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Radiological anatomy thoracic imaging Grzegorz Staskiewicz MD, PhD Human Anatomy Department, Medical University of Lublin • Methods of thoracic imaging • • • • X-ray (PA, AP and lateral projections), fluoroscopy Computed Tomography Magnetic Resonance Imaging Ultrasonography Computed Tomography • Advantages • TimeSoft tissueRepeatability DepthAvailability Procedures • Disadvantages • • • • Radiation High dose Contrast medium Patient weight Ultrasound • Advantages • Disadvantages • QuicklyCheaplyEveryw hereReal timeBlood flow: DopplerTreatments procedures • • • Limited range Obstacles: air, gases, bones Dependence on operator MRI • Advantages • • • No ionizing radiation multi-planar imaging Excellent resolution of soft tissue • Disadvantages • • • • • Cost Availability Claustrophobia Time Contraindications Anatomia radiologiczna klatki piersiowej Ao PT Hilum Pulmonary vessels LA RA LV cardiophrenic angle costophrenic angle KPŻ Anatomia radiologiczna klatki piersiowej Thoracic imaging • Native scanning • Chest CT with contrast medium • High Resolution CT (HRCT) • Computed Tomography angiography (CTA) • Cardiac CT examinations (ECG-gating) • Low dose screening chest CT Pulmonary segments Pulmonary segments - Left Lung Pulmonary segments - Right Lung • Thoracic lymph nodes classification • pulmonary arteries - embolism extent • Qanadli score • Qanadli SD et al. AJR (176)2001 • 10 segmental arteries in both lungs • extent: 0/1/2 • The heart • Norm values for echocardiography Female Male LP 2.7-3.8 cm 3.0-4.0 cm LV 3.9-5.3 cm 4.2-5.9 cm LV (volume) 56-104 cm3 67-155 cm3 Ejection Fraction ≥ 55% ≥ 55% LV wall 0.6-0.9 cm 0.6 – 1.0 cm Halpern E. Clinical Cardiac CT: Anatomy and Function. Thieme. • Aorta Hager et al. Diameters of the thoracic aorta throughout life as measured with helical computed tomography. JTCS, 2008 • Pulmonary trunk 29 mm Karazincir et al. CT assessment of main pulmonary artery diameter. Diagn Interv Radiol, 2008 • Coronary arteries • • • • RCA: 1-4 LCA: 5 LAD: 6-10 LCx: 11-15 Radiological anatomy head imaging Grzegorz Staskiewicz MD, PhD Human Anatomy Department, Medical University of Lublin • Non-‐contrast study • Contrast study • Angio CT • Perfusion CT Head CT in ER pa-ent Anatomy Falx cerebri Longitudinal fissure Anatomy Lateral ventricle, Frontal horn Caudate nucleus, Head Fornix Lateral ventricle, Occipital horn Choroid plexus Thalamus Anatomy Internal capsule, Anterior crus Putamen Internal capsule, Posterior crus Lateral ventricle, Frontal horn Head of caudate nucleus 3rd ventricle Pineal gland Thalamus Lateral ventricle, Occipital horn Anatomy Cistern of lateral fossa Quadrigeminal lamina Qadrigeminal cistern Anatomy 3rd ventricle Interpeduncular cistern Cisterna ambiens Cerebral aqeduct Quadrigeminal cistern Anatomy Lateral ventricle, Temporal horn Basal cistern 4th ventricle Anatomy Pontine cistern 4th ventricle Anatomy Cerebello-pontine angle 4th ventricle Increased intracranial pressure? Hirsch W. et al. Reliability of cranial CT versus intracerebral pressure measurement for the evaluation of generalised cerebral oedema in children. Pediatr Radiol (2000) 30: 439-443 Objec-ve assessment A B D C E F (A) Frontal horns distance; (B) Caudate nuclei distance (C) 3rd ventricle width; (D) Minimal lateral ventricles width; (E) Internal cranial width; (F) External cranial width Objec-ve assessment A B D C E (A)/(E) = Evans score (C)/(E) = 3rd ventricle score (D)/(F)= cella media score F Aging LeMay M. Radiologic changes of the aging brain and skull. AJR, 1984; 143: 383-‐9. Trauma Trauma Intracranial hemorrhages Intracranial hemorrhage: mass effect Hemorrhagic stroke: evolution • Hyperdense ICA sign • Up to 50% cases • Very high specificity • Low sensitivity • White/gray matter homogeneity: first 3 hrs • Lentiform nucleus • Insula • Hypodensity • Swelling of gyri – flatening of sulci Ischemic stroke