Basics with Radiological anatomy of brain

Slide 1: 

Good morning … BASICS with THE BRAIN YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis

Slide 2: 

YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis Embryology Cerebrum Lobes White Matter Tracts Basal Ganglia Thalamus Subthalamic Limbic System Sella Pituitary Gland Cavernous sinuses Pineal Region Part I BASICS with THE BRAIN

Slide 3: 

Embryology

Slide 4: 

E mbryology Neurulation NF bends medially and close Neural Tube <2wks (early stage) Simple Bilaminar Disk About 2 wks Neural Plate Appears About 18 days Neural Groove Lateral portion of NG thickens Neural Fold

Slide 5: 

E mbryology Shaping Folding Convergence Closure Elevation

Slide 6: 

Proximal 2/3 rd Brain Caudal 1/3 rd Spinal Cord Neural tube lumen Brain Ventricular System Central Canal Of Spinal Cord E mbryology

Slide 7: 

Neural Tube Closure E mbryology Closure Starts at the Hindbrain end Processed both the end. Caudaly Distends the brain cavity C ephalic end C onstricts to form primary brain vesicles Ciliated epi cell of the neural tube lining secrete watery liquid “ Zipperlike ”

Slide 8: 

E mbryology Morphogenesis Ant. neorupore Gestational week 4 Gestational week 5

Slide 9: 

E mbryology Prosen - cephalon Mesen - cephalon Rhomben - cephalon Telen cephalon Dien cephalon Mesen cephalon Metaen cephalon Myelen cephalon Encephalonation Spinal Cord Formation of Brain Vesicles PRIMARY SECONDARY

Slide 10: 

Formation of Brain Vesicles E mbryology Telen cephalon Dien cephalon Mesen cephalon Metaen cephalon Myelen cephalon Spinal Cord Cerebral hemispheres (cortex, white matter, basal nuclei) Thalamus Hypothalamus Epithalamus Mid Brain Tectum Pons Cerebellum Medulla SECONDARY ADULT STRUCTURES Spinal Cord

Slide 11: 

E mbryology Formation of Brain Flexures Cervical Flexure Pontine Flexure Cephalic Flexure

Slide 12: 

E mbryology Formation of Ventricles Lateral Ventricle Third Ventricle Cerebral Aqueduct Fourth Ventricle Central Canal Telen cephalon Dien cephalon Mesen cephalon Rhomben cephalon

Slide 13: 

E mbryology

Slide 14: 

Terms & Conventions Longitudinal axis of the brainstem & Spinal Cord Longitudinal axis of The forebrain

Slide 15: 

Anterior Posterior Superior Inferior Rostral Caudal Caudal Terms & Conventions

Slide 16: 

Coronal Sagittal Horizontal Terms & Conventions

Slide 17: 

Cerebrum

Slide 18: 

The crests of the cortical folds ( gyri ) are separated by furrows ( sulci ) or deeper fissures . The folding of the cortex into gyri and sulci permits the cranial vault to contain a large area of cortex (nearly 2 ½ square feet), more than 50% of which is hidden within the sulci and fissures. Cerebrum is the largest division of the brain. It is divided into two hemispheres, each of which is divided into four lobes. Cerebrum

Slide 19: 

Fissures Deep grooves, generally dividing large regions/lobes of the brain Longitudinal Fissure Divides the two Cerebral Hemispheres Transverse Fissure Separates the Cerebrum from the Cerebellum Sylvian /Lateral Fissure Divides the Temporal Lobe from the Frontal and Parietal Lobes Sulci Small grooves dividing the gyri Central Sulcus Divides the Frontal Lobe from the Parietal Lobe Gyri elevated ridges “winding” around the brain. Cerebrum

Slide 20: 

Cerebrum

Slide 21: 

Cerebrum

Slide 22: 

Cerebrum

Slide 23: 

Cerebrum

Slide 24: 

Cerebrum

Slide 25: 

Cerebrum

Slide 26: 

Lobes

Slide 27: 

Frontal lobe Central sulcus separates frontal, parietal lobes Precentral gyrus contains primary motor cortex Detailed topographically-organized map (" motor homunculus ") of contralateral body Three additional major gyri : Superior frontal gyrus , middle frontal gyrus & inferior frontal gyrus separated by superior & inferior frontal sulci

Slide 28: 

Primary Motor Cortex/ Precentral Gyrus Broca’s Area Orbitofrontal Cortex Olfactory Bulb Frontal lobe

Slide 29: 

Posterior to central sulcus Separated from occipital lobe by parietooccipital sulcus ( medial surface ) Postcentral gyrus: Primary somatosensory cortex • Contains topographical map of contralateral body • Superior & inferior parietal lobules lie posterior to postcentral gyrus Medial surface of parietal lobe is precuneus Parietal lobe

Slide 30: 

Primary Somatosensory Cortex/ Postcentral Gyrus Primary Gustatory Cortex Somatosensory Association Cortex Parietal lobe

Slide 31: 

•Posterior to parietooccipital sulcus o Primary visual cortex on medial occipital lobe o Cuneus on medial surface Occipital lobe

Slide 32: 

Primary Visual Cortex Visual Association Area Occipital lobe

Slide 33: 

• Inferior to sylvian fissure o Superior temporal gyrus : Contains primary auditory cortex o Middle temporal gyrus : Connects with auditory, somatosensory , visual association pathways o Inferior temporal gyrus: Higher visual association area o Includes major subdivisions of limbic system • Parahippocampal gyrus on medial surface, merges into uncus Temporal lobe

Slide 34: 

Primary Auditory Cortex Wernike’s Area Primary Olfactory Cortex (Deep) Conducted from Olfactory Bulb Temporal lobe

Slide 35: 

• Insula o Lies deep in floor of sylvian fissure , overlapped by frontal , temporal, parietal operculae o Somatosensory function • Base of brain o Orbital gyri cover base of frontal lobe: Gyrus rectus Medially Olfactory bulb/tract lie within olfactory sulcus Olfactory Bulb Insula & Base

Slide 36: 

Axial CT

Slide 37: 

Axial CT

Slide 38: 

Axial CT

Slide 39: 

Axial T1 MR

Slide 40: 

Axial T1 MR

Slide 41: 

Axial T1 MR

Slide 42: 

Coronal T1 MR

Slide 43: 

Coronal T1 MR

Slide 44: 

Sagittal T1 MR

Slide 45: 

Sagittal T1 MR

Slide 46: 

Sagittal T2 MR

Slide 47: 

Coronal T2 MR

Slide 48: 

Coronal T2 MR

Slide 49: 

White Matter Tracts

Slide 50: 

Three major types of fibers ( by course ) o Association fibers : Interconnect different cortical regions in same hemisphere ( Cingulum ) o Commissural fibers : Interconnect similar cortical regions of opposite hemispheres (Corpus callosum) o Projection fibers : Connect cerebral cortex with deep nuclei , brainstem, cerebellum, spinal cord (Corona radiata, internal capsule) White Matter Tracts

Slide 51: 

White Matter Tracts • Association fibers (may be short or long ) o Short ( arcuate or "u" fibers ) link adjacent gyri o Long fibers form fasciculi connecting widely spaced Gyri • Cingulum : Long, curved fasciculus deep to cingulate gyrus interconnects parts of frontal/parietal/temporal lobes • Uncinate fasciculus : Connects motor speech area & orbital gyri of frontal lobe with temporal lobe cortex

Slide 52: 

• Superior longitudinal ( arcuate ) fasciculus: connects frontal to parietal, temporal and occipital cortex • Inferior longitudinal fasciculus: Connects temporal and occipital cortex, • Superior occipitofrontal fasciculus: lies beneath corpus callosum (CC) • Inferior occipitofrontal fasciculus Association fibers White Matter Tracts

Slide 53: 

White Matter Tracts • Commissural fibers o Corpus callosum • Largest commissure; links hemispheres • Four parts: Rostrum, genu, body, splenium • Tapetum : Formed by body, some splenium fibers ; • Most fibers from splenium curve into occipital lobes as forceps major o Anterior commissure • Transversely oriented bundle of compact myelinated fibers • Splits into two bundles laterally • Larger posterior fans out into temporal lobe o Posterior commissure: Small ; transversely in posterior pineal

Slide 54: 

White Matter Tracts • Projection fibers o Corona radiata Fibers from internal capsule fan out represent all cortical areas o Internal capsule: Major conduit of fibers to/from cerebral cortex • Anterior limb • Genu • Posterior limb

Slide 55: 

White Matter Tracts • Projection fibers o Corticospinal tract & o Corticobulbar tract: Major efferent projection fibers connect motor cortex to brainstem and spinal cord o Corticopontine tract: Motor information to pons o Corticothalamic tract : Connects entire cerebral cortex with isotopic location in thalamus

Slide 56: 

White Matter Tracts • MR signal depends on maturation • Myelination generally proceeds inferior to superior central to peripheral posterior to anterior • Fully myelinated white matter hyperintense on T1WI hypointense on T2Wl

Slide 57: 

White Matter Maturation • Occurs at different rates, times on Tl /T2 imaging <6 months , Tl WI most useful >6months , T2WI is most useful • Newborn T1WI: Newborn brain resembles T2 image in an adult • White matter has lower signal than gray matter • With maturation, intensity of white matter increases T2WI : Newborn brain resembles T1 image in an adult • White matter has higher signal than gray matter • T2 superior for evaluating cerebellum and brainstem maturation White Matter Tracts

Slide 58: 

• First six months T1WI • Three months : High signal in anterior limb , internal capsule and cerebellar folia • Four months: High signal in CC splenium • Six months : High signal in CC genu • Eight months: Near adult appearance, except most peripheral fibers • Six to eighteen months T2WI • Six months : Low signal in CC splenium • Eight months: Low signal in CC genu • Eleven months : Low signal in anterior limb , internal capsule • Fourteen months: Low signal in deep frontal white matter • Eighteen months: Near adult appearance, except most peripheral fibers White Matter Tracts

Slide 59: 

White Matter Tracts

Slide 60: 

White Matter Tracts

Slide 61: 

White Matter Tracts

Slide 62: 

White Matter Tracts

Slide 63: 

| RED – Left – Right | GREEN - Anterior – Posterior | BLUE - Superior – Inferior | 3T DTI

Slide 64: 

3T DTI

Slide 65: 

3T DTI

Slide 66: 

3T Axial DTI

Slide 67: 

3T Axial DTI

Slide 68: 

Axial MR BIRTH T1 T2

Slide 69: 

Axial MR BIRTH T1 T2

Slide 70: 

Axial MR 3months T1 T2

Slide 71: 

Axial MR 6 months T1 T2

Slide 72: 

Axial MR 6 months T1 T2

Slide 73: 

Axial T1 MR 12 Months 3 Years

Slide 74: 

Axial T1 MR 12 Months 3 Years

Slide 75: 

Axial T2 MR 12 Months 3 Years

Slide 76: 

Axial T2 MR 12 Months 3 Years

Slide 77: 

Axial T2 MR 12 Months 3 Years

Slide 78: 

Basal Ganglia Thalamus Subthalamic

Slide 79: 

Basal Ganglia Basal ganglia (BG): Subcortical nuclear masses in inferior hemispheres Involved in motivation, controlling movement Lentiform nucleus: Putamen + globus pallidus (GP ) Corpus striatum : Caudate nucleus + putamen + GP; neostriatum = putamen, caudate Definition recently narrowed to exclude claustrum , amygdala

Slide 80: 

o Anterior limb of internal capsule separates caudate head from putamen, GP o Posterior limb separates thalamus from BG • Caudate nucleus: "C-shaped" curved nucleus with large head , tapered body, down-curving tail • Putamen: Located lateral to GP, separated by lateral ( external) medullary lamina • GP: Two segments o Lateral (external), medial (internal) segments separated by internal medullary lamina o Higher myelin content than putamen (darker on T2) Basal Ganglia

Slide 81: 

Thalamus Paired ovoid nuclear complexes Relay stations for most sensory pathways . E xtends from foramen of Monro to quadrigeminal plate of midbrain Medially forms lateral walls of third ventricle Laterally bordered by internal capsule Subdivided into nuclear groups (anterior, medial , lateral ), geniculate nuclei (lateral, medial), pulvinar

Slide 82: 

Geniculate Nuclei Lateral geniculate nucleus: Ovoid ventral projection from posterior thalamus (part of visual system) Medial geniculate.nucleus : Along posterior thalamus (part of auditory system ) Pulvinar Occupies caudal third of thalamus & overhangs superior colliculus Massa intermedia (interthalamic adhesion): Connects thalami across third ventricle Thalamus

Slide 83: 

Complex region of nuclear masses, Fiber tracts that plays major role in normal BG function Associated with Parkinson disease Subthalamic nucleus is lens-shaped Lies superolateral to red nucleus Subthalamic

Slide 87: 

Axial CT

Slide 88: 

Axial CT

Slide 89: 

Axial T1 MR

Slide 90: 

Axial T1 MR

Slide 91: 

Axial T1 MR

Slide 92: 

Axial T1 MR

Slide 93: 

Axial T1 MR

Slide 94: 

Coronal T1 MR

Slide 95: 

Coronal T1 MR

Slide 96: 

Coronal T2 MR

Slide 97: 

Limbic System

Slide 98: 

• Limbic lobe Major role in memory, olfaction, emotion Composed of subcallosal , cingulate , parahippocampal gyri + hippocampus, Dentate gyrus , subiculum , entorhinal cortex • Limbic system o Limbic lobe o Plus some subcortical structures (e.g., amygdala, mammillary bodies, septal nuclei, etc .) Limbic System

Slide 99: 

• Limbic lobe : formed by nested "C-shaped" arches of tissues • Outer arch Largest of the three arches Extends from temporal to frontal lobes comprised of Uncus Parahippocampal gyrus Cingulate gyrus Subcallosal ( paraolfactory area) • Middle arch Extends from temporal to frontal lobes Comprised of Hippocampus proper (Ammon horn) Dentate gyrus Supracallosal gyrus Paraterminal gyrus S mallest arch Extends from temporal lobe to mamillary bodies Comprised of fornix, fimbria Limbic System

Slide 100: 

Imaging Anatomy • Hippocampus Consists of two interlocking "U-shaped" gray matter structures Hippocampus proper (Ammon horn) upside-down U Dentate gyrus forms inferomedial U Has three anatomic subdivisions Head ( pes hippocampus): Body : Cylindrical Tail : Most posterior portion • Ammon horn (hippocampus proper) Subdivided into four zones (based on histology of main cell layers) • CA1 • CA2 :• CA3: • CA4 Limbic System

Slide 101: 

• Fornix Primary efferent system from hippocampus Four parts • Crura (arch under CC splenium ) • Commissure (connects crura ) • Body (formed by convergence of crura ) • Columns (curve inferiorly to mammillary bodies, anterior thalamus, septal nuclei) • Amygdala Large complex of gray nuclei medial to uncus Tail of caudate nucleus ends in amygdala Limbic System

Slide 102: 

Limbic System

Slide 103: 

Limbic System

Slide 104: 

Limbic System

Slide 105: 

Coronal T1 MR

Slide 106: 

Coronal T1 MR

Slide 107: 

Coronal T2 MR

Slide 108: 

Coronal T2 MR

Slide 109: 

Coronal T2 MR

Slide 110: 

Coronal T2 MR

Slide 111: 

Axial T2 MR

Slide 112: 

Axial T2 MR

Slide 113: 

Sella Pituitary Gland Cavernous sinuses

Slide 114: 

Sella C oncave midline depression in basisphenoid Diaphragma sellae covers sella Variable-sized central opening transmits infundibulum

Slide 115: 

Pituitary Gland Adenohypophysis 80 % of gland Includes pars anterior (pars distalis or glandularis ), pars intermedia , pars tuberalis Pars intermedia < 5% of pituitary , located between AH/NH Contains axons from hypothalamus, infundibulum

Slide 116: 

Neurohypophysis 20% of pituitary Includes pars posterior (nervosa), Infundibular stem, median eminence of tuber cinereum "bright spot" on T1WI Gland enhances strongly, uniformly, somewhat < CS Pituitary Gland

Slide 117: 

Normal Variants • Normal size- varies with age, gender < 6 mm children 8 mm males, post-menopausal females 10 mm upper limit physiologic hypertrophy in young females (can bulge upwards) 12 mm pregnant/lactating females Pituitary Gland

Slide 118: 

Cavernous sinuses Paired septated , dural -lined venous sinuses that lack Valves Contents (venous blood, cranial nerves, ICAs + sympathetic plexus ) CN3 oculomotor CN4 trochlear CN5 Trigeminal V1 (ophthalmic division of CNS) V2 (maxillary division of CNS) V3 (mandibular division of CNS) does NOT enter CS proper (passes from Meckel cave inferiorly into foramen ovale ) CN6 Abducens

Slide 123: 

Axial T1 C+ MR

Slide 124: 

Axial T1 C+ MR

Slide 125: 

Axial T1 C+ MR

Slide 126: 

Coronal T2 MR

Slide 127: 

Coronal T2 MR

Slide 128: 

Coronal T1 C+ MR

Slide 129: 

Coronal T1 C+ MR

Slide 130: 

Sagittal FS T2 MR

Slide 131: 

Sagittal FS T2 MR

Slide 132: 

Sagittal FS T2 MR

Slide 133: 

Sagittal FS T2 MR

Slide 134: 

Sag. FAT-Saturated T1 MR

Slide 135: 

Sag. FAT-Saturated T1 MR

Slide 136: 

Pineal Region

Slide 137: 

Pineal Region Synonyms • Pineal gland, pineal body, epiphysis cerebri • Posterior commissure: Epithalamic commissure Major components of pineal region Pineal gland Posterior recesses of third ventricle Internal cerebral veins, vein of Galen; medial posterior choroidal artery Epithalamus , quadrigeminal plate (tectum), CC Dura , arachnoid

Slide 138: 

Unpaired midline endocrine organ located within quadrigeminal cistern Structure • Attached to diencephalon & posterior wall of third ventricle by pineal stalk • Pineal stalk consists of superior/inferior lamina (form superior & inferior borders of pineal recess of third ventricle ) Superior lamina connect – H abenular inferior lamina connect -Posterior commissures Contents : Pineal parenchymal cells, germ cells, some neuroglial cells (predominately astrocytes ) Pineal Gland

Slide 139: 

• Pineal gland lacks blood-brain barrier, enhances after contrast admin. CT -Pineal gland calcifications common, increase with age -Globular or concentric lamellar patterns common -Incidence increases with age < 3% at 1 year, 7% by 10 years, 33 % by 18 years, 50 % of older patients Central calcifications normal, generally ≤10 mm Larger , peripheral /" exploded" calcificatn . abnormal-? Ca Habenular commissure sometimes calcifies (" C-shaped" on lateral projections ) MR - Homogeneous enhancement is typical Pineal Gland

Slide 140: 

Pineal Region

Slide 141: 

Pineal Region

Slide 142: 

C oronal T2 MR

Slide 143: 

C oronal T2 MR

Slide 144: 

Sagittal T2 MR

Slide 145: 

YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis Posterior Fossa Midbrain Pons Medulla Cerebellum Part II BASICS with THE BRAIN

Slide 146: 

Thank You

Slide 147: 

Posterior Fossa

Slide 148: 

Posterior Fossa Below Tentorium Cerebelli ( Infratentorial ) Brainstem Cerebellum Composed Of Midbrain Pons and Medulla Oblongata Functional division – ventral & Dorsal Largest Part of Hindbrain Integrates Coordinations Fine-tuning of Movement Regulation of Muscle Tone Cerebral Aqueduct Fourth Ventricle CSF Cisterns Containing Cns Vertebrobasilar Arterial System And Veins Posterior Fossa

Slide 149: 

Brainstem

Slide 150: 

Midbrain connects pons and cerebellum with forebrain Pons Relays information from brain to cerebellum Medulla Relays information from spinal cord to brain Ventral part Contains large descending white matter tracts Dorsal part common to midbrain , pons and medulla contains CN nuclei and reticular formation Brainstem

Slide 151: 

Midbrain

Slide 152: 

" Butterfly-shaped " Midbrain connections Rostral (superior): Cerebral hemispheres, basal ganglia and thalami Dorsal (posterior): Cerebellum Caudal (inferior): Pons Midbrain

Slide 153: 

Cerebral peduncles Mesencephalic Tegmentum Tectum (quadrigeminal plate ) White matter tracts Corticospinal corticobulbar & corticopontine fibers Directly continuous with pontine tegmentum Multiple WMT* Gray matter formations Substantia nigra Red nucleus: Periaqueductal grey: Pigmented nuc . imp - movement Pars compacta Pars reticularis dopaminergic cells GABAergic cells Important in muscle tone, posture, locomotion Important in modulation of pain and defensive behavior CN nuclei Reticular formation CN3 nuclei EW (PS) nuclei CN4 nuclei Important in consciousness, motor function, respiration and cardiovascular control Superior coIIicuIi Inferior coIIiculi Visual pathway Auditory pathway * WMT- White Matter Tracts Midbrain

Slide 154: 

Midbrain

Slide 155: 

Midbrain

Slide 156: 

Axial T1 MR

Slide 157: 

Axial T1 MR

Slide 158: 

Axial T1 MR

Slide 159: 

Axial T1 MR

Slide 160: 

Axial T2 MR

Slide 161: 

Axial T2 MR

Slide 162: 

Pons

Slide 163: 

Two main parts Ventral (anterior) pons Dorsal tegmentum Pons Ventral (anterior) pons: Continuous -superiorly with cerebral peduncles -Inferiorly with medullary pyramids Contains -longitudinal fibers primarily from corticospinal , corticobulbar & corticopontine tracts (WMT ) -Multiple transverse pontine fibers make up bulk May be referred to as pontine bulb or belly

Slide 164: 

Pons Dorsal tegmentum Continuation -Superiorly with midbrain tegmentum -Inferiorly medullary tegmentum Contains - • Multiple white matter tracts of tegmentum & gray matter nuclei • Cranial nerve nuclei

Slide 165: 

Pons Cranial Nerve Nuclei CN5 Nuclei Bulk of motor, main sensory and mesencephalic nuclei located in pons CN6 Nucleus Axons of facial nerve (CN7) loop around abducens nucleus creating a bulge in floor of fourth ventricle, the facial colliculus CN7 Nucleus Three main nuclei within pons : Motor , superior salivatory , solitary tract CN8 Nuclei Beneath lateral recess along floor of fourth ventricle (rhomboid fossa) O n lateral surface of inferior cerebellar peduncle ( restiform body) Dorsal and ventral cochlear nuclei Vestibular nuclei

Slide 166: 

Pons

Slide 167: 

Pons

Slide 168: 

Axial T1 MR

Slide 169: 

Axial T1 MR

Slide 170: 

Axial T2 MR

Slide 171: 

Axial T2 MR

Slide 172: 

Coronal T2 MR

Slide 173: 

Medulla

Slide 174: 

Two Main Parts Ventral (Anterior) Medulla Dorsal Tegmentum also be divided into rostral (superior) & Caudal (inferior) Medulla Ventral (anterior) medulla: Olive & pyramidal tract Medullary pyramids: Corticospinal tracts (pyramidal tracts) make up bulk Medullary olives: Consists of inferior olivary nucleus dorsal & medial accessory olivary nuclei & superior olivary nucleus Inferior olivary nucleus is largest and forms bulge on surface of medulla " medullary olive"

Slide 175: 

Dorsal Tegmentum Multiple white matter tracts of tegmentum Reticular formation afferent and efferent connections Important in consciousness, motor function, respiration and cardiovascular control Cranial nerve nuclei Medulla Medulla external features Pyramid: Paired structure on anterior surface, Olive : Medullary olives are lateral to pyramids, Inferior cerebellar peduncle ( restiform body) Gracile and cuneate tubercles

Slide 176: 

Medulla Cranial Nerve Nuclei CN9 Nuclei Nucleus ambiguus , solitary tract nucleus, inferior salivatory nucleus CN10 Nuclei Nucleus ambiguus , solitary tract nucleus, dorsal vagal nucleus CN11 Nuclei Bulbar nuclei Ambiguus nuclei CN12 Nuclei Dorsally results in hypoglossal eminence or trigone (bulge in fourth ventricle )

Slide 177: 

Medulla

Slide 178: 

Medulla

Slide 179: 

Axial T2 MR

Slide 180: 

Axial T2 MR

Slide 181: 

Axial T2 MR

Slide 182: 

Axial T2 MR

Slide 183: 

Cerebellum

Slide 184: 

Bilobed Structure One - midline vermis Two - hemispheres Three - surfaces Three - fissures Three - p aired penduncles Four - cerebellar nuclei Nine - lobules of vermis Eighteen - hemispheric lobules Cerebellum

Slide 185: 

Surfaces Superior ( tentorial ) surface Primary ( tentorial ) fissure divides it into anterior & posterior parts Inferior ( suboccipital ) surface Prebiventral / prepyramidal ( suboccipital ) fissure divides it into superior & inferior parts Anterior ( petrosal ) surface Horizontal (petrosal) fissure divides it into superior & inferior parts Cerebellum

Slide 186: 

Cerebellum Peduncles : 3 paired peduncles attach cerebellum to brainstem Superior cerebellar peduncle (brachium conjunctivum ) • Connects to midbrain • Contains efferent fiber systems extending to red nucleus & thalamus Middle cerebellar peduncle (brachium pontis ) • Connects to pons • Contains fiber mass originating from pontine nuclei & represent continuation of corticopontine tracts Inferior cerebellar peduncle ( restiform body) • Connects to medulla • Contains spinocerebellar tracts & connections to vestibular nuclei

Slide 187: 

Superior Vermis Inferior Vermis Lobules Of Vermis Hemispheric Lobules Lingula Wing Of Lingula Central Lobule Wing Of Central Lobule Culmen Quadrangular Lobule Primary ( Tentorial ) Fissure Declive Simple Lobule Folium Superior Semilunar Lobule Horizontal ( Petrosal ) Fissure Tuber Inferior Semilunar Lobule Prebiventral / Prepyramidal ( Suboccipital ) Fissure Pyramid Biventral Lobule Uvula Tonsils Nodule Flocculus Cerebellum

Slide 188: 

Cerebellum

Slide 189: 

Cerebellum Cerebellar Nuclei Fastigial nucleus Medial group ( vermis ) Globose (posterior) nucleus Intermediate group Emboliform (anterior) nucleus Intermediate group Dentate nucleus Lateral group Largest nucleus, shaped as a heavily folded band with medial opening (hilum)

Slide 190: 

Cerebellum

Slide 191: 

Axial T1 MR

Slide 192: 

Axial T1 MR

Slide 193: 

Axial T1 MR

Slide 194: 

Coronal T2 MR

Slide 195: 

Coronal T2 MR

Slide 196: 

Coronal T2 MR

Slide 197: 

Coronal T2 MR

Slide 198: 

Sagittal T2 MR

Slide 199: 

Sagittal T2 MR

Slide 200: 

Sagittal T2 MR

Slide 201: 

Sagittal T2 MR

Slide 202: 

YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis Choroid Plexus Ventricular System CSF Flow in Breif Cisterns Part III BASICS with THE BRAIN

Slide 203: 

Choroid Plexus

Slide 204: 

Secretory epithelium that produces cerebrospinal fluid From the modified ependymal cells Present in all components of the ventricular system except for the aqueduct of Sylvius ( cerebral aqueduct ) Choroid Plexus newborn

Slide 205: 

Ventricles

Slide 206: 

Four cerebrospinal fluid-filled, ependymal lined cavities deep within brain Paired lateral Cerebral ventricles, midline third and fourth ventricles Communicate with each other as well as central canal of spinal cord, SAS Ventricles Lateral ventricles "C-shaped " Each has body, atrium, three horns Body formed by • Roof: Corpus callosum • Floor: Dorsal surface of thalamus • Medial wall, floor: Fornix • Lateral wall, floor: Body, tail of caudate nucleus

Slide 207: 

Ventricles (Lateral) Atrium : Confluence of horns; contains glomi of choroid plexus Frontal horn formed by • Roof: Corpus callosum • Lateral wall, floor: Caudate nucleus • Medial wall: Septum pellucidum Temporal horn formed by • Roof: Tail of caudate nucleus • Medial wall, floor: Hippocampus • Lateral wall: Geniculocalcarine tract, arcuate fasciculus Occipital horn Surrounded by white matter Lateral ventricles communicate with each other third ventricle via Y-shaped " foramen of Monro

Slide 208: 

Third ventricle Midline , slit-like vertical cavity that contains interthalamic adhesion Recesses • Inferior: Optic, infundibular • Posterior: Suprapineal , pineal Communicates with fourth ventricle via cerebral Aqueduct Ventricles (Third)

Slide 209: 

Fourth ventricle Diamond-shaped cavity (rhomboid fossa) along dorsal pons & upper medulla Five recesses Paired posterior superior: Paired lateral: communicate with SAS via foramina of Luschka Fastigium : Blind-ending, Communicates with SAS via foramina of Magendie and Luschka , with central canal of cord via obex Communicate with each other as well as central canal of spinal cord, subarachnoid space (SAS) Ventricles (Fourth)

Slide 210: 

CSF Flow

Slide 211: 

Ventricles

Slide 212: 

Ventricles

Slide 213: 

Axial T2 MR

Slide 214: 

Axial T2 MR

Slide 215: 

Axial T2 MR

Slide 216: 

Axial T2 MR

Slide 217: 

Axial T2 MR

Slide 218: 

Axial T2 MR

Slide 219: 

Axial T2 MR

Slide 220: 

Axial T2 MR

Slide 221: 

Coronal T2 MR

Slide 222: 

Coronal T2 MR

Slide 223: 

Coronal T2 MR

Slide 224: 

Coronal T2 MR

Slide 225: 

Sagittal T2 MR

Slide 226: 

Sagittal T2 MR

Slide 227: 

Numerous trabeculae , septae , membranes cross subarachnoid spaces creating a small compartment termed CISTERNS Linliequist membrane separates it into Supra sellar , interpeduncular & prepontine cisterns Anterior/lateral pontine , medial/lateral pontomedullary membranes separate posterior fossa cisterns • All s ubarachnoid spaces cisterns communicate with each other and with ventricular system (through foramina of Magendie and Luschka ) • Cisterns provide natural pathways for disease spread as well as surgical approaches Subarachnoid spaces cisterns divided into Supra- and Peritentorial Group, Infratentorial Group Cisterns

Slide 228: 

Cisterns

Slide 229: 

• Supratentorial / peritentorial cisterns Suprasellar cistern Interpeduncular cistern Ambient ( perimesencephalic ) cisterns Quadrigeminal cistern Cistern of velum interpositum • Infratentorial (posterior fossa) cisterns Midline (unpaired) • Prepontine cistern • Premedullary cistern • Superior cerebellar cistern • Cisterna magna Lateral (paired ) • Cerebellopontine cistern • Cerebellomedullary Cisterns

Slide 230: 

Cisterns

Slide 231: 

Cisterns

Slide 232: 

Cisterns

Slide 233: 

Cisterns

Slide 234: 

Axial T2 MR

Slide 235: 

Axial T2 MR

Slide 236: 

Axial T2 MR

Slide 237: 

Axial T2 MR

Slide 238: 

Coronal T2 MR

Slide 239: 

Coronal T2 MR

Slide 240: 

Sagittal T2 MR

Slide 241: 

Sagittal T2 MR

Slide 242: 

Sagittal T2 MR

Slide 243: 

Thank you The Vodafone PUG 23 rd Jan 2011 Photographed by: Rohit Madhurkar

Slide 244: 

YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis Vascular BASICS with THE BRAIN Anatomy

Slide 245: 

YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis EXTRACRANIAL ARTERIES Aortic Arch & Great Vessels Cervical Carotid Arteries Part IV BASICS with THE BRAIN

Slide 246: 

Aortic Arch & Great Vessels

Slide 247: 

Carotid Artery

Slide 248: 

Carotid Artery

Slide 249: 

YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis INTRACRANIAL ARTERIES Internal Carotid Artery Circle of Willis Anterior Cerebral Artery Middle Cerebral Artery Posterior Cerebral Artery Vertebrobasilar System ICA OVERVIEW Part V BASICS with THE BRAIN

Slide 250: 

Internal Carotid Artery

Slide 251: 

SEGMENTS (C1) Cervical - EXTRACRINAL ( C2) Petrous (C3 ) Lacerum ( C4 ) Cavernous (C5) Clinoid (C6) Ophthalmic (C7 ) Communicating Internal Carotid Artery

Slide 252: 

PETROUS (C2) SEGMENT Internal Carotid Artery Contained within carotid canal of temporal bone Surrounded by extensive sympathetic plexus BRANCHES • Vidian Artery (Artery of Pterygoid Canal) Anastomoses with ECA • Caroticotympanic artery supply middle ear SUBSEGMENTS Short vertical segment • "Genu " • Longer horizontal segment • Exits carotid canal at petrous apex Vidian Artery

Slide 253: 

Internal Carotid Artery PETROUS (C2) SEGMENT

Slide 254: 

LACERUM (C3) SEGMENT Small segment that extends from petrous apex above foramen lacerum , Covered by trigeminal ganglion No branches Internal Carotid Artery

Slide 255: 

• Inferolateral Trunk Arise - horizontal segment | supplies - CS dura/ cranial nerves Anastomoses - ECA branches through f . rotundum , spinosum , ovale Internal Carotid Artery CAVERNOUS (C4) SEGMENT • Posterior vertical (ascending) portion • Posterior (more medial) genu MAJOR BRANCHES • Meningohypophyseal trunk Arises - posterior genu | Supplies - pituitary , tentorium and clival dura SUBSEGMENTS • Horizontal segment • Anterior (more lateral) genu • Anterior vertical ( subclinoid ) segment

Slide 256: 

Internal Carotid Artery CAVERNOUS (C4) SEGMENT

Slide 257: 

Internal Carotid Artery CLINOID (C5) SEGMENT b/w proximal , distal dural rings of CS No important branches OPHTHALMIC (C6) SEGMENT Two important branches • Ophthalmic Artery Passes - optic canal to orbit; Gives - ocular,lacrimal , muscular Br.’s Anastomoses -Extensive with ECA • Superior hypophyseal artery supplies – anterior pituitary , infundibulum, optic nerve/chiasm

Slide 258: 

Internal Carotid Artery OPHTHALMIC (C6) SEGMENT CLINOID (C5) SEGMENT and

Slide 259: 

COMMUNICATING (C7) SEGMENT Bifurcation into anterior cerebral artery (ACA ) & middle cerebral artery ( MCA) Major branches Posterior Communicating Artery Anterior Choroidal Artery Supplies - choroid plexus, medial temporal lobe, BG, posteroinferior IC Internal Carotid Artery

Slide 260: 

Internal Carotid Artery COMMUNICATING (C7) SEGMENT

Slide 261: 

Internal Carotid Artery

Slide 262: 

Internal Carotid Artery

Slide 263: 

Internal Carotid Artery

Slide 264: 

ICA Lateral DSA

Slide 265: 

Circle of Willis Central arterial anastomotic ring of brain Circle of Willis is an arterial polygon Synonyms - circulus arteriosus

Slide 266: 

Ten components 2 ICAs 2 proximal or horizontal ACA segments 1 ACoA 2 PCoAs 1 Basilar artery 2proximal or horizontal PCA segments Circle of Willis

Slide 267: 

Circle of Willis

Slide 268: 

Circle of Willis

Slide 269: 

Anterior Cerebral Artery medial terminal branch of supraclinoid ICA excellent midline marker Displacement from midline common with space-occupying lesions or hemisphere atrophy

Slide 270: 

THREE SEGMENTS (A1) Horizontal or precommunicating segment (A2) Vertical or postcommunicating segment (A3) Distal segment and cortical branches ACoA connects right, left A1 segments ANATOMY RELATIONSHIPS AI : Extends medially over optic chiasm/nerves A2 : Runs superiorly in interhemispheric fissure, A3 : Curves around corpus callosum genu, divides into pericallosal , callosomarginal arteries Anterior Cerebral Artery

Slide 271: 

Branches Cortical branches Orbitofrontal artery Frontopolar artery Pericallosal artery Callosomarginal artery Perforating branches (arise from A1 or ACoA ) Medial lenticulostriate arteries Recurrent artery of Heubner Anterior Cerebral Artery Pericallosal artery Callosomarginal artery

Slide 272: 

Vascular Territory • Cortical branches Anterior 2/3 of medial hemispheres convexity • Penetrating branches Medial BG, CC genu , anterior limb of IC Anterior Cerebral Artery

Slide 273: 

Anterior Cerebral Artery

Slide 274: 

Anterior Cerebral Artery

Slide 275: 

Anterior Cerebral Artery

Slide 276: 

Anterior Cerebral Artery

Slide 277: 

Anterior Cerebral Artery

Slide 278: 

Middle Cerebral Artery Larger, lateral terminal branch of supraclinoid ICA

Slide 279: 

Four segments Middle Cerebral Artery (M4) Cortical branches segments (M3) Opercular segments (M2) Insular segments (M1) Horizontal segment

Slide 280: 

BRANCHES • Perforating Branches Lenticulostriate arteries • Cortical Branches (M4 Segments) Orbitofrontal (lateral frontobasal ) artery Prefrontal arteries Precentral sulcus ( prerolandic ) artery Central sulcus ( rolandic ) artery Postcentral sulcus (anterior parietal) artery Posterior parietal artery Angular artery Temporooccipital artery Posterior temporal, medial temporal arteries Middle Cerebral Artery

Slide 281: 

Middle Cerebral Artery

Slide 282: 

Middle Cerebral Artery

Slide 283: 

VASCULAR TERRITORY • Cortical branches Supply most of lateral surface of cerebral hemispheres except for convexity and inferior temporal gyrus Anterior tip of temporal lobe (variable) • Penetrating branches Medial lenticulostriate arteries Medial basal ganglia, C audate nucleus Internal capsule Lateral lenticulostriate arteries Lateral putamen, caudate nucleus External capsule Middle Cerebral Artery

Slide 284: 

Middle Cerebral Artery

Slide 285: 

Posterior Cerebral Artery Main Basilar artery terminal branches = two PCAs

Slide 286: 

FOUR SEGMENTS (P1) Precommunicating ( mesencephalic ) segment (P2) Ambient segment (P3) Quadrigeminal segment (P4) Calcarine segment Posterior Cerebral Artery P4

Slide 287: 

BRANCHES • Perforating (central) branches Posterior thalamoperforating arteries Thalamogeniculate arteries Peduncular perforating arteries • Ventricular/ choroidal branches (arise from P2) Medial posterior choroidal artery . Lateral posterior choroidal arteries • Cortical branches Anterior temporal artery Posterior temporal artery Distal PCA divides into two terminal trunks Medial branches: Medial occipital artery , parietooccipital artery, calcarine artery, posterior splenial arteries Lateral branches: Lateral occipital artery, temporal arteries Posterior Cerebral Artery

Slide 288: 

Posterior Cerebral Artery

Slide 289: 

Posterior Cerebral Artery

Slide 290: 

VASCULAR TERRITORY • Penetrating branches: Midbrain, thalami, posterior limb of IC, optic tr • ventncular / choroidal branches: Choroid plexus of third/lateral Ventricles , parts of thalami, posterior commissure, cerebral peduncles • Splenial branches: Posterior body and splenium of corpus callosum .. • Cortical branches: Posterior 1/3 of medIal hemIsphere surface; Most of inferior temporal lobe, Most of occipital lobe ( including visual cortex) Posterior Cerebral Artery

Slide 291: 

Posterior Cerebral Artery

Slide 292: 

Vertebrobasilar System

Slide 293: 

FOUR SEGMENTS Extraosseous ( V1) segment (arch -> C6) Foraminal (V2) segment (C6 -> C1) Extraspinal (V3) segment ( C1 -> foramen magnum) Intradural (V4) segment (intracranial) Vertebrobasilar System

Slide 294: 

BRANCHES • VA VI: Segmental cervical muscular, spinal branches V2: Anterior meningeal artery, unnamed muscular/spinal branches V3: Posterior meningeal artery V4 Anterior , posterior spinal arteries Perforating branches to medulla PICA: perforating medullary,choroid , tonsillar , cerebellar b. • BA Pontine, midbrain perforating branches (numerous) AICA SCAs PCAs (terminal Branches ) Vertebrobasilar System

Slide 295: 

Vascular Territory • VA ASA: Upper cervical spinal cord, inferior medulla PSA: Dorsal spinal cord to conus medullaris Penetrating branches: Olives, inferior cerebellar peduncle, part of medulla PICA: Lateral medulla, choroid plexus of fourth ventricle, tonsil, inferior vermis /cerebellum • BA Pontine perforating branches: Central medulla, pons, midbrain AICA: anterolateral cerebellum SCA: Superior vermis , superior cerebellar peduncle, dentate nucleus, brachium pontis , superomedial surface of cerebellum, upper vermis Vertebrobasilar System

Slide 296: 

Vertebrobasilar System

Slide 297: 

Vertebrobasilar System

Slide 298: 

ICA OVERVIEW

Slide 299: 

ICA OVERVIEW

Slide 300: 

ICA OVERVIEW

Slide 301: 

ICA OVERVIEW

Slide 302: 

WATERSHED Area

Slide 303: 

YENEPOYA UNIVERSITY Dr. Rohit Madhurkar Dept. of Radio Diagnosis INTRACRANIAL VEINS & SINUSES Dural Sinuses Superficial Cerebral Veins Deep Cerebral Veins Posterior Fossa Veins EXTRACRINAL VEINS OVERVIEW Part VI BASICS with THE BRAIN

Slide 304: 

Dural Sinuses

Slide 305: 

Anatomy Relationships Endothelial-lined , outer (periosteal),inner (meningeal) dural layers Often fenestrated, septated , multi- channeled Contain arachnoid granulations, villi Extension of subarachnoid space (SAS)+ arachnoid through dural Returns cerebrospinal fluid (CSF)to venous circulation Dural Sinuses

Slide 306: 

• Superior sagittal sinus (SSS) Important hemispheric tributary: Vein of Trolard • Inferior sagittal sinus (ISS) joining with vein of Galen ( VofG ) to form straight sinus • Straight sinus (SS) Receives tributaries from falx , tentorium, cerebral hemispheres • Torcular Herophili ( venous sinus confluence) • Transverse (lateral) sinuses (TSs) Tributaries from tentorium, cerebellum, inferior temporal/occipital lobes Important tributary: Vein of Labbe • Sigmoid sinuses Terminate by becoming internal jugular veins • Cavernous sinuses (CS) • Miscellaneous dural venous sinuses Superior & Inferior petrosal sinus Sphenoparietal sinus Occipital sinus & Clival venous plexus Dural Sinuses

Slide 307: 

Dural Sinuses

Slide 308: 

Dural Sinuses Dural Sinuses

Slide 309: 

Dural Sinuses

Slide 310: 

Dural Sinuses

Slide 311: 

Dural Sinuses

Slide 312: 

Superficial Cerebral Veins

Slide 313: 

• Located within subarachnoid space (SAS), cisterns Organized anatomically into three groups • Superior group 8-12 superficial cortical veins Pierce arachnoid, inner dura , join SSS at right angles • Middle group Superficial middle cerebral vein Terminates in CS or SPS • Inferior group Basal vein (of Rosenthal) Receives anterior cerebral, DMCV tributaries ( from insula , basal ganglia, para hippocampal gyrus ) Drains into great cerebral vein (of Galen ) Superficial Cerebral Veins

Slide 314: 

• Three major named large anastomotic cortical veins o Vein of Trolard : Major superior anastomotic vein o Vein of Labbe : Major inferior anastomotic vein o Superficial middle cerebral vein: Major middle anastomotic vein Superficial Cerebral Veins

Slide 315: 

Vascular Territories • Superior group (cortical veins + SSS, ISS) o Superolateral hemispheric surfaces o Most of medial hemispheric surfaces (b/w ISS &SSS) o Most of frontal lobes except for perisylvian area • Middle group (SMCV + cavernous sinus) o Perisylvian area, anterior temporal lobes • Inferior group o BVR: Inferior insula, basal ganglia, medial temporal lobes o Vein of Labbé (plus TS): Posterior temporal, lower parietal lobes Superficial Cerebral Veins

Slide 316: 

Superficial Cerebral Veins

Slide 317: 

Superficial Cerebral Veins

Slide 318: 

Superficial Cerebral Veins

Slide 319: 

Superficial Cerebral Veins

Slide 320: 

Superficial Cerebral Veins

Slide 321: 

Superficial Cerebral Veins

Slide 322: 

Deep Cerebral Veins

Slide 323: 

• Medullary veins • Subependymal veins Septal veins Thalamostriate Veins • Deep paramedian veins Internal cerebral v. VofG (great cerebral vein ) – “U” shaped ( icv+Basal v ein of rosenthal ) Deep Cerebral Veins

Slide 324: 

IMAGING ANATOMY DSA, lateral view • "Dots" of contrast at subependymal /medullary vein junction define roof of lateral ventricle DSA , AP view • TSV defines size, configuration of lateral ventricle; characteristic "double curve" appearance • BVR, tributary of VofG , begins at medial temporal lobe, curves around midbrain, looks like "frog leg " Deep Cerebral Veins

Slide 325: 

Deep Cerebral Veins

Slide 326: 

Veins

Slide 327: 

Deep Cerebral Veins

Slide 328: 

Deep Cerebral Veins

Slide 329: 

Deep Cerebral Veins

Slide 330: 

Deep Cerebral Veins

Slide 331: 

Deep Cerebral Veins

Slide 332: 

Posterior Fossa Veins

Slide 333: 

• Three major posterior fossa/midbrain drainage systems o Superior ( galenic ) group drains up into vein of Galen , three major named veins • Precentral cerebellar vein • Superior vermian vein • Anterior ponto mesencephalic vein Posterior Fossa Veins o Anterior ( petrosal ) group • Petrosal vein o Posterior ( tentorial ) group • Inferior vermian veins

Slide 334: 

Posterior Fossa Veins

Slide 335: 

Posterior Fossa Veins

Slide 336: 

Posterior Fossa Veins

Slide 337: 

EXTRACRINAL VEINS

Slide 338: 

EXTRACRINAL VEINS

Slide 339: 

EXTRACRINAL VEINS

Slide 340: 

OVERVIEW

Slide 341: 

OVERVIEW

Slide 342: 

OVERVIEW

Slide 343: 

OVERVIEW

Slide 344: 

OVERVIEW

Slide 345: 

Thank You