being the anatomical wiseguy by knowing your landmarks · • always indicate image orientation in...
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Being the anatomical wiseguy
by knowing your landmarks
Julian Caspers
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Why landmarks ...
MRI 2 days later CT
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Surface Anatomy
CS
SF
POS
CinS
Frontal Parietal Parietal
Frontal
Temporal Temporal
Occipital
(Limbic)
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Lateral Surface
CS
SF
IPL
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Medial Surface
POS
CinS SFG PCL
mCin
Fus
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Sectional anatomy: Orientation
Radiological orientation: - upward view from the bottom / feet
- you stand in front of the subject
Neurological orientation: - downward view from the top
- you stand behind the subject
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Radiologist Neurosurgeon
Different perspectives…
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Sectional anatomy: Orientation
Teaching Point: Always indicate image orientation in
sectional brain images.
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Sagittal sections
tri
preCS CS
“M“-sign “U“-sign
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Sagittal sections
Hook-sign
CS
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Sagittal sections
precentral glioma
“M“
CS preCS (hook)
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Transverse sections
• bracket sign
• “L“ or “T“ sign
• omega or handknob sign
• thin postcentral gyrus sign
Central region
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(Pars) Bracket sign
pars marginalis
Cingulate sulcus {
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CS
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“L“ or “T“ sign
SFG • “L“-sign: SFG merges with
PreCG in form of an L
• “T“-sign: SFS intersects
PreCS in a T-junction
SFS
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Omega sign
„Knob of the hand“
→ hand motor area
Formed like an inverted Ω
OpenStax College, 1421 Sensory Homunculus, CC BY 3.0
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Omega sign… or epsilon sign
„Knob of the hand“
→ hand motor area
Formed like an inverted Ω ca. 80%
or
Formed like a horizontal ε ca. 10%
10% variants
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Thin postcentral gyrus
>
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Central region
{ • bracket sign
• „L“ or „T“ sign
• omega or handknob sign
• thin postcentral gyrus sign >
{
Ω
L /
T
CS
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Central region: Cerebral mass
{
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Intraparietal sulcus
3 9
7 5
• from 3 to 5 and 7 to 9 clock-positions
• merges with postCS
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Intraparietal sulcus
3 9
7 5
• can be separated
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Broken letter M sign
IOS IOS POS
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AC-PC line
AC PC
VAC
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VAC line …
Kim J-H et al., NeuroImage 2010, CC BY-NC-ND 3.0
… separates SMA from pre-SMA
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AC-PC line
AC PC
VPC
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VPC line …
… indicates posterior insular border (in 95 %)
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Teaching points
• always indicate image orientation in sectional brain images
• consider slice inclination when analysing sectional images
• identify SF, CS and POS for lobar segregation
• M-sign, U-sign and hook-sign identify IFG, pre-CS and CS in sagittal
sections
• bracket-sign, L- / T-sign, knob-of-the-hand and thin-postCG-sign
identify CS in transverse sections
• VAC separates SMA and pre-SMA; VPC indicates posterior insular
border
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Thank you for your attention!