intro headneck

„Selected Chapters from theCross-Sectional Anatomy of

the Human Body”András Jakab MD, Levente István Lánczi MD

Why to choose this elective?

Images support the everyday medical practice. Medical students should become familiar with images (radiography, CT, MRI, US, NM).

Theoretical knowledge -> clinical use Medical students have strong anatomy

background Clinical correlations

Why to choose this elective?

Support clinical and imaging education Images are important on exams, such as

State exam (last exam before graduation), USMLE Step 1,2 & 3 and others

„Every picture tells a story”

Structure of the Lectures

1. Background information

2. Macroscopic anatomy revision

3. Clinical anatomy – „Why is this region important?”

4. Cross-sectional demonstration using www.imaios.com and other sources

5. Selected clinical cases (www.eurorad.com)

6. Sources

About medical imaging

Methods using X-ray ”Classical” two-directional x-ray CT

Ultrasound (US) Magnetic Resonance Imaging (MRI) Nuclear Medicine imaging and hybrid

technologies SPECT, PET PET-CT, PET-MR Image fusion

On a CT scan/radiography…

White bone, contrast agent (vessels, bowels, masses,

etc.), implants/foreign body (metalic) Grey

parenchymal organs (liver, brain, etc.) Black

air (gas), water, liquor

On a T1 MRI scan…

White fat

Black water, liquor

Good gray matter/white matter contrast in the brain

On a T2 MRI scan…

White water, liquor

Black Fat

Edema imaging

„ Selected Chapters from the Cross-Sectional Anatomy ” – Head and neck anatomy:

pharynx, larynx, oral cavityAndrás Jakab MD, Levente István Lánczi MD

What can be seen on the axial MR images of the neck?

Bones hyoid bone vertebrae

Neck muscles Vessels

common carotid artery Inferior/superior thyroid artery vertebral artery Internal/external/anterior jugular veins

Larynx: cartilages, muscles, cavities Esophagus, pharynx Spinal cord

Bones – cervical vertebrae

spinous process

vertebral archvertebral foramen

Transverse process

sup./inf. articular process

vertebral body

C1: atlas, C2: axisposterior arch

arcus anterior

lateral mass

transverse process

articular surface

dens of axis

Hyoid bone

body

greater horn

lesser horn

Muscles of the neck

Platysma Sternocleidomastoid muscle (SCM) Suprahyoid – infrahyoid muscles Triangles of the neck

carotid, submandibular, supraclavicular (omoclavicular, omotrapezoid)

submental Scaleni muscles

anterior, medius, posterior

Superficial neck muscles sternocleidomastoid muscle (SCM)

manubrium of sternum mastoid process

platysma

Infrahyoid muscles

sternohyoid muscle

sternothyroid musclethyrohyoid muscle

omohyoid muscleomohyoid muscle

Suprahyoid muscles

mylohyoid muscle digastric muscle stylohyoid muscle geniohyoid muscle

Triangles of the neck

1. Submandibular

2. Carotid

3. Submental

4. Supraclaviculara. omoclavicular

b. omotrapezoid

Deep neck & scalenus muscles

trapezius muscle

splenius capitis, semispinalis capitis m.

scalenus anterior m.

scalenus medius m.

scalenus posterior m.

levator scapulae m.

T2 MRI, Level Th1

Axialis metszet a Th1 magasságában (T2 MRI)T2 MRI, Level Th1

Axialis metszet a Th1 magasságában (T2 MRI)T2 MRI, Level Th1

Axialis metszet a Th1 magasságában (T2 MRI)T2 MRI, Level Th1

T2 MRI, Level Th1

T2 MRI, Level C7

T2 MRI, Level C7

T2 MRI, Level C7

T2 MRI, Level C7

Larynx

Respiratory system Hyaline cartilage, ligaments, muscles, mucosa

Hyoid bone -> trachea Cartilages

Thyroid cartilage (Prominentia laryngea – Pomum Adami)

Cricoid cartilage Arytenoid cartilage Epiglottis Small cartilages: cuneiform, corniculate

hyoid bone

thyroid cartilage

cricoid cartilage

trachea

arytenoid cartilage

corniculate cartilage

epiglottis

thyroid membrane

median cricothyroid ligament

median thyrohyoid ligament

thyroid cartilage

epiglottis

hyoid bone

cricoid cartilage

- arcus

cricoid cart.

- lamina

thyroid

membrane

T2 MRI, Level C6

T2 MRI, Level C6

T2 MRI, Level C6

T2 MRI, Level C6

T2 MRI, Level C6

T2 MRI, Level C6

T2 MRI, Level C6

Internal structure of pharynxthyroid cartilage

vocal muscle

arytenoid cart.

Cricoid cart.

pharynx

constrictor pharyngis inferior m.

vocal lig.

T2 MRI, Level C5

T2 MRI, Level C5

T2 MRI, Level C5

T2 MRI, Level C5

T2 MRI, Level C5

T2 MRI, Level C5

T2 MRI, Level C4

T2 MRI, Level C4

T2 MRI, Level C4

T2 MRI, Level C4

T2 MRI, Level C4

Larynx– coronal plane

thyroid gland

thyroid cartilage

cricoid cartilage

epiglottis

vocalis m., vocal lig.

vestibule

trachea

T2 MRI, laryngeal cavities, coronal plane

T2 MRI, laryngeal cavities, coronal plane

T2 MRI, Level C3

T2 MRI, Level C3

T2 MRI, Level C3

T2 MRI, Level C3

Head – face & masticatory muscles

SCM

parotid glandule

m. masseter

zygomaticus major m.

orbicularis oris m.

buccinator m.

ramus of manibule

external carotid a.

facial a.

occipitalis a.

pterygoideus med & lat m.

buccinator m.

facial a.

T2 MRI, Level C1-2

Axialis metszet a C1-C2 magasságában (T2 MRI)T2 MRI, Level C1-2

Axialis metszet a C1-C2 magasságában (T2 MRI)T2 MRI, Level C1-2

Axialis metszet a C1-C2 magasságában (T2 MRI)T2 MRI, Level C1-2

Axialis metszet a C1-C2 magasságában (T2 MRI)T2 MRI, Level C1-2

Axialis metszet a C1-C2 magasságában (T2 MRI)

T2 MRI, Level C1-2

T2 MRI saggital plane

Sagittalis metszet a fej-nyak régióról (T2 MRI)

T2 MRI saggital plane

Sagittalis metszet a fej-nyak régióról (T2 MRI)

T2 MRI saggital plane

Sagittalis metszet a fej-nyak régióról (T2 MRI)

T2 MRI saggital plane

Sagittalis metszet a fej-nyak régióról (T2 MRI)

Sagittalis metszet a fej-nyak régióról (T2 MRI)

Sagittalis metszet a fej-nyak régióról (T2 MRI)

Sagittalis metszet a fej-nyak régióról (T2 MRI)

Sinuses

Frontal sinus

Maxillary sinus

Selected clinical case #1

48 y old man for fistulography thyreoglossal cyst incision 5 years before Fistulography

thyroglossal tract, sinus dilatation; taste of contrast agent Ultrasound

ovoid hypoechoic lesion, subtle flow CT

cystic components MRI

cystic suprahyoid lesion

Thyroglossal duct fistulahttp://www.eurorad.org/case.php?id=8884

Selected clinical case #2

50 y old female History: dry eyes & mouth 1 y duration; foreign body

sensation, enlargement of parotids US: mildly enlarged parotid glands demonstrating

echotexture heterogeneity MR sialography imaging:

bilateral diffuse intra-glandular duct ectasia no sialolith

Positive Schirmer’s test

Sjogren’s syndrome

http://www.eurorad.org/case.php?id=8515

Selected clinical case #3

21 y old male History: car accident CT examination

Air bubbles between muscles Linear band of negative density

Surgical intervention: 10 cm piece of wood

http://www.eurorad.org/case.php?id=5072

Selected clinical case #4

Sinus piriformis carcinomahttp://www.eurorad.org/case.php?id=4930