intro headneck
TRANSCRIPT
„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