Cross-Sectional Anatomy for Computed Tomography

Cross-Sectional Anatomy for Computed Tomography

Michael L. Farkas Cross-Sectional Anatomy for Computed Tomography A Self-Study Guide with Selected Sections from Head, Neck, Thorax, Abdomen, and Pelvis With Collaboration from S. Kubik Translated by James D. Fix Foreword by Elliot K. Fishman With 93 Figures Springer-Verlag N ew York Berlin Heidelberg London Paris Tokyo

Michael L. Farkas, M.D. Diplomate, American Board of Plastic Surgery, 3013 Bern, Switzerland James D. Fix, Ph.D. Professor, Department of Anatomy, Marshall University, School of Medicine, Huntington, West Virginia 25704, USA Stefan Kubik, M.D. Associate Professor, Head, Department of Macroscopy, Institute of Anatomy, University of Zurich-Irchel, CH-8057 Zurich, Switzerland On the front cover: Fig. 30. Planes of section through thorax, p. 43 Library of Congress Cataloging-in-Publication Data Farkas, M. (Michael) Cross-sectional anatomy for computed tomography. Translation of: Querschnittanatomie zur Computertomographie. Bibliography: p. I. Anatomy, Human-Atlases. 2. Tomography-Atlases. I. Kubik, Stefan. II. Title. [DNLM: l. Anatomyatlases. 2. Anatomy-programmed instruction. 3. Tomography, X-Ray Computed-atlases. 4. Tomography, X-Ray Computed-programmed instruction. QS 18 F229q] WM25.F3713 1988 611'.0022'2 88-6554 Translation of Querschnittanatomie zur Computertomographie/Eine Einfiihrung mit ausgewiihlten Schnitten aus dem Kopf-, Hals-, Brust- und Beckenbereich. Springer-Verlag Berlin Heidelberg, 1986. 1988 by Springer-Verlag New York Inc. Softcover reprint of the hardcover I st edition 1988 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag, 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions ''that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Typeset by Bi-Comp, Inc., York, Pennsylvania. Printed and bound by Arcata Graphics/Halliday Lithograph, West Hanover, Massachusetts. 9 8 7 6 5 4 321 ISBN-13: 978-1-4613-8784-8 e-isbn-13: 978-1-4613-8782-4 DOl: 10,1007/ 978-1-4613-8782-4

Foreword The clinical acceptance of computed tomography (CT) as an integral part of our diagnostic armamentarium was based on its ability to display cross-sectional anatomy with near anatomic precision. However, the radiologist must first be knowledgeable of the complexities of normal anatomy before he can truly make full use of this technology. Michael Farkas has truly made our task as radiologists easier. As noted in the preface, the book carefully correlates representative CT slices with corresponding anatomic cross-sections. Schematic line drawings are also generously used to illustrate particularly complex anatomic regions and help the reader obtain a correct perspective on these more difficult regions. The book successfully presents a clear perspective on the anatomy we see daily in using cross-sectional imaging techniques. This book will prove useful as a learning guide for the uninitiated, and as a reference for the more experienced. Either way, it is an important contribution to our literature. Elliot K. Fishman, M.D. Associate Professor Director, Division of Computed Body Tomography Department of Radiology and Radiological Science The Johns Hopkins Medical Institutions Baltimore, Maryland

Preface This self-study guide is intended to explain the basic principles of computed tomography (CT) and to stress the importance of cross-sectional anatomy, using cardinal transverse sections of the body to interpret CT-images. The objectives of this manual are to enable the reader: 1. To understand the basic principles of CT. 2. To study the cross-sectional anatomy of selected cardinal levels of the head, neck, and trunk. 3. To learn the orientation and interpretation of CT -images with the aid of corresponding cross-sectional preparations. At most medical schools, students do not receive enough instruction in cross-sectional anatomy because of curricular time constraints. With the advent of CT the importance of cross-sectional anatomy cannot be overestimated. Cross-sectional anatomy is the foundation for understanding" and interpreting the CT-image. Most textbooks of cross-sectional anatomy and CT are written for the clinical specialist, contain too much detail, and hence cannot be used for self-study. This work provides the reader with a brief and easily understandable self-study guide to crosssectional anatomy and CT. A learning program in its present form was considered to be one of the best methods for self-study. In the beginning of this text the principles of CT are explained in a clear and simple way. An optimal number of cross sections were selected so that a representative series through the body regions could be achieved. Ten sections from the head, two from the neck, three from the thorax, three from the abdomen, and three from the pelvis were used. Sections from both the male and the female pelvis are presented. The relative number of CT scans included for the head/neck, chest, and abdominal regions reflect the complexity of the structures contained in these areas, and not the relative emphasis in clinical applications of CT. Line drawings were used with the sections to aid the reader in his orientation and three-dimensional visualization. After selection of the transverse sections, corresponding CT -scans were chosen to match the anatomical sections. From the CT -scans only those structures were labeled that could be positively identified. Since this manual is intended to serve as a self-instructional program it was decided to clearly label only the most important structures. I cordially thank Professor S. Kubik for his support in the composition and

viii compilation of this text as well as for his photography of the cross sections. I thank Professor A. Valvanis for his aid and advice in the selection of the CTpictures. I thank Ms. M. Muller for her Bern, Switzerland Preface assistance in the photography laboratory, Mr. A. Lange for his help in preparing the anatomical sections, and Dr. B. Szarvas for his aid in labeling the pictures. Michael L. Farkas

Contents Foreword by E. K. Fishman Preface vii v 1. Introduction 1 2. Principles of Computed Tomography 3 2.1 Overview 3 2.2 Data Acquisition 4 2.3 CT Image Production 6 2.4 CT Systems 7 3. Cross-Sectional Anatomy with Corresponding CT Images 11 3.1 Head, Brain and Visceral Cranium 11 3.2 Neck 34 3.3 Thorax 42 3.4 Abdomen 52 3.5 Pelvis and Hip 60 Male Pelvis 60 Female Pelvis 68 References 76 Index 79