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Anatomy on Magnetic
R e s o n a n c e Im a g i n g
Bryan Pukenas, MD
KEYWORDS
Brain anatomy Magnetic resonance imaging Sagittal
Axial
PROTOCOL
The overwhelming advantage of MR imaging is its
ability to provide images with increased signal to
noise ratios. Tissue characteristics with respect to
different imaging sequences provide valuable clues
when interpreting an MR image of the brain. Therefore, it is important to understand the accentuated
tissue features on each scan. T1-weighted images
provide good tissue discrimination and, in conjunction with the postcontrast scans, allow assessment
for tissue enhancement. Precontrast and postcontrast scans must be obtained with identical imaging
parameters to truly assess contrast enhancement
(Table 1). T1-weighted and T2-weighted images
are complementary to each other because the
mri.theclinics.com
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Table 1
Hospital of the University of Pennsylvania imaging parameters
Scan
1.5-T Brain MR Imaging
Sagittal T1 spin echo
Axial T2 turbo spin echo
Axial gradient echo
Axial FLAIR
Axial diffusion echo planar spin echo
Axial T1 precontrast spin echo
Axial T1 postcontrast spin echo
Coronal T1 postcontrast spin echo
3.0-T Brain MR Imaging
Sagittal T1 FLAIR
Axial FLAIR
Axial T1 precontrast spin echo
Axial T2 gradient echo
Axial T2 susceptibility weighted
Axial T2 turbo spin echo
Axial diffusion echo planar spin echo
Axial T1 postcontrast spin echo
Coronal T1 postcontrast spin echo
Repetition
Time (ms)
Echo
Time (ms)
Inversion
Time (ms)
Flip Angle
(degrees)
450
5490
800
8900
4000
500
500
500
10
73
26
141
83
17
17
17
NA
NA
NA
2500
NA
NA
NA
NA
90
150
20
180
NA
90
90
90
2100
9000
700
700
27
5440
6400
700
700
9
119
12
19.9
20
96
109
12
8.9
896.2
2500
NA
NA
NA
NA
NA
NA
NA
150
150
90
20
15
150
NA
90
90
Abbreviations: FLAIR, fluid-attenuated inversion recovery; NA, not available; TE, echo time; TI, inversion time; TR, repetition time.
horizontal, whereas the inferior surface is triangular and divided into 3 parts: the pars orbitalis,
pars triangularis, and pars opercularis.
The superficial temporal lobe contains 3 superficial gyri: the superior temporal gyrus, middle
temporal gyrus, and inferior temporal gyrus. The
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Midline Structures
The easiest structure to identify on the midline
sagittal image is the corpus callosum, consisting
of the rostrum, genu, body, and splenium (see
Fig. 6). The cingulate gyrus parallels the corpus callosum anteriorly until its marginal branch courses to
the superior brain surface. The sulcus anterior to
the marginal sulcus is named the central sulcus.
Deep Structures
The deep central cerebral structures located
between the insula and the sagittal midline are
referred to as the central core (Fig. 8).13 This core
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Cerebellum
The cerebellum can be divided into 4 lobes: the
anterior and posterior lobes, separated by the
primary fissure (see Fig. 3), the vermis, and
the flocculonodular lobe. The inferior vermis
and flocculonodular lobes help regulate balance
and eye movements via interactions with the
vestibular system. It is generally assumed that
these regions, along with other parts of the vermis,
are involved in control of the proximal trunk
muscles, whereas the more lateral regions help
control the distal appendicular muscles. The most
lateral cerebellar hemispheres are involved in
motor planning.16 The cerebellar tonsils are located
inferolaterally and herniate through the foramen
magnum in patients with Chiari malformations.17
The dentate nucleus may be seen on T1-weighted
images and is located lateral to the white matter
of the cerebellum.18 There are 3 main white matter
tracts connecting the cerebellum to the brainstem:
the superior cerebellar peduncle (cerebellum to
midbrain), middle cerebellar peduncle (pons to
cerebellum), and inferior cerebellar peduncle
(medulla to cerebellum).19
Brainstem
The brainstem, consisting of the diencephalon,
mesencephalon, pons, and medulla oblongata,
serves as the connection between the cerebral
hemispheres, the cerebellum, and the medulla,
and is responsible for the basic life functions
such as breathing, heartbeat, blood pressure,
consciousness, and sleep.20 There are 3 main
longitudinal divisions of the brainstem: the basis,
the tectum, and the tegmentum. The motor
Sagittal T1
Although several anatomic features of the brain
are well delineated on standard sagittal T1 images,
these images also allow evaluation of the orbits
and cranial marrow signal. T1-weighted images
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provide some insight into cerebrovascular structures, and normal flow voids can be visualized in
the deep venous structures and dural venous
sinuses.
The orbit is bounded medially by the thin-walled
lamina papyracea, separating the orbit from the
ethmoid air cells. The inferior boundary of the orbit,
the orbital floor, also serves as the roof of the maxillary sinus,22 whereas the orbital roof is formed by
the frontal bone. The extraocular muscles, seen
well on axial and sagittal T1-weighted images,
show slight increase in signal intensity relative to
the temporalis muscle on T1-weighted images
and greater enhancement relative to the temporalis
muscle after gadolinium adminstration.23 Thus, the
extraocular muscles should be evaluated on more
than 1 imaging sequence when evaluating for pathologic abnormalities. The normal orbital fat demonstrates increased signal intensity on T1-weighted
images and decreased signal intensity on T1weighted fat-saturated images. When evaluating
the orbital fat with frequency-selective fat suppression techniques, field inhomogeneity can contribute to incomplete fat suppression in the orbital
fat. Inversion recovery techniques can be particularly useful because these sequences yield more
uniform fat suppression.24
Conversion of red (active) marrow to yellow (inactive) marrow is a normal process usually completed
by 25 years of age. Red marrow usually demonstrates a relative isointense signal compared with
skeletal muscle, and yellow marrow appears
hyperintense to muscle and relatively isointense
to subcutaneous fat. Loevner and colleagues25
described alterations of the normal marrow signal
intensity on T1-weighted images, which may be
the first indicator of a systemic disorder.
Enclosed in dural leaves, the dural venous
sinuses are the major drainage pathways of the
cerebral veins, and their flow voids are often seen
on the sagittal T1-weighted images. However, evaluation of the dural sinuses must be performed
using multiple pulse sequences. T1-weighted
images are not diagnostic for sinus thrombosis
because 24% to 31% of normal patients may
have hypoplasia of a sinus.26,27
Axial T2
Although T2-weighted images provide substantial
anatomic detail about the brain, these sequences
also provide important detail about the intracranial
vascular structures. Flow voids appear as areas of
signal dropout on T2-weighted images and are
normally expected for intracranial arteries. Loss
of an expected flow void should key the interpreting physician to the possibility of vascular
DW Imaging
As discussed earlier, DW images are exquisitely
sensitive to the detection of acute infarction. In
addition, these images are fat-saturated, so evaluation of calvarial lesions is aided by this sequence,
particularly if there is concern for a scalp or calvarial lipoma.
SUMMARY
The exquisite detail provided by brain MR imaging
scans can make interpretation simultaneously
straightforward and complicated, particularly to
the novice. For this reason, it is essential to
become familiar with normal structures before
describing the pathologic condition. This article
serves as a practical reference point to further
enhance knowledge of the intracranial anatomy.
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