superior.

83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102

Hippocampus
Ambient cistern
Posterior cerebral artery
Inferior colliculus
Straight sinus
Superior sagittal sinus
Superior rectus muscle
Frontal sinus
Crista gali
Olfactory nerve (first cranial
nerve)
Middle cerebral artery
Bifurcation of internal
carotid artery
Anterior cerebral artery
Suprasellar cistern
Anterior communicating
artery
Optic chiasma
Basilar artery bifurcation
Quadrigeminal cistern
Midbrain (mesencephalon)
Orbital plate of frontal bone

103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120

Falx cerebri
Interhemispheric fissure
Insular gyri
Optic tract
Sylvian fissure (lateral
sulcus)
Mamillary body (of
hypothalamus)
Cerebral peduncle
Aqueduct of Sylvius
Superior colliculus
Folia of cerebellum
Middle cerebral artery
(second order branch)
Occipital horn of lateral
ventricle
Posterior limb of internal
capsule
Anterior commisure
Third ventricle
Thalamus
Posterior commisure
Pineal gland

121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139

Trigone of lateral ventricle
Choroid plexus
Basal vein (of Rosenthal)
Internal cerebral vein (of
Galen)
Head of caudate nucleus
Frontal horn of lateral
ventricle
Frontal lobe
Anterior limb of internal
capsule
Globus pallidus
Putamen
External capsule
Claustrum
Choroidal vessels
Splenium of corpus
callosum
Inferior sagittal sinus
Parietal lobe
Occipital lobe
Callosomarginal artery
Genu of corpus callosum

Numbers 1–161 are common to pages 42–45.

140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161

Septum pellucidum
Optic radiation
Forceps minor
Forceps major
Frontopolar artery
Cingulate gyrus
Body of caudate nucleus
Cortical vein
Calvarium of skull
Body (atrium) of lateral
ventricle
Precentral gyrus
Central sulcus of Rolando
Post central gyrus
Centrum semiovale
Corona radiata
Grey matter
White matter
Outer table of calvarium
Diploe
Inner table of calvarium
Arachnoid granulation
Interpeduncular cistern

Brain

46

14

13
5
21

31

13
31

23
48

29
30

55

54

50
8
26
4
52
44
19 10

3
40
43
47

8

28
4

35

46

18
38

54
49

11

10

36
25

15

2
39

56

45
12
b

a

17
7

17

16
6
32
24

42

20

51

42

37

53

22

9

22

34

53

41
27

10

34

1
1

c

d

33

(a)–(d) Brain, sagittal MR images.
1 Alveolar ridge
2 Anterior arch of atlas (first
cervical vertebra)
3 Anterior cerebral artery
4 Basilar artery
5 Body of corpus callosum
6 Body of lateral ventricle
7 Central sulcus of Rolando
8 Cerebellar folia
9 Cerebellar hemisphere
10 Cerebellum
11 Cerebral peduncle
12 Cervical spinal cord
13 Cingulate gyrus
14 Cingulate sulcus

15 Cisterna magna
(cerebellomedullary cistern)
16 Corona radiata
17 Cortical vein
18 Foramen magnum
19 Fourth ventricle
20 Frontal sinus
21 Genu of corpus callosum
22 Globe
23 Great cerebral vein of Galen
24 Head of caudate nucleus
25 Inferior cerebellar peduncle
26 Inferior colliculus
27 Inferior rectus muscle
28 Internal carotid artery (in
cavernous sinus)

29 Internal cerebral vein
30 Interventricular foramen of
Monro
31 Lateral ventricle
32 Lentiform nucleus
33 Mandible
34 Maxillary sinus (antrum)
35 Medulla oblongata
36 Middle cerebellar peduncle
37 Middle cerebral artery
38 Nasopharynx
39 Odontoid process (dens)
40 Optic chiasma in suprasellar
cistern
41 Optic nerve

42
43
44
45
46
47
48
49
50
51
52
53
54
55
56

Orbital cortex of frontal lobe
Pituitary gland
Pons
Posterior arch of atlas
Prepontine cistern
Sphenoidal sinus
Splenium of corpus callosum
Superior cerebellar peduncle
Superior colliculus
Sylvian fissure
Tegmentum of pons
Temporal lobe of brain
Tentorium cerebelli
Pineal gland
Vertebral artery

Brain

47

14

12
6
31
20
19

25
22
17
41
23
27
36
21
32
3
45
24
44
38
2
26
10
39
7
4
33
42
37
43 18
34
5
40
9
15

28
8

29

16
1

13
35

30
11

Brain, sagittal MR midline image.
1 Anterior arch of atlas (first cervical
vertebra)
2 Anterior cerebral artery
3 Anterior commissure
4 Aqueduct of Sylvius
5 Basilar artery
6 Body of corpus callosum
7 Cerebellar folia
8 Cerebellar tonsil
9 Cerebellum
10 Cerebral peduncle of midbrain
11 Cervical spinal cord
12 Cingulate gyrus
13 Cisterna magna (cerebellomedullary
cistern)
14 Diploe of calvarium

15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Fat in marrow of clivus
Foramen magnum
Fornix
Fourth ventricle
Frontal sinus
Genu of corpus callosum
Great cerebral vein of Galen
Internal cerebral vein
Interventricular foramen of Monro
Lamina terminalis
Lateral ventricle
Mammillary body
Massa intermedia of thalamus
Medulla oblongata
Nasopharynx
Odontoid process (dens)

31
32
33
34
35
36
37
38
39
40
41
42
43
44
45

Parieto-occipital fissure
Pineal gland
Pituitary gland
Pons
Posterior arch of atlas
Posterior commissure
Prepontine cistern
Quadrigeminal cistern
Quadrigeminal plate (tectum) of midbrain
Sphenoidal sinus
Splenium of corpus callosum
Superior medullary velum
Tegmentum of pons
Tentorium cerebelli
Third ventricle

Brain

48

1
18

2
3
7
4

6

5

24

10

9

34 26

25

14
8

19
20
21

32
33

28

43

11

29

11

30 31

12

18
13
49

15

17
16

a

b

57
41

35

23 22

40

3
51

60

42

52 30
53

58

27
55

59

44
45

54
50

36

14

56

48

39
47

50
46

37
38
d

c

(a)–(p) Brain, coronal T2w MR images, from anterior to posterior.
1
2
3
4
5
6

Superior sagittal sinus
Falx cerebri
Anterior cerebral artery
Callosomarginal artery
Genu of corpus callosum
Frontal horn of lateral
ventricle
7 Cingulate gyrus
8 Temporal lobe

9
10
11
12
13
14
15
16
17

Anterior clinoid process
Olfactory cortex
Sphenoidal sinus
Greater wing of sphenoid
Nasopharynx
Temporalis muscle
Hard palate
Oropharynx
Masseter muscle

18
19
20
21
22

Frontal lobe
Body of corpus callosum
Septum pellucidum
Head of caudate nucleus
Anterior limb of internal
capsule
23 External capsule
24 Insula gyrus
25 Sylvian fissure (lateral sulcus)

Numbers 1–130 are common to pages 48–51.

26 Putamen
27 Middle cerebral artery
28 Supraclinoid part of internal
carotid artery
29 Dural lateral wall of
cavernous sinus
30 Internal carotid artery
31 Pituitary gland
32 Optic chiasma

Brain

49

41
71

22
72

42

61

64
58 64

62

63

87

65

59

63

69

77

48

68

76

56

30
76

46

70

66

67
50

e

f

24
72
73

84

74
64

86 83
87

82
63
79

75

64
85
87

81

30

80
88

78

81

h

g

(a)–(p) Brain, coronal T2w MR images, from anterior to posterior.
33 Suprasellar cistern
34 Globus pallidus
35 Body (atrium) of lateral
ventricle
36 Lateral pterygoid muscle
37 Medial pterygoid muscle
38 Tongue
39 Soft palate
40 Choroid plexus
41 Corona radiata

42 Optic tract
43 Optic nerve (second cranial
nerve)
44 Trigeminal ganglion in
Meckel’s cave
45 Body of sphenoid
46 Inferior alveolar vessels
47 Inferior alveolar nerve
48 Head of mandible
49 Coronoid process of mandible

50 Parotid gland
51 Occulomotor nerve (third
cranial nerve)
52 Trochlear nerve (fourth
cranial nerve)
53 Ophthalmic nerve (fifth
cranial nerve, first division)
54 Maxillary nerve (fifth cranial
nerve, second division)

Numbers 1–130 are common to pages 48–51.

55 Abducens nerve (sixth cranial
nerve)
56 Infratemporal fossa
57 Parietal lobe
58 Hippocampus
59 Temporal horn of lateral
ventricle
60 Middle cerebral artery
(second order branch)
61 Third ventricle

Brain

50

1

71

35

19

25

89
72

61

72

59
58
92
93

86

83

95

82

87

96
97

94
94

79
80 90

98

88

91

j

i

2

104

72

64

114

99
82

112

101

110

105
106
113
107

100

102
109

79

79

79
108

79

79

111

k

79

l

(a)–(p) Brain, coronal T2w MR images, from anterior to posterior.
62
63
64
65
66
67
68
69

Prepontine cistern
Basilar artery
Posterior cerebral artery
Superior cerebellar artery
Retromandibular vein
Tragus of external ear
Basiocciput
Spheno-occipital
synchondrosis
70 Auriculotemporal nerve
71 Foramen of Monro

72 Thalamus
73 Hypothalamus
74 Mamillary body (of
hypothalamus)
75 Cochlea
76 Pharyngobasilar raphe
77 Basisphenoid
78 Anterior arch of C1
79 Vertebral artery
80 Lateral mass of C1
81 Sternocleidomastoid muscle

82 Pons
83 Cerebral peduncle
84 Massa intermedia of
thalamus
85 Abducens nerve (sixth cranial
nerve) in ambient cistern
86 Interpeduncular cistern
87 Trigeminal nerve (fifth cranial
nerve)
88 Internal jugular vein
89 Body of caudate nucleus

Numbers 1–130 are common to pages 48–51.

Odontoid peg of C2
Body of C2
Internal auditory meatus
Facial (seventh) and
vestibulocochlear (eighth)
nerves
94 Vestibule of vestibular
apparatus
95 Arcuate eminence of petrous
temporal bone
96 Superior semicircular canal

90
91
92
93

Brain

51

3

115

103
105

27

59

130

116
118

122
128

117

128

m

n

1

119
120
121

124

40

122

125
126
129

123
127

68

p

o

(a)–(p) Brain, coronal T2w MR images, from anterior to posterior.
97 Horizontal (lateral)
semicircular canal
98 Posterior semicircular canal
99 Midbrain (mesencephalon)
100 Medulla oblongata
101 Middle cerebellar peduncle
102 Cerebellar folia
103 Pineal gland
104 Internal cerebral veins
105 Superior colliculus

106
107
108
109
110
111
112

Inferior colliculus
Aqueduct of Sylvius
Spinal cord
Foramen magnum
Mastoid air cells
Trapezius muscle
Tectum (quadrigeminal
plate) of midbrain
113 Tentorium cerebelli
114 Uncus of temporal lobe

115 Splenium of corpus callosum
116 Superior cerebellar
peduncle
117 Inferior cerebellar peduncle
118 Cerebellar hemisphere
119 Trigone of lateral ventricle
120 Internal cerebral vein (of
Galen)
121 Basal vein (of Rosenthal)
122 Fourth ventricle

Numbers 1–130 are common to pages 48–51.

123 Cerebellar tonsil
124 Inferior sagittal sinus
125 Dentate nucleus of
cerebellum
126 Nodule of cerebellum
127 Cisterna magna
128 Lateral foramen (of Lushka)
129 Medial foramen (of
Magendie)
130 Quadrigeminal cistern

Neonatal brain

52

7

6
3

8
11

7
6
9
3
1

9

14

13

11

13
2

12

12

b

a

7

7
10

9 6
9
5

5

12

4

d

c

(a)–(d) Neonatal brain, coronal ultrasound images.

1
2
3
4
5
6
7
8
9
10
11
12
13
14

Body of caudate nucleus
Brainstem
Cavum septum pellucidum
Cerebellum
Choroid plexus
Corpus callosum
Falx cerebri
Head of caudate nucleus
Lateral ventricle
Parietal lobe of brain
Sylvian fissure
Temporal lobe
Thalamus
Third ventricle

Neonatal brain

53

15

9
10

4

2

2

10

12

19 18

18 16

16
14

7
3

14

7

8
5

e

f

15

15

9

9
1 13

13
18

12
18

6

11

6

11

14
17

g

17

14

h

(e)–(h) Neonatal brain, sagittal ultrasound images.

1
2
3
4
5
6
7
8
9
10

Body of caudate nucleus
Body of corpus callosum
Brainstem
Cavum septum pellucidum
Cerebellum
Choroid plexus
Clivus
Fourth ventricle
Frontal lobe
Genu of corpus callosum

11
12
13
14
15
16
17
18
19

Greater wing of sphenoid
Head of caudate nucleus
Lateral ventricle
Occipital lobe
Parietal lobe of brain
Splenium of corpus callosum
Temporal lobe
Thalamus
Third ventricle

Pituitar y fossa

54

5

5

6

6
16

20

2
20

2

11

11
7

1

4

14
17

24

1
18

23

22

23

4

8

15

17

24

9

21

9

22

21

25

10

13

3

13

12
a

b

29

29

15

23

18

14

28

33
19

19

26
18

23
27

26 27

31
30

32

c

d

T1w MR images of pituitary fossa (a) and (b) coronal, (c) sagittal, (d) sagittal post gadolinium.
1 Anterior cerebral artery
2 Anterior horn of lateral
ventricle
3 Bifurcation of internal carotid
artery
4 Branch of middle cerebral
artery in lateral sulcus
(Sylvian fissure)
5 Cingulate gyrus
6 Corpus callosum

7 Insula
8 Interhemispheric fissure
9 Internal carotid artery in
cavernous sinus
10 Lateral pterygoid muscle
11 Lateral sulcus (Sylvian
fissure)
12 Medial pterygoid muscle
13 Nasopharynx
14 Optic chiasma

15
16
17
18
19
20
21
22
23
24

Optic tract
Parietal lobe of brain
Pituitary gland
Pituitary stalk
Posterior clinoid process
Septum pellucidum
Sphenoidal sinus
Supraclinoid carotid artery
Suprasellar cistern
Temporal lobe of brain

25
26
27
28
29
30
31
32
33

Temporalis muscle
Anterior pituitary gland
Posterior pituitary gland
Mammillary body
Thalamus
Prepontine cistern
Fourth ventricle
Cisterna magna
Interpeduncular cistern

55

2

Ver tebral column and spinal cord

Ver tebral column

56

3

5

2

23

7

2

6

4

1
3
8
25

7
10
11

9

8
25

10
11

24

12
13

18

17

20

22

14

12 19

15
A

21

13

16

B

(a) Cervical spine, anteroposterior projection, (b) cervical spine, lateral projection.
1
2
3
4
5
6
7
8

9 Uncovertebral joint (Lushka) of
C5/6
10 Superior articular process of
C5
11 Inferior articular process of C5
12 Transverse process of C7
13 Transverse process of T1
14 First rib

Anterior arch of atlas
Basiocciput
Odontoid peg (of axis)
Occipital condyle
Lateral mass of atlas (C1)
Lateral mass of axis (C2)
Body of axis (C2)
Spinous process of C3

15
16
17
18
19

Spinous process of T1
Clavicle
Pedicle of C6
Lamina of C6
Intervertebral foramen of C7/
T1 (for C8 root)
20 Epiglottis

21 Facet (zygaphophyseal joint) of
C3/4
22 Pars interarticularis of C7
23 Angle of mandible
24 Transverse process of C5
25 Intervertebral disc at C3/4

12

17

8
18

9

a

16

11

12
14 13
15
11
d

18
2

4

8

1 Anterior arch of atlas (first cervical
vertebra)
2 Anterior tubercle of transverse process of
fourth cervical vertebra
3 Body of axis (second cervical vertebra)
4 Inferior articular process (facet) of fourth
cervical vertebra
5 Odontoid process (dens) of axis
(second cervical vertebra)
6 Posterior arch of atlas (first cervical

6

5
7

1
3

b

X-ray films of dessicated cervical vertebrae.
(a) AP view C4.
(b) Lateral view C1.
(c) Lateral view C2.
(d) Lateral view C4.

vertebra)
7 Body of atlas (first cervical vertebra)
8 Posterior tubercle of transverse process
of fourth cervical vertebra
9 Posterior tubercle of atlas (first cervical
vertebra)
10 Spinous process of axis (second cervical
vertebra)
11 Spinous process of fourth cervical
vertebra

10
c

12 Superior articular process (facet) of
fourth cervical vertebra
13 Pedicle of C4
14 Pars interarticularis of C4
15 Lamina of C4
16 Intertubercular lamella of C4 transverse
process
17 Posterolateral lip (uncus) of C4
18 Body of transverse process of C4

Ver tebral column

1
14

22

19
10
19
7
2

19

1

14

10

22

19

7

b

c

1
13

12
2
4
6

d

3

8

e

12
13


6
8

16
9

24

g
18

5

8

11
21

17

4

3

3

15

3

23

a

f

4

4

23

57





1 Anterior arch of atlas (first cervical
vertebra)
2 Atlanto-axial joint
3 Bifid spinous process of axis
(second cervical vertebra)
4 Body of axis (second cervical
vertebra)
5 Body of fifth cervical vertebra
6 Hyoid bone
7 Inferior articular process (facet) of
atlas (first cervical vertebra)
8 Intervertebral foramen
9 Lamina of fifth cervical vertebra
10 Lateral mass of atlas (first cervical
vertebra)
11 Left first rib
12 Mandible
13 Occipital bone
14 Odontoid process (dens) of axis
(second cervical vertebra)
15 Posterior tubercle of transverse
process of fifth cervical vertebra
16 Posterolateral lip (uncus) of fifth
cervical vertebra
17 Right first rib
18 Spinous process of fifth cervical
vertebra
19 Superior articular process (facet) of
atlas (first cervical vertebra)
20 Superior articular process (facet) of
axis (second cervical vertebra)
21 Trachea
22 Transverse process of atlas (first
cervical vertebra)
23 Transverse process of axis (second
cervical vertebra)
24 Transverse process of fifth cervical
vertebra

(a) Atlas (first cervical vertebra) and axis
(second cervical vertebra), ‘open mouth’
anteroposterior projection.
(b) Dried atlas (first cervical vertebra), anteroposterior projection.
(c) Dried axis (second cervical vertebra), anteroposterior projection.
(d) Cervical spine X-ray of a 3 year old, lateral projection. The atlanto-axial joint
can normally be up to 5 mm (up to 3 mm in adults).
(e) Cervical spine X-ray of a 9 year old, lateral projection. Note normal
physiological wedging of the vertebral bodies (arrows) due to unossified superior
endplate apophyses.
(f) Oblique X-ray of adult cervical spine.
(g) Line drawing of (f).

Ver tebral column

58

13

5

4

10

20

3

10

13

20
11

2

9

14

6

19

15

17

11

12

15

16

11

b

a

19
19
11
21

11

21

2

8

7
16
c

16

7

d

(a) Thoracic spine, anteroposterior
projection.

(d) Dried sixth thoracic vertebra,
lateral projection.

(b) Thoracic spine, lateral projection.

Thoracic spine, (e) of a 7-day-old
neonate, (f) of a 12-year-old child,
lateral projections.

(c) Dried thoracic vertebra,
anteroposterior projection.

f

e

1

18

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Body of sixth thoracic vertebra
Body of vertebra
Clavicle
First rib
First thoracic vertebra
Inferior annular epiphysial discs for vertebral body
Inferior articular process (facet)
Inferior vertebral notch
Left main bronchus
Natal cleft
Pedicle
Pedicle of eleventh thoracic vertebra
Ribs
Right main bronchus
Site of intervertebral disc
Spinous process
Spinous process of sixth thoracic vertebra
Superior annular epiphysial discs for vertebral
body
19 Superior articular process (facet)
20 Trachea
21 Transverse process

Ver tebral column

59

(a) Lumbar spine, anteroposterior
radiograph.
8

(b) Lumbar spine, lateral projection.
(c) Dried second lumbar vertebra,
anteroposterior projection.

8

9

10

(d) Dried second lumbar vertebra,
lateral projection.

1
1

5

(e) Lumbar spine, oblique projection.
1 Body of first lumbar vertebra

14

5

15
3 4
13
9

3
12
6
6

8
8

2
7

2
16

11

16

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

Intervertebral disc L4/5
Inferior articular process (facet) of L2
Superior articular process (facet) L3
Lamina of L2
Spinous process of L3
Facet (zygapophyseal joint) of L4/5
Pedicle
Pars interarticularis
Right twelfth rib
Sacral promontory
Transverse process of L3
Mamillary process
Inferior vertebral notch of L2
Neural foramen of L2/3 (for L2 root)
Iliac crest
Sacroiliac joint

1
2
3
4
5

Psoas muscle outline
Body of second lumbar vertebra
Body of twelfth thoracic vertebra
Body of fourth lumbar vertebra
Inferior articular process (facet) of
second lumbar vertebra
Inferior vertebral notch of second
lumbar vertebra
Mammillary process of second lumbar
vertebra
Pars interarticularis
Pedicle of second lumbar vertebra
Twelfth rib
Intervertebral disc space between L2
and L3
Spinous process of second lumbar
vertebra
Superior articular process (facet) of
second lumbar vertebra
Transverse process of second lumbar
vertebra

17

b

a

3
13
10

2
9

14
12

13

6

5
8

c

9

7

14

8
9
10
11

11

13

5

1

12

7
14
6

12
d

13

5

4

e

14

Ver tebral column

60

11

3

11

11
3

4

6
4
10

2

1

8

5

8
7
12
12
15
13

9
9
13

a

16

14

17

(a) Sacrum, anteroposterior projection.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

Sacroiliac joint
Ala of sacrum
Superior articular process of sacrum
Sacral promontory
Sacral foramen (S1/2 for right S1 root)
Upper part of sacral canal
Lower part of sacral canal
Spinous tubercle on median sacral crest
Coccyx
Rudimentary S1/2 disc space
Iliac crest
Preauricular (paraglenoid) sulcus
Acetabular roof
Superior pubic ramus
Rectum
Levator ani (outlined by fat in ischioanal fossa)
Symphysis pubis

The preauricular (paraglenoid) sulcus is a characteristic of the
female pelvis and is due to bone resorption at the insertion
of the anterior sacroiliac ligament. It is prominent in parous
women.

b

(b) Sacrum and coccyx, lateral projection.

Ver tebral column

61

10

8
11
9

9

3

7

2

1

4

13

12

6

4

5

b

a

23

28
27
25
21
22

18
16
14

24

19

26

20
15
29
17

d

c

Axial CT images of the upper cervical spine at C1/2 (a,b), C2 (c) and C2/3 level (d).
1
2
3
4
5
6
7
8
9
10

Mastoid process (tip)
Transverse ligament (attachment)
Anterior arch of atlas (C1)
Lateral mass of atlas
Posterior arch of C1
Groove for vertebral artery
Odontoid process (dens) of axis (C2)
Lingula of mandible
Styloid process
Hamulus of medial pterygoid plate

11 Inferior alveolar foramen of mandibular
ramus
12 Foramen transversarium of C1
13 Transverse process of C1
14 Inferior articular process of C2
15 Lamina of C2
16 Pedicle of C2
17 Spinous process of C2
18 Body of C2
19 Intervertebral foramen of C2/3
20 Spinal cord

21 Anterior tubercle of transverse process of
C2
22 Posterior tubercle of transverse process
of C2
23 Thyroid cartilage
24 Uncus of C3 vertebral body
25 Uncovertebral joint (of Luschka) at C2/3
26 Facet (zygapophyseal) joint at C2/3
27 Epiglottis
28 Vallecula
29 Ligamentum flavum

62

Ver tebral column and spinal cord

11

10
1
29

20
5

19
12

17

13

21

24
22
2
9
16

b
4

14

15

9

5

3

27

4
16

6

21
22

24

15
c
15
7

6

27

26
24
23

8

8
a

18

30

19
16

17

25

MR images of the spine, (a) sagittal T2 wide field of view
and axial T2 sections from the (b) cervical, (c) thoracic and
(d) lumbar regions.

22

24

28

d
1 Foramen magnum
2 Body of C7
3 Nucleus pulposus of T5/6
intervertebral disc
4 Spinal cord
5 CSF in subarachnoid space
(flow void artefact)
6 Basivertebral vein

7
8
9
10
11
12
13

Conus medullaris
Cauda equina
Trachea
Internal jugular vein
Common carotid artery
Grey matter of spinal cord
White matter of spinal
cord

14
15
16
17
18
19
20
21
22

Spinous process of T4
Supraspinous ligament
Ligamentum flavum
Facet (zygapophyseal) joint
Epidural fat
Dorsal root ganglion
Spinal nerve root
Lamina
Spinous process

23
24
25
26
27
28
29
30

Psoas major muscle
Erector spinae muscle
Multifidus muscle
Inferior vena cava
Aorta
Thoracolumbar fascia
Ligamentum nuchae
Descending colon

Ver tebral column and spinal cord

63

7

9
7
1



8



8
11
10

14

3
1
2

16

17

1

20
5

15

4







19

17


18

5

22
19
6

21
21
a

b

c



Lumbosacral spine, (a) sagittal MR image, (b) parasagittal MR image, (c) coronal MR image.
1
2
3
4
5
6
7
8

Annulus fibrosus
Anterior longitudinal ligament
Basivertebral vein
Body of third lumbar vertebra
Cauda equina
Caudal lumbar thecal sac
Cerebrospinal fluid
Conus medullaris

9
10
11
12
13
14
15
16

Dural sac
Epidural space (fat filled)
Internuclear cleft
Interspinous ligament
Intervertebral foramen
Kidney
Ligamentum flavum
Nucleus pulposus

17 Pedicle
18 Posterior longitudinal ligament and
annulus fibrosus
19 Psoas muscle
20 Radicular vessels
21 Sacral promontory
22 Spinal nerve root in intervertebral
foramen

Spinal cord

64

16
8
11

14

2

10

1

6

5

4

15

12

3

2

6

5

Cervical myelogram, (a) with the neck extended, (b) with the
neck slightly flexed, anteroposterior projections.
Non-ionic water-soluble contrast medium is introduced into the
lumbar subarachnoid space via a lumbar puncture. The patient
is positioned prone, with the neck hyperextended, and strapped
onto a tilting table. The contrast medium is then run up into the
cervical region to demonstrate the cervical spinal cord and exiting
nerve roots. There are eight cervical nerve roots: the roots of
the eighth cervical nerve exit through the intervertebral foramina
between the seventh cervical vertebra and the first thoracic
vertebra. The normal cervical cord enlargement (3) (for the
brachial plexus) extends from the third cervical vertebra to the
second thoracic vertebra. It is maximal at the fifth cervical
vertebra and should not be mistaken for an intramedullary lesion.

15
9

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

4

7
12

13

13

a

b

Cervical myelogram, (c) with the patient prone, (d) with the patient
supine, lateral projections.

8

7

Anterior spinal artery
Cervical cord
Cervical cord enlargement
Cervical spinal nerve exiting through intervertebral foramen
Contrast medium in cervical subarachnoid space
Dorsal root of spinal nerve
First rib
Lateral mass of atlas (first cervical vertebra)
Normal large transverse process of seventh cervical vertebra
Occiput
Odontoid process (dens)
Root of eighth cervical nerve
Thoracic cord
Transverse foramen
Ventral root of spinal nerve
Vertebral artery

5
12

2

6
1

10

9

3
c

1
7

9

3
6

11
13
d

4 12
8

1
2
3
4
5
6
7
8
9
10
11
12
13

Anterior arch of atlas (first cervical vertebra)
Anterior rim of foramen magnum
Cervical cord
Cisterna magna (cerebellomedullary cistern)
Clivus
Contrast medium in cervical subarachnoid space
External acoustic meatus
Occiput
Odontoid (process) dens
Posterior indentation on theca from ligamentum flavum
Posterior inferior cerebellar artery
Posterior rim of foramen magnum
Posterior tubercle of atlas (first cervical vertebra)

Spinal cord

65

Lumbar radiculogram, (a) lateral projection, (b) oblique projection, (c) anteroposterior
projection.
Non-ionic water-soluble contrast medium is introduced into the lumbar subarachnoid
space via a lumbar puncture. The nerve roots of the cauda equina are well
demonstrated and exit through the intervertebral foramina. The nerve roots extending
from the conus to the terminal thecal sac pass below the pedicle of the corresponding
vertebra. The thecal sac terminates at the level of the first/second sacral vertebrae.
The filum terminale may be seen. Tilting the prone patient slightly head down allows
the contrast to flow cranially and outlines the conus and lower thoracic cord. The
cord is uniform in size from the second to the tenth thoracic vertebra, at which point
its second, smaller expansion (for the lumbosacral plexus) extends from the tenth
thoracic vertebra to the level of the first lumbar vertebra. The conus medullaris
usually terminates at the first/second lumbar vertebrae, but may be seen at a level
above and below as a normal variant.
4

2

16

15

2
11

12

7

9

3
8
1

14

6

5

4
3

16

10

13
b

a

c

13
1
2
3
4
5
6
7

Anterior median fissure
Body of second lumbar vertebra
Contrast medium in subarachnoid space
Conus medullaris
Fifth lumbar spinal nerve
Fourth lumbar spinal nerve
Intervertebral disc indentations in anterior
thecal margin

8 Lateral extension of subarachnoid space
around spinal nerve roots
9 Lumbar puncture needle in space between
third and fourth lumbar vertebrae
10 Sacral promontory
11 Spinal nerves within subarachnoid space
(cauda equina)

12 Spinous process of third lumbar vertebra
13 Terminal theca at first/second sacral
vertebra
14 Test tube containing contrast medium to
indicate tilt of patient
15 Thoracic cord
16 Twelfth rib

66

Ver tebral column and spinal cord

(a) Subtracted lumbar venogram.
Since the advent of CT and MR imaging techniques, lumbar
venography is rarely performed. However, the anatomy of the
vertebral veins is optimally demonstrated by this technique.
Venous drainage of the spinal cord is longitudinally arranged via
plexi, which anastomose freely with the internal (6) and external
(1 and 4) vertebral venous plexi, which also communicate (4 and
2). Note how the internal veins bend laterally at the level of the
disc interspace and medially at the level of pedicles, where they
unite via a connecting vein (2).
1
2
3
4
5
6
7
8

6

Ascending lumbar veins
Basivertebral veins
Catheter in common iliac vein
Intervertebral veins
Lateral sacral veins
Longitudinal vertebral venous plexi
Sacral venous plexus
Tip of catheter in intravertebral vein

6
2

(b) Spinal arteriogram.
1
2
3
4

4
2

Anterior spinal artery
Arteria radicularis magna (Adamkiewicz)
Normal transdural stenosis of the arteria radicularis magna
Selective catheterisation of left eleventh intercostal artery

6

1

2

8

1
2
3

7
3

a

5

b

4

67

3

Upper limb

68

Shoulder

(a) Shoulder, anteroposterior radiograph.

1
2
3
4
5
6
7
8
9
10

Acromion of scapula
Anatomical neck
Clavicle
Coracoid process of scapula
Glenoid fossa of scapula
Greater tubercle (tuberosity) of
humerus
Head of humerus
Lesser tubercle (tuberosity) of
humerus
Scapula
Surgical neck

9
3
1
4
7
5

2

8 6

5
10
9

a

(b) Shoulder, axial (supero-inferior)
projection.

1
2
3
4
5
6
7
8
9

Acromion of scapula
Clavicle
Coracoid process of scapula
Glenoid fossa of scapula
Greater tubercle (tuberosity) of
humerus
Head of humerus
Intertubercular groove of humerus
Lesser tubercle (tuberosity) of
humerus
Spine of scapula

9

1
4
6

4

2

6

6

5
7
8

3

b

10

Shoulder

5

5
1

3

4

69

8

2
5

4

3

2

8

6
6

6
4
1

a

c

b

5
7
5

2

5

7

1

4

3

4
6

3

8
6

8
1

d

2

4

8

6

f

e

Shoulder, (a) (anteroposterior) of a 1-year-old child, (b) (anteroposterior) and
(c) (axial) of a 6-year-old child, (d) (anteroposterior) and (e) (axial) of a 12-year-old child
(f) (anteroposterior) and (g) (axial) of a 14-year-old child.

5

2

8
4

6

1 Acromion of scapula
2 Centre for coracoid process
3 Centre for greater tubercle (tuberosity) of
humerus
4 Centre for head of humerus

5
6
7
8

Clavicle
Epiphysial line
Centre for acromion
Glenoid fossa of scapula

1

g

CLAVICLE (m)
Lateral end
Medial end

Appears
5 wiu
15 yrs

Fused
20+ yrs
20+ yrs

SCAPULA (c)
Body
Coracoid
Coracoid base
Acromion

8 wiu
<1 yr
Puberty
Puberty

15 yrs
20 yrs
15–20 yrs
15–20 yrs

70

Upper limb

1

10
8

11
7

1
12

4

5

6
9

b

2

3

1

5

2
9
14

3

14

6
2

13

9

6
4

3

13

a

(a) Humerus, lateral projection, (b) elbow, anteroposterior
projection, (c) elbow, lateral projection.

1
2
3
4
5
6
7

Humerus
Radius
Ulna
Capitulum of humerus
Coronoid process of ulna
Head of radius
Lateral epicondyle of humerus

8
9
10
11
12
13
14

c

Medial epicondyle of humerus
Neck of radius
Olecranon fossa of humerus
Olecranon of ulna
Trochlea of humerus
Trochlear notch of ulna
Tuberosity of radius

HUMERUS (c)
Shaft
Head
Greater tubercle
Lesser tubercle
Capitulum
Medial trochlea
Medial epicondyle
Lateral epicondyle

Appears
8 wiu
1–6 mths
6 mths–1 yr
3–5 yrs
4 mths–1 yr
10 yrs
3–6 yrs
9–12 yrs

Fused
15–20 yrs
15–20 yrs
15–20 yrs
18–20 yrs
13–16 yrs
13–16 yrs
13–16 yrs
13–16 yrs

Elbow

71

7
7
1

7

8
3

1
1

9

9

1

8

9

8

7

8
b

a

7

7

2

9

3

1

6

9

5

4
1

8

c

4

4

Elbow images, (a) 7-month-old child, (b) 3-year-old child,
(c) 6-year-old child, (d) 9-year-old child.

5

8
9

6
10

d

RADIUS (c)
Shaft
Proximal
Distal

8 wiu
4–6 yrs
1 yr

13–16 yrs
16–18 yrs

ULNA (c)
Shaft
Proximal
Distal

8 wiu
8–10 yrs
5–7 yrs

13–15 yrs
16–18 yrs

1
2
3
4
5
6
7
8
9
10

8

Centre for capitulum
Centre for lateral epicondyle
Centre for medial epicondyle
Centre for radial head
Centre for trochlea
Epiphysial line
Humerus
Radius
Ulna
Centre for olecranon

Elbow

72

7

7

3

1
4
4
8

5

1

9
10

a

8

9

b

7

7

6

4

8

9
3

2

10

1
4

c

8

d

9

Elbow images, (a) and (b) 11-year-old child, (c) and (d) 14-year-old child.

1
2
3
4
5

Centre
Centre
Centre
Centre
Centre

for
for
for
for
for

capitulum
lateral epicondyle
medial epicondyle
radial head
trochlea

6
7
8
9
10

Epiphyseal line
Humerus
Radius
Ulna
Centre for olecranon

Forearm

11

73

11

11

11

8
15
14
10

13
9
12
6
7
10
13
12

4

5

4

5

3
2

1

a

1

b

Forearm images, (a) lateral and (b) anteroposterior.
1
2
3
4

Humerus
Medial epicondyle of humerus
Lateral epicondyle of humerus
Radius

5
6
7
8
9

Ulna
Styloid of ulna
Trapezium
Trapezoid
Triquetral

10
11
12
13
14
15

Scaphoid
Metacarpals
Lunate
Pisiform
Capitate
Hamate

7

Wrist and hand

74

5
9
23
2

14

11

16
6

24
3

17

21
8
20
22

27

25
a

27 28
19

1

28

4

12

7
29
13

19
18

15

29
26
26

13

25

26

18

10

10
30

(a) Bones of the hand, dorsopalmar and oblique projection.
1
2
3
4
5
6
7
8
9
10
11

Base of fifth metacarpal
Base of middle phalanx of middle finger
Base of proximal phalanx of ring finger
Capitate
Distal phalanx of index finger
Distal phalanx of thumb
Hamate
Head of fifth metacarpal
Head of middle phalanx of middle finger
Head of ulna
Head of proximal phalanx of ring finger

12
13
14
15
16
17
18
19
20
21

Hook of hamate
Lunate
Middle phalanx of index finger
Pisiform
Proximal phalanx of index finger
Proximal phalanx of thumb
Radius
Scaphoid
Second metacarpal
Sesamoid bone

22
23
24
25
26
27
28
29
30
31

Shaft of fifth metacarpal
Shaft of middle phalanx of middle finger
Shaft of proximal phalanx of ring finger
Styloid process of radius
Styloid process of ulna
Trapezium
Trapezoid
Triquetral
Ulnar notch of radius
Base of metacarpal

27

27

12

19

1

4

7

28
31

4

15

31

13
b

(b) Axial CT through carpal tunnel.

18
26

(c) Bones of the wrist, lateral projection.
c

Wrist and hand

75

8
1
10

1

10 1

10

3

10 1

12

b

a

2
6

6

8

8

10 1

3

3
12

c 17

9

7

8
8
8

10

15

14

4
d

5

3
17

3

9

12

CARPUS (c)
Capitate
Hamate
Triquetral
Lunate
Scaphoid
Trapezium
Trapezoid
Pisiform (sesamoid)

Appears
1–3 mths
2–4 mths
2–3 yrs
2–4 yrs
4–6 yrs
4–6 yrs
4–6 yrs
8–12 yrs

Fused

METACARPALS (c)
Shaft
Head

9 wiu
1–2 yrs

14–19 yrs

PHALANGES (c)
Shaft
Base

8–12 wiu
1–3 yrs

14–18 yrs

1
13

16
11
9

7

5

6

e

8

3

4
17

1 Capitate
2 Centre for distal phalanx of
ring finger
3 Centre for distal radius
4 Centre for distal ulna

9

12

5 Centre for first metacarpal
6 Centre for middle phalanx of
middle finger
7 Centre for proximal phalanx
of middle finger

Bones of the hand (dorsopalmar projections), (a) of a 10-monthold child, (b) of a 2-year-old child, (c) of a 6-year-old child, (d) of
a 9-year-old child, to