correlation between neuro anatomy and neuro MRI.pptx

This presentation help young neurosurgeon residents to apply their neuroanatomy knoledge on MRI

1. Mohamed Wael Samir, MD Professor of neurosurgery Ain Shams University Cairo, Egypt Neuro -Radiology Correlation Between Neuroanatomy & MRI

2. ILOs Describe the basic physics principles of MRI Describe the safety of MRI procedures Enumerate the different MRI sequences and their main usages Interpret different tissue characters in MRI Interpret normal MRI brain Identify normal brain structures in MRI Interpret normal MRI spine

3. Major Cortical Sulci

4. 2/27/2025 5 Central (Rolandic) Sulcus

5. Inferior stem Sphenoidal part Insular part Opercular part Lateral stem: Anterior horizontal ramus Anterior ascending ramus, Posterior ramus Sylvian Fissure

6. Sylvian Fissure Anterior horizontal ramus of the sylvian fissure Anterior ascending ramusi of the sylvian fissure Posterior ramus of the sylvian fissure Precentral sulcus Central sulcus Post central sulcus

7. Parito -occipital & Calcarine Sulci in Coronal sections Parieto -occipital sulcus Calcarine sulcus Cingulate sulcus

8. Parito -occipital & Calcarine Sulci in Axial sections

9. Different Pattern of Calcarine Sulcus

10. Cingulate & Callosal Sulci Marginal part of cingulate sulcus Subparital part of cingulate sulcus

11. Major Cortical Gyri

12. Major Frontal Gyri

13. Frontal Gyri: Lateral Surface

14. Frontal Gyri: Lateral Surface – Inf. Frontal Gyri Pars orbitalis of inferior frontal gyrus Pars Triangularis of inferior frontal gyrus Pars Obercularis of inferior frontal gyrus Motor strip Sensory strip

15. 1) Prefrontal cortex 2) Frontal eye field area 3) Supplementary motor area Major Cortical Areas on Lateral Surface of Frontal Lobe Broca’s Area: Olfactory Bulb Primary Motor Cortex Frontal eye field 10 11 12 46 47 8 9 Orbitofrontal Cortex 4 44,45 6 8 Prefrontal Cortex Premotor cortex

16. Frontal Gyri: Lateral Surface - Precentral Gyrus

17. Frontal Gyri: Medial Surface - Supplementary Motor Complex (SMC)

18. Frontal Gyri: Medial Surface: Supplementary Motor Area & Paracentral lobule

19. Frontal Gyri: Medial Surface – Cingulum Gyrus

20. Frontal Gyri: Inferior Surface

21. Major Parietal Gyri

22. Major Parietal Gyri

23. Major Temporal Gyri

24. Major Temporal Gyri: Lateral Surface

25. Major Cortical Areas on Lateral Surface of Temporal Lobe Supramarginal gyrus: Angular gyrus :

26. Major Temporal Gyri: Medial Surface Anteriorly: Uncus Anteriorly: Amygdala Posteriorly: Head of hyppocampus Posteriorly: Parahyppocampus

27. Major Temporal Gyri: Inf. Surface Calcarine sulcus Occipito-Temporal sulcus Collateral sulcus Latera Occipito -Temporal (Fusiform) gyrus Parahippocampal gyrus Medial Occipito -Temporal (Lingual) gyrus Inf. Temporal sulcus Rhinal sulcus

28. Major Temporal Gyri: Sup. Surface

29. Major Insular Gyri

30. Insula Anterior short shallow insular gyri (3-5) Posterior long deep insular gyri (2)

31. Major Insular Gyri Central sulcus: It is the deepest sulcus and is a relatively constant sulcus that extends upward and backward across the insula, nearly parallel and deep to the central sulcus on the convexity. It divides the insula into a large anterior part and a small posterior part. 3-5 Short anterior sulci: Two long post. gyri:

32. Major Occipital Gyri

33. Major Occipital Gyri on Medial Surface: Cunes & Lingual (Medial Occipito -Temporal ) Gyri

34. Calcarine Gyrus in Coronal sections Parieto -occipital sulcus Calcarine sulcus

35. Major Occipital Gyri on Inf. Surface: Calcarine sulcus Occipito-Temporal sulcus Collateral sulcus Latera Occipito -Temporal (Fusiform) gyrus Parahippocampal gyrus Medial Occipito -Temporal (Lingual) gyrus Inf. Temporal sulcus Rhinal sulcus

36. Inf. Surface of Occipital Lobe: Tentorium cerebelli Medial occipito -temporal (Lingual) gyrus Lateral occipito -temporal (Fusiform gyrus Tentorium cerebelli

37. Major Sulci & Gyri on Lateral Surface of Axial Cut Sup. Frontal gyrus Middle Frontal gyrus: Motor strip: Hand area Sensory strip

38. Major Sulci & Gyri on Lateral Surface of Coronal Cut Interhemispheric fissure: Sup. Frontal gyrus: Sup. Frontal sulcus: Middle frontal gyrus: Inf. Frontal sulcus: Inf. Frontal gyrus: Sylvian fissure: Sup. Temporal gyrus Sup. Temporal sulcus Middle temporal gyrus: Inf. Temporal sulcus: Inf. Temporal gyrus

39. Major Sulci & Gyri on Inf. Surface of Coronal Cut Occipito temporal sulcus Lateral occipito temporal gyru (Fusiform gyrus) Collateral sulcus Parahyppocampal gyrus

40. Major Sulci & Gyri on Medial Surface of Coronal Cut Callosal sulcus: Cingulate sulcus: Calcarine sulcus (with calcar avis ) Calcarine & Parieto-occipital sulcus

41. Major Sulci & Gyri on Lateral Surface of Sagital Cut

42. Major Sulci on Medial Surface ► Callosal sulcus: ► Cingulate sulcus: ► Parito -occipital sulcus: ► Calcarin sulcus: ► Medial end of precentral sulcus ► Medial end of Central sulcus

43. Major Sulci on Medial Surface ► Callosal sulcus: ► Cingulate sulcus: ► Parito -occipital sulcus: ► Calcarin sulcus: ► Medial end of precentral sulcus ► Medial end of Central sulcus

44. Cingulate gyrus (turquoise): Paracentral lobule (gold) Precuneus ( purple ) Cuneus Lingual gyrus Major Gyri on Medial Surface

45. White Matter Projection Fibers

46. Corticospinal Tract in DTI

47. Corticospinal Tract 2/27/2025 48 STC Middle3/5 of crus cerebri of midbrain Motor cortex on Precentral gyrus Genu & post. Limb of internal capsule Basis pontis (ventral part of pons) Pyramid of medulla

48. White Matter Associated Fibers

49. Association Fibers A) Short association fibers: B) Long association fibers: 1) Superior longitudinal Fasciculus (including Arcuate Fasciculus) 2) Inferior longitudinal Fasciculus: 3) Uncinate Fasciculus: 4) Cingulum:

50. Association Fibers: Sup. Longitudinal Fasciculus (SLF) Superior longitudinal Fasciculus (including Arcuate Fasciculus) Role in language SLF I (green), SLF II (blue) SLF III (purple)

51. Association Fibers: Inf. Longitudinal Fasciculus (ILF) Connect temporal pole to occipital cortex Disruption of the ILF may lead to Visual agnosia, Prosopagnosia, Alexia, Visual hallucinations

52. Association Fibers: Uncinate Fasciculus Connects parts of the limbic system such as the parahippocampus and amygdala in the temporal lobe with portions of the frontal lobe such as the orbitofrontal cortex Famous face naming

53. Association Fibers: Cingulum Papez circuit Play role in limbic system (emotion & behaviour )

54. White Matter Commissural Fibers

55. Corpus Callosum Rostrum: Genu: Body: Forceps minor Forceps major: Tabetum Splenium Each part has relation to lateral ventricle

56. Anterior Commissure (AC) It is a compact bundle of fibers that crosses the midline in front of the columns of the fornix It is the upper border of lamina terminalis

57. Posterior Commissure PC It is a compact bundle of fibers that crosses the midline in the caudal lamina of the pineal stalk

58. Fornix 1) Fimbria 2) Crus 3) Body 4) Column

59. Fornix: Fimbria Found in floor of the temporal horn of lateral ventricle

60. Fornix: Crus Found in medial wall of trigon of lateral ventricle

61. Fornix: Body & Commissure (Hippocampal Commissure) Separates the roof of the third ventricle from the floor of the bodies of the lateral ventricles. It is found in the lower part of the medial wall

62. Fornix: Column Forms superior and anterior margins of the foramen of Monro

63. Basal Ganglia

64. Misnomer Basal # Subcortical: Ganglia # Nuclei: Extrapyramidal Three # More:

65. Classification Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal forebrain Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + STN SN Rostral basal ganglion Dorsal basal ganglion Caudal basal ganglion Ventral basal ganglion

66. Anatomical: 1) Caudate 2) Lentiform nucleus (putamen & GP) 3) Nucleus accumbens 4) Basal forebrain Nuclei 5) Amygdala 6) Claustrum Functional: As B4 + STN SN

67. Corpus Striatum Caudate Nucleus Lenticular Nucleus Putamen Globus Pallidus Paleostriatum (Pallidum) Corpus Amygdaloideum Archistriatum Nucleus Accumbens Traditional Concepts of Basal Ganglia Neostriatum (Striatum) (afferent part) (Efferent part)

68. Classification Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal forebrain Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + STN SN

69. Neostriatum ( Caudate + Putamen)

70. Caudate Nucleus Head: It forms lateral wall of ant. horn and body of lateral ventricle Body: It forms part of floor of body of lateral ventricle Tail: It forms part of lateral wall of the atrium It forms part of the roof of temporal horn of lateral ventricle

71. Caudate Nucleus Inferior lateral part of thalamus Tail of caudate Tapetum of C.C.

72. Classification Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal forebrain Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + STN SN

73. Putamen (Outer Part of Lentiform Nucleus)

74. Globus Pallidus Lateral medullary lamina ( lpl ) Globus pallidus externus ( GPe ) Medial medullary lamina (lpm) Globus pallidus internus ( GPi )

75. Classification Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal forebrain Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + STN SN

76. Basal Nuclei (Forebrain) 1) The septal nucleus 2) The olfactory tubercle 3) The substantia innominata 4) Ventral basal ganglia (including nucleus accumbens  and ventral pallidum),  5) Nucleus basalis of Meynert 6) Diagonal band of Broca Septal region Substantia Innominata Septal region Substantia Innominata

77. Basal Forebrain Nuclei Nucleus basalis Septal nuclei Substantia innominata

78. Nucleus Accumbens Main source of acetylcholine in brain It has been implicated in numerous neurological and psychiatric disorders, including depression, obsessive-compulsive disorder, bipolar disorder, anxiety disorders, Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, obesity, and in drug abuse and addiction.

79. Classification Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + STN SN

80. Amygdala Uncus: Ant. Part: amygdala Post. Part: head of hyppocampus

81. Classification Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + STN SN

82. Claustrum

83. Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + SN STN Classification

84. Anatomical: 1) Caudate 2) Lentiform nucleus ( putamen & GP) 3) Basal Nuclei 4) Amygdala 5) Claustrum Functional: As B4 + SN STN Classification

85. Subthalamic Nucleus ( Corpus Luysi ) 2/27/2025 87 Subthalamus in posterior coronal cut

86. Thalamus

87. Thalamus Sup. Surface: Medially: roof of 3 rd ventricle Laterally: floor of body of lat. ventricle

88. Thalamus Inferior surface: Anteriorly: the hypothalamus Posteriorly: midbrain

89. Thalamus Lateral surface: Separated from GP by posterior limb of internal capsule Medial surface: superior part of lateral wall of 3 rd venricle

90. Hypothalamus & Pituitary Gland

91. Pituitary in MRI Post pituitary gland Pituitary stalk: centralized

92. Hypothalamus Mamillary body Pituitary stalk

93. Ventricular System

94. Ventricular System in Axial Cuts Lateral ventricle: Ant. (frontal) Horn & Foramen of Monro Body Post (occipital) horn & atrium Temporal horn 3 rd ventricle: 4 th ventricle:

95. Ventricular System in Sagital Cuts Lateral ventricle: Ant. (frontal) Horn & Foramen of Monro Body Post (occipital) horn & atrium Temporal horn 3 rd ventricle: 4 th ventricle:

96. Anterior Horn

97. Anterior Horn of Lateral Ventricle Anteriorly: Genu of C.C Posteriorly: communicate with body Roof: genu and body of C.C Floor: Rostrum of C.C

98. Anterior Horn of Lateral Ventricle Laterally: Head of Caudate Medially: septum pellucidum stretched between rostrum and body of C.C

99. Body of Lateral Ventricle

100. Body of Lateral Ventricle Anterior: open into ant. horn at the level of foramen of Monro Posterior: open into atrium Roof: Body of C.C. Floor: Thalamus

101. Body of Lateral Ventricle Medially: Septum pellucidum stretched between body of C.C above & body of fornix below Laterally: head of caudate

102. Foramen of Monro

103. Foramen of Monro Normal non dilated foramen is oval in antero-posterior direction, normally 4-5mm in the longest dimension 4-5 mm 1.0 to 3.5 mm (average, 2.2 mm) Thalamus Chor . Plex . Column of fornix

104. Atrium Occipital Horn

105. Atrium & Occipital Horn Anteriorly: Occipital horn: open in atrium Atrium: has a medial part composed of the crus of the fornix as it wraps around the posterior part of the pulvinar, and a lateral part, formed by the pulvinar of the thalamus Posteriorly: Occipital horn: cul-de-sac in the occipital lobe Atrium: end by forming occipital horn (if present).

106. Atrium & Occipital Horn Roof: Tapetum (As trigon except both roof & lateral wall formed by tapetum).. Floor: Collateral trigone (area that bulges upward over the posterior end of the collateral sulcus)

107. Occipital Horn & Atrium Lateral Wall: Occipital horn: tapetum Atrium: tapetum + tail of caudate Medial wall: The upper prominence: Bulb of the corpus callosum The lower prominence: Calcar avis

108. Temporal Horn Inferior wall Superior wall Lateral wall

109. Temporal Horn Anteriorly: cul-de-sac just posterior to amygdala (related to uncus). Posteriorly: opens in the atrium

110. Temporal Horn Floor: 2 bulges Medial bulge: hippocampus Lateral bulge: collateral sulcus Roof: 3Ts (From lateral to medial) Tapetum Tail of caudate Thalamus (inferior surface)

111. Temporal Horn Laterally: by tapetum of C.C. which separating it from optic radiation Medially: Choroidal fissure

112. 3 rd Ventricle

113. 3 rd Ventricle: Anterior Wall From up down A.C. → lamina terminalis → optic recess → optic chiasm

114. 3 rd Ventricle: Posterior Wall Suprapineal recess, → habenular commissure, → pineal body ( Epiphesis ) and its recess, → habenular commissure → posterior commissure, → the aqueduct of sylvius 27-2-2025 117

115. Endoscopic View of Posterior Wall Aqueduct P.C. Pineal recess 2/27/2025 118 Habenular commissure Suprapineal recess Tela choroidea

116. Endoscopic View of Posterior Wall 2/27/2025 119 Aqueduct PC Pineal recess Hab. Com. Supra pineal recess

117. Aqueduct of Sylvius Dimension: 6-18 mm long & 1-2 mm in diameter Boundaries: 2/27/2025 120 Tectum Tegmentum Crus cerebri

118. Structures Related to Aqueduct of Sylvius : At Sup. Colliculus Level 1) Sup. Colliculus. 2 ) Sup. Col. Com. 3) Aqueduct (Sylvius). 4) Periaqueductal gray matter. 5) Oculomotor nucleus. 6) Med. Long. Fasciculus (M.L.F.). 7) Central tegmental tract. 8) Midbrain reticular formation. 2/27/2025 121

119. Structures Related to Aqueduct of Sylvius : At Inf. Colliculus Level 1) Inf. Colliculus. 2) A queduct. 3) Periaqueductal gray matter. 4) Troch. Nucleus. 5) Med. Long. Fasciculus (M.L.F.). 6) Central tegm . Tract. 2/27/2025 122

120. 3 rd Ventricle: Roof 4 layers 1 st layer: neneural layer formed by the fornix 2 nd & 3 rd layers: tela choroidea with velum interpositum in between + Parallel strands of choroid plexus project downward on each side of the midline from the inferior layer of tela choroidea 4 th layer: vascular layers (medial posterior choroidal arteries + internal cerebral veins)

121. 3 rd Ventricle: Roof 4 th layer: vascular layers Medial posterior choroidal arteries Internal cerebral veins

122. Venous Angle Venous angle is the angle between thalamostriate vein and the internal cerebral vein (opened large arrow) is a landmark for foramen of Monoro

123. 3 rd Ventricle: Floor (MRI View) Optic chiasm, Infundibulum of the hypothalamus, the tuber cinereum, Mamillary bodies, Posterior perforated substance, Part of tegmentum of midbrain 27-2-2025 Mohamed Wael Ain Shams University 126 D M

124. 3 rd Ventricle: Floor (Cadaveric-Basal view) 27-2-2025 Mohamed Wael Ain Shams University 127 D M Optic chiasm, Infundibulum of the hypothalamus, the tuber cinereum, Mamillary bodies, Posterior perforated substance, Part of tegmentum of midbrain

125. 3 rd Ventricle: Floor (Cadaveric-Interior view) 2/27/2025 128

126. 3 rd Ventricle: Floor (Endoscopic view) 2/27/2025 129

127. 3 rd Ventricle: Floor (Endoscopic View During ETV) 2/27/2025 130

128. 3 rd Ventricle: Floor (Endoscopic View During ETV) 2/27/2025 131 Naked basilar artery Another membrane covering basilar artery

129. Laterally to 3 rd nerve 1-3 components Sellar segment: Diencephalic segment: Mesencephalic segment: 2/27/2025 132 SL Liliequist Membrane

130. Dilated, Thinned Out, Herniated Floor of 3 rd Ventricle 2/27/2025 133

131. 3 rd Ventricle: Lateral Wall 2/27/2025 134 Upper part: Thalamus Lower part: Hypothalamus In between: Hypothalamic sulcus Stria medullaris (thalami)

132. 3 rd Ventricle: Medial Wall 2/27/2025 135 No medial wall Inter-thalamic Connection (ITC)

133. Recess of 3 rd Ventricle 27-2-2025 136 Chiasmatic recess Infundipular recess Pineal recess Suprapineal recess

134. 4 th Ventricle Ventricle

135. Roof: Sup. Part: Inf. Part: Floor: Sup./inf: Med./lat. Lateral recess: Foramina: Magendie: Luschka 4 th Ventricle

136. Roof: Sup. Part: Inf. Part: Floor: Sup./inf: Med./lat. Lateral recess: Foramina: Magendie: Luschka Obex 4 th Ventricle

137. Cerebellum

138. Cerebellum Cerebellar hemisphere: Cerebellar tonsils: Vermis: Pyramid Uvula Nodule Flocculus:

139. Cerebellum Cerebellar tonsils: Vermis: Pyramid Uvula Nodule: Flocculus:

140. Cerebellum Cerebellar hemisphere: Cerebellar tonsils: Vermis: Flocculus:

141. Cerebellar Peduncles Sup. cerebellar peduncle: Middle cerebellar peduncle: Inf. cerebellar peduncle:

142. Brain Stem

143. Brain Stem in Axial Cuts

144. Brain stem In Sagittal Cuts

145. Brain stem In Coronal Cuts

146. CSF Cisterns

147. Cisterns in Mid Sagittal Section

148. Cisterns in Axial Section Sylvian fissure: Sphenoidal part Insular part Opercular part Lateral part

149. Cisterns in Axial Section Suprasellar: Interpeduncular: Crural : Ambient: Quadrigeminal:

150. Cisterns in Axial Section Trigeminal: CPA: Cisterna magna:

151. Cranial Nerves

152. Cranial Nerves MRI Steady-state free procession (SSFP) images are the best sequences for the visualization of the cisternal segments showing dark cranial nerves against a background of bright cerebrospinal fluid (CSF) The enhancement of the nerve, after gadolinium administration, is associated to disruption of the blood-nerve barrier and may be secondary to neoplasm, inflammation, demyelination, ischemia, trauma, radiation treatment, and axonal degeneration.

153. Olfactory Nerve Olfactory tract Medial & lateral olfactory stria Suprasellar cistern Optic tract Suprachiasmatic recess of 3 rd ventricle

154. Visual Pathway on Axial MRI Optic nerve: Optic chiasma: Optic tract: Lateral geniculate body of thalamus: Sup. Colliculus of midbrain: Optic radiation: Visual cortex: around calcarine sulcus

155. Visual Pathway on Coronal MRI Optic chiasma Optic tract Visual cortex: around calcarine sulcus

156. Optic Pathway In Sagittal MRI Optic nerve: Optic chiasma: Optic tract: Visual cortex: around calcarine sulcus

157. Oculomotor Nerves on Axial MRI

158. Oculomotor Nerves on Sagittal MRI 3 rd 3 rd

159. Trochlear Nerve on Axial MRI

160. Trigeminal Nerves on Axial MRI

161. Trigeminal Nerves on Axial MRI Three roots of trigeminal nerve are best visualized in Ct through their bony foramina

162. Radiological Anatomy: Middle cranial base Foramen ovale Foramen spinosum Foramen lacerum Foramen Rotundum SOF

163. Abducens Nerve on Axial MRI Why increase ICP cause 6 th nerve palsy? It is a thin nerve. 4 th nerve is thinner Because of its long course. Vagus is longer Because of its ascending course within a fibrobony canal ( Droll’s canal)

164. Facial & Vestibulo -cochlear Nerves

165. Lower Cranial Nerves: Glossopharyngeal, Vagus Nerves & Accessory Nerves

166. Hypoglossal Nerve In Axial Cuts Hypoglossal canal

167. Hypoglossal Nerve In Coronal Cuts

168. ILOs Describe the basic physics principles of MRI Describe the safety of MRI procedures Enumerate the different MRI sequences and their main usages Interpret normal MRI brain Identify normal brain structures in MRI Interpret normal MRI spine

169. Normal Cervical MRI Nasal cavity Palate Oral cavity Trachea Esophagus & Prevertebral soft tissue

170. Clivus C1 anterior arch C2 Intervertebral disc CSF Spinal cord Spinus process

171. T1 Axial Cervical Spine Trachea Vertebral body Vertebral foramen Spinal root Spinal cord Facetal joints Vertebral Lamina Paravertebral muscles

172. T2 Axial Cervical Spine Vertebral artery

173. MRI of Transverse Atlantal Ligament 176

174. Sagital Dorsal Spine

175. Axial Dorsal spine Prevertebral great vessels Vertebral body Transverse process & Rib Vertebral foramen and root Spinal cord CSF Epidural fate Vertebral arch & spinous process Paravertebral muscles Lung

176. Sagital Lumbar Spine Abdominal aorta Conus medullaris Cauda Equine Sacrum

177. Parasagital Lumbar Spine Intervertebral foramen Vertebral pedicle Facetal joint Intervertebral Disc Root Radicular vessels

178. MRI Myelography Conus medullaris Cauda equine Spinal nerves

179. Axial Lumbar Spine Vertebral body Paravertebral Muscles Transverse process Lamina & Spinous process Cauda Equina

180. Axial Lumbar Spine DRG Superior articular process of lower vertebra (L5) Inferior articular process of upper vertebra (L4) Facetal joint

181. Conjoint Lumbar Root

182. 27-2-2025 Mohamed W Samir Ain Shams University 185 Thank you for attention