intro headneck

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intro headneck

  1. 1. „SelectedChaptersfromtheCross-SectionalAnatomy ofthe Human Body”András Jakab MD, Levente István Lánczi MD<br />
  2. 2. Why to choose this elective?<br />Images support the everyday medical practice. Medical students should become familiar with images(radiography, CT, MRI, US, NM).<br />Theoretical knowledge -> clinical use<br />Medical students have strong anatomy background<br />Clinical correlations<br />
  3. 3. Why to choose this elective?<br />Support clinical and imaging education<br />Imagesareimportantonexams, suchasStateexam (lastexambeforegraduation), USMLE Step 1,2 & 3 and others<br />„Every picture tells a story”<br />
  4. 4. Structure of the Lectures<br />Background information<br />Macroscopic anatomy revision<br />Clinical anatomy – „Why is this region important?”<br />Cross-sectional demonstration using www.imaios.com and other sources<br />Selected clinical cases (www.eurorad.com)<br />Sources<br />
  5. 5. About medical imaging<br />Methods using X-ray<br />”Classical” two-directionalx-ray<br />CT<br />Ultrasound (US)<br />Magnetic Resonance Imaging (MRI)<br />Nuclear Medicine imaging and hybrid technologies<br />SPECT, PET<br />PET-CT, PET-MR<br />Image fusion<br />
  6. 6. On a CT scan/radiography…<br />White<br />bone, contrastagent (vessels, bowels, masses, etc.), implants/foreign body (metalic) <br />Grey<br />parenchymalorgans (liver, brain, etc.)<br />Black<br />air (gas), water, liquor<br />
  7. 7. On a T1 MRI scan…<br />White<br />fat<br />Black<br />water, liquor<br />Good graymatter/whitemattercontrastinthebrain<br />
  8. 8. On a T2 MRI scan…<br />White<br />water, liquor<br />Black<br />Fat<br />Edemaimaging<br />
  9. 9. „ Selected Chapters from the Cross-Sectional Anatomy ” –Head and neck anatomy: pharynx, larynx, oral cavityAndrásJakab MD, LeventeIstvánLánczi MD<br />
  10. 10.
  11. 11. Whatcan be seenontheaxial MR images of theneck?<br />Bones<br />hyoidbone<br />vertebrae<br />Neckmuscles<br />Vessels<br />commoncarotidartery<br />Inferior/superiorthyroidartery<br />vertebralartery<br />Internal/external/anteriorjugularveins<br />Larynx: cartilages, muscles, cavities<br />Esophagus, pharynx<br />Spinalcord<br />
  12. 12. Bones – cervicalvertebrae<br />spinousprocess<br />vertebralarch<br />vertebralforamen<br />sup./inf. articularprocess<br />Transverseprocess<br />vertebral body<br />
  13. 13. C1: atlas, C2: axis<br />densof axis<br />posteriorarch<br />lateralmass<br />transverseprocess<br />articularsurface<br />arcus anterior<br />
  14. 14. Hyoidbone<br />greaterhorn<br />lesserhorn<br />body<br />
  15. 15. Muscles of theneck<br />Platysma<br />Sternocleidomastoidmuscle (SCM)<br />Suprahyoid – infrahyoidmuscles<br />Triangles of theneck<br />carotid, submandibular, supraclavicular (omoclavicular, omotrapezoid)<br />submental<br />Scalenimuscles<br />anterior, medius, posterior<br />
  16. 16. Superficialneckmuscles<br />sternocleidomastoidmuscle (SCM)<br />manubrium of sternum<br />mastoidprocess<br />platysma<br />
  17. 17. Infrahyoidmuscles<br />sternohyoidmuscle<br />thyrohyoidmuscle<br />sternothyroidmuscle<br />omohyoidmuscle<br />omohyoidmuscle<br />
  18. 18. Suprahyoidmuscles<br />mylohyoidmuscle<br />digastricmuscle<br />stylohyoidmuscle<br />geniohyoidmuscle<br />
  19. 19. Triangles of theneck<br />Submandibular<br />Carotid<br />Submental<br />Supraclavicular<br />omoclavicular<br />omotrapezoid<br />
  20. 20. Deep neck & scalenusmuscles<br />spleniuscapitis, semispinaliscapitis m.<br />levatorscapulae m.<br />scalenusanterior m.<br />scalenusmedius m.<br />trapeziusmuscle<br />scalenusposterior m.<br />
  21. 21.
  22. 22. T2 MRI, Level Th1 <br />
  23. 23. Axialis metszet a Th1 magasságában (T2 MRI)<br />T2 MRI, Level Th1<br />
  24. 24. Axialis metszet a Th1 magasságában (T2 MRI)<br />T2 MRI, Level Th1<br />
  25. 25. Axialis metszet a Th1 magasságában (T2 MRI)<br />T2 MRI, Level Th1<br />
  26. 26. T2 MRI, Level Th1<br />
  27. 27. T2 MRI, Level C7<br />
  28. 28. T2 MRI, Level C7<br />
  29. 29. T2 MRI, Level C7<br />
  30. 30. T2 MRI, Level C7<br />
  31. 31. Larynx<br />Respiratorysystem<br />Hyalinecartilage, ligaments, muscles, mucosa<br />Hyoidbone -> trachea<br />Cartilages<br />Thyroidcartilage(Prominentialaryngea – Pomum Adami)<br />Cricoidcartilage<br />Arytenoidcartilage<br />Epiglottis<br />Smallcartilages: cuneiform, corniculate<br />
  32. 32. medianthyrohyoid ligament<br />epiglottis<br />hyoidbone<br />thyroidmembrane<br />corniculatecartilage<br />thyroidcartilage<br />arytenoidcartilage<br />cricoidcartilage<br />trachea<br />mediancricothyroid ligament<br />
  33. 33. epiglottis<br />thyroid<br />membrane<br />hyoidbone<br />thyroidcartilage<br />cricoidcart.<br />- lamina<br />cricoidcartilage<br />- arcus<br />
  34. 34. T2 MRI, Level C6<br />
  35. 35. T2 MRI, Level C6<br />
  36. 36. T2 MRI, Level C6<br />
  37. 37. T2 MRI, Level C6<br />
  38. 38. T2 MRI, Level C6<br />
  39. 39. T2 MRI, Level C6<br />
  40. 40. T2 MRI, Level C6<br />
  41. 41. Internalstructure of pharynx<br />thyroidcartilage<br />vocalmuscle<br />vocallig.<br />arytenoidcart.<br />Cricoidcart.<br />pharynx<br />constrictorpharyngisinferior m.<br />
  42. 42. T2 MRI, Level C5<br />
  43. 43. T2 MRI, Level C5<br />
  44. 44. T2 MRI, Level C5<br />
  45. 45. T2 MRI, Level C5<br />
  46. 46. T2 MRI, Level C5<br />
  47. 47. T2 MRI, Level C5<br />
  48. 48. T2 MRI, Level C4<br />
  49. 49. T2 MRI, Level C4<br />
  50. 50. T2 MRI, Level C4<br />
  51. 51. T2 MRI, Level C4<br />
  52. 52. T2 MRI, Level C4<br />
  53. 53. Larynx– coronalplane<br />epiglottis<br />vestibule<br />thyroidcartilage<br />vocalis m., vocallig.<br />cricoidcartilage<br />thyroidgland<br />trachea<br />
  54. 54. T2 MRI, laryngealcavities, coronal plane<br />
  55. 55. T2 MRI, laryngealcavities, coronal plane<br />
  56. 56. T2 MRI, Level C3<br />
  57. 57. T2 MRI, Level C3<br />
  58. 58. T2 MRI, Level C3<br />
  59. 59. T2 MRI, Level C3<br />
  60. 60. Head – face & masticatorymuscles<br />buccinator m.<br />parotidglandule<br />zygomaticus major m.<br />orbicularisoris m.<br />SCM<br />ramusof manibule<br />m. masseter<br />
  61. 61. pterygoideusmed & lat m. <br />buccinator m.<br />occipitalis a.<br />externalcarotid a.<br />facial a.<br />facial a.<br />
  62. 62. T2 MRI, Level C1-2<br />
  63. 63. Axialis metszet a C1-C2 magasságában (T2 MRI)<br />T2 MRI, Level C1-2<br />
  64. 64. Axialis metszet a C1-C2 magasságában (T2 MRI)<br />T2 MRI, Level C1-2<br />
  65. 65. Axialis metszet a C1-C2 magasságában (T2 MRI)<br />T2 MRI, Level C1-2<br />
  66. 66. Axialis metszet a C1-C2 magasságában (T2 MRI)<br />T2 MRI, Level C1-2<br />
  67. 67. Axialis metszet a C1-C2 magasságában (T2 MRI)<br />T2 MRI, Level C1-2<br />
  68. 68. T2 MRI saggital plane<br />
  69. 69. Sagittalis metszet a fej-nyak régióról (T2 MRI)<br />T2 MRI saggital plane<br />
  70. 70. Sagittalis metszet a fej-nyak régióról (T2 MRI)<br />T2 MRI saggital plane<br />
  71. 71. Sagittalis metszet a fej-nyak régióról (T2 MRI)<br />T2 MRI saggital plane<br />
  72. 72. Sagittalis metszet a fej-nyak régióról (T2 MRI)<br />
  73. 73. Sagittalis metszet a fej-nyak régióról (T2 MRI)<br />
  74. 74. Sagittalis metszet a fej-nyak régióról (T2 MRI)<br />
  75. 75. Sagittalis metszet a fej-nyak régióról (T2 MRI)<br />
  76. 76. Sinuses<br />Frontal sinus<br />Maxillary sinus<br />
  77. 77. Selectedclinicalcase #1<br />48 y old man forfistulography<br />thyreoglossalcystincision 5 yearsbefore<br />Fistulography<br />thyroglossaltract, sinus dilatation; taste of contrastagent<br />Ultrasound<br />ovoidhypoechoiclesion, subtle flow<br />CT<br />cysticcomponents<br />MRI<br />cysticsuprahyoidlesion<br />Thyroglossalductfistula<br />http://www.eurorad.org/case.php?id=8884<br />
  78. 78. Selectedclinicalcase #2<br />50 y old female<br />History: dry eyes & mouth 1 yduration; foreign body sensation, enlargement of parotids<br />US: mildlyenlargedparotidglandsdemonstratingechotextureheterogeneity<br />MR sialographyimaging:<br />bilateraldiffuseintra-glandularductectasia<br />no sialolith<br />PositiveSchirmer’s test<br />Sjogren’ssyndrome<br />http://www.eurorad.org/case.php?id=8515<br />
  79. 79. Selectedclinicalcase #3<br />21 y old male<br />History: caraccident<br />CT examination<br />Air bubblesbetweenmuscles<br />Linearband of negativedensity<br />Surgicalintervention: 10 cm piece of wood<br />http://www.eurorad.org/case.php?id=5072<br />
  80. 80. Selectedclinicalcase #4<br />Sinus piriformiscarcinomahttp://www.eurorad.org/case.php?id=4930<br />

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