Philip Borg 1, Abdul Rahman J. Alvi2, Nicholas T. Skipper3 and Christopher S. Johns3
(1)
Interventional Oncology Fellow, The Christie Hospital Manchester, Manchester, UK
(2)
Radiology Intervention Fellow, Royal Free Hospital, London, UK
(3)
Radiology Registrar, Sheffield Teaching Hospitals, Sheffield, UK
CT C-Spine
1.
Name the structure labelled 1.
2.
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3.
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4.
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5.
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Wrist Radiograph6.
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7.
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8.
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9.
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10.
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MRI Pelvis11.
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12.
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13.
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14.
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15.
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Ultrasound Pelvis16.
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17.
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18.
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19.
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20.
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MRCP21.
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22.
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23.
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24.
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25.
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MRI Ankle26.
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27.
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28.
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29.
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30.
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Barium Enema31.
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32.
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33.
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34.
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35.
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MRI Shoulder36.
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37.
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38.
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39.
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40.
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MRI Brain41.
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42.
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43.
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44.
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45.
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Chest Radiograph46.
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47.
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48.
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49.
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50.
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Cardiac CT51.
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52.
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53.
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54.
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55.
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MRI Knee56.
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57.
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58.
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59.
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60.
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MR Angiogram61.
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62.
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63.
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64.
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65.
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MRI Brain66.
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67.
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68.
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69.
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70.
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CT Foot71.
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72.
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73.
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74.
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75.
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CT Abdomen76.
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77.
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78.
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79.
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80.
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CT Chest81.
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82.
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83.
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84.
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85.
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MRI Brain86.
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87.
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88.
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89.
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90.
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Urethrogram91.
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92.
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93.
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94.
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95.
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MRI Knee96.
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97.
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98.
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99.
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100.
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Test 2 AnswersCT C-Spine
1.
Sphenoid sinus
2.
Anterior arch of atlas (C1 vertebra)
3.
Body of C3 vertebra
4.
Hyoid bone (body of)
5.
Manubrio-sternal joint
When trying to identify the vertebral level on a lateral c-spine, the odontoid process (or odontoid peg or dens) of the C2 vertebra is a useful landmark.
The manubrio-sternal joint or angle of Louis is at the approximate level of the beginning and end of the aortic arch and the bifurcation of the trachea.
Wrist Radiograph
6.
Base of right thumb metacarpal
7.
Right trapezium
8.
Right scaphoid
9.
Base of right little finger metacarpal
10.
Styloid process of right ulna
MRI Pelvis
11.
Sacrum/sacral promontory
12.
Left obturator internus muscle
13.
Right obturator externus muscle
14.
Left gluteus medius muscle
15.
Right vastus lateralis muscle
Ultrasound Pelvis
16.
Urinary bladder
17.
Myometrium
18.
Endometrium
19.
Cervix
20.
Vagina
MRCP
21.
Common hepatic duct
22.
Right hepatic duct
23.
Gallbladder (fundus of)
24.
Common bile duct
25.
Fluid in fundus of stomach
Tips: MRCP uses heavily T2-weighted sequences to utilise the properties of bile. It is a relatively quick investigation, involves no radiation and is noninvasive (compare with ERCP). Look for anatomical variations including accessory hepatic ducts, pancreas divisum and annular pancreas. The pancreatic duct should be clearly seen on MRCP.
MRI Ankle
26.
Tibialis anterior tendon (left)
27.
Extensor hallucis longus tendon (left)
28.
Peroneus brevis tendon (left)
29.
Tibialis posterior tendon (left)
30.
Achilles』 tendon (left)
There is no marker on the case but you can work out that it is the left lower limb (fibula on the lateral aspect).
Remember the acronym Tom Dick Harry (Tibialis posterior, flexor Digitorum longus, flexor Hallucis longus) for the tendons posterior to the medial malleolus.
For the anterior tendons Tom Harry Dick (Tibialis anterior, extensor Hallucis longus, extensor Digitorum longus).
Barium Enema
31.
Sacral promontory
32.
Presacral/postrectal space
33.
Rectum
34.
Sigmoid colon
35.
L5 vertebral body
The presacral (or postrectal) space is clinically very important to determine tumour invasion and leaks following bowel anastomosis breakdown. The measurement between the anterior sacrum at the S4 level and the posterior wall of the rectum should not measure more than 4 mm.
MRI Shoulder
36.
Right deltoid muscle
37.
Right biceps brachii tendon (long head, in bicipital groove)
38.
Right subscapularis (muscle/tendon)
39.
Right infraspinatus muscle
40.
Lung (apex right lung)
This is an axial T1-weighted MR shoulder.
MRI Brain
41.
Right trigone of lateral ventricle
42.
Splenium of corpus callosum
43.
Choroid plexus (within the left lateral ventricle)
44.
Tentorium cerebelli
45.
Cisterna magna (cerebellomedullary cistern)
The choroid plexus is found in the lateral and third ventricles. It is responsible for CSF production.
Chest Radiograph
46.
Left coracoid process
47.
Right 1st rib (anterior)
48.
Medial border of left scapula
49.
Right hilar point
50.
Interlobar artery (right lower lobe artery)
The hilar points are the angles formed by the descending upper lobe veins, as they cross behind the lower lobe arteries.
Cardiac CT
51.
Right atrium
52.
Aortic root
53.
Left main stem coronary artery
54.
Right bronchus intermedius
55.
Descending thoracic aorta
The left coronary artery arises from the left posterior aortic sinus. It then divides into left anterior descending and circumflex branches. The right coronary artery arises from the anterior aortic sinus, runs in the atrioventricular groove and anastamoses with the circumflex branch of the left coronary artery.
MRI Knee
56.
Quadriceps tendon
57.
Posterior cruciate ligament
58.
Hoffa’s (infrapatellar) fat pad
59.
Tibia (proximal physis)
60.
Popliteus muscle
Anterior and posterior cruciate ligaments are named according to their tibial origins.
Remember AL, PM: Anterior cruciate goes Lateral and Posterior cruciate goes Medial.
MR Angiogram
61.
Left lumbar artery
62.
Right common iliac artery
63.
Urinary bladder
64.
Right lateral circumflex femoral artery
65.
Right superficial femoral artery
The bladder fills up with contrast in many investigations including this MRA. Always label as the 『urinary bladder』.
The lateral circumflex femoral artery delineates the border between external iliac and femoral artery.
Remember that the superficial femoral lies medial to the profunda femoris artery.
MRI Brain
66.
Anterior limb of right internal capsule
67.
Right external capsule
68.
Left globus pallidus
69.
Left putamen
70.
Right internal cerebral vein
The globus pallidus (medial) and the putamen (lateral) make up the lentiform nucleus. The external capsule is found lateral to the lentiform nucleus.
The internal cerebral veins are found in the quadrigeminal cistern.
CT Foot
71.
Head of talus
72.
Neck of talus
73.
Navicular bone
74.
Base of first metatarsal
75.
Head of first metatarsal
CT Abdomen
76.
Right external oblique muscle
77.
Left internal oblique muscle
78.
Inferior vena cava
79.
Left quadratus lumborum muscle
80.
Right erector spinae muscles
This axial CT is taken in the arterial phase of contrast enhancement. Notice how the aorta and other arteries are enhancing. Determining the phase of a CT examination is important when identifying vascular structures and pathology.
CT Chest
81.
Right breast tissue
82.
Ascending aorta
83.
Pulmonary trunk
84.
Left main pulmonary artery
85.
Oesophagus
This axial CT chest (CTPA) is taken in the arterial phase. There is an apparent discontinuation between the pulmonary trunk and the left pulmonary artery because of the orientation of the slice.
Remember the oesophagus is always found behind the trachea and here behind the carina.
MRI Brain
86.
Superior sagittal sinus
87.
Body of corpus callosum
88.
Pituitary gland
89.
Torcula herophili (confluence of venous sinuses)
90.
Soft palate
Urethrogram
91.
Right acetabulum
92.
Penile urethra
93.
Bulbous urethra
94.
External sphincter (sphincter urethrae)
95.
Neck of bladder
This is a urethrogram, very simple to identify the anatomy if you are familiar with the procedure. Try to observe a urethrogram at least once before the exam.
MRI Knee
96.
Patella
97.
Great saphenous vein
98.
Sartorius muscle
99.
Lateral condyle of femur
100.
Medial head of gastrocnemius
Identifying medial and lateral on an axial knee may be a bit tricky. Try to identify the great saphenous vein – a superficial vessel on the medial aspect in a thicker layer of superficial fat than the lateral side of the knee.
If the menisci are visible on an axial section, the medial meniscus can be identified as the larger of the two.