Ebook Sectional anatomy for imaging professionals (3rd edition): Part 1

(BQ) Part 1 book Sectional anatomy for imaging professionals presents the following contents: Introduction to sectional anatomy, cranium and facial bones, brain, spine, neck, thorax. Invite you to consult.

Lorrie L Kelley, MS, RT(R)(MR)(CT) Associate Professor, CT/MRI Program Director Boise State University Boise, Idaho Connie M Petersen, MS, RT(R)(CT) Adjunct Instructor, Radiologic Sciences Program Boise State University Boise, Idaho 3251 Riverport Lane St Louis, Missouri 63043 SECTIONAL ANATOMY FOR IMAGING PROFESSIONALS, THIRD EDITION ISBN: 978-0-323-08260-0 Copyright © 2013 by Mosby, an imprint of Elsevier Inc Copyright © 2007, 1997 by Mosby, Inc., an affiliate of Elsevier Inc No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notice Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein ISBN: 978-0-323-08260-0 Senior Content Strategist: Jennifer Janson Associate Content Development Specialist: Amy Whittier Publishing Services Manager: Catherine Jackson Designer: Paula Catalano Printed in China Last digit is the print number:  9  8  7  6  5  4  3  2  To James, Min beste venn og evig ledsager, jeg smil hver dag på grunn av deg Your strength sustains me during the dark moments, your unconditional patience and love elevates me, and your faith inspires me And to Kristina, Matt, Jennifer, John, Michael, Natalie, Angela, James, Daniel, Dean, Maren, Evelyn, McKenzie, and Jakob, et al, my greatest treasures, who bless me with their laughter and enthusiasm for life Thanks for reminding me to dream and never stop learning And to my parents, Bill and Darhl Buchanan, for teaching me the value of hard work and sharing their wisdom and encouragement in ways that strengthen and inspire me LLK Thank you to my family and friends whose guidance, love, and support carried me through my most trying times I dedicate this book to: My greatest blessings, Brady and Trinity, for the countless joys you have graced my life with May you never lose sight of the incredible good and strengths within you as you reach for greatness Always know that you are loved and how truly honored I am to be your mom Carl and Ellen Collins, my parents, for the wonderful gifts of life and love Thank you for your ever-present understanding, wisdom, and encouragement I love you both dearly Grant, my amazing gift from God, for loving me and being there when I needed you most CMP ACKNOWLEDGMENTS Many provided encouragement and direction as the compilation of this text commenced Amy Whittier had the tiresome duty of encouraging us to meet deadlines, which she did with grace and humor Jennifer Geistler had the daunting task of strategically pulling it all together We are indebted to them for their editorial assistance in seeing this project through completion We wish to extend our gratitude to everyone who thought the first and second editions had value and to those who took the time to provide constructive criticism and suggestions for further improvements and increased accuracy And to the many students who were not shy in providing feedback so that we could see the text from many different perspectives The following individuals and institutions deserve special acknowledgment: • iv The faculty at Boise State University for their support and patience as we faced fast-approaching deadlines • • • Chris Hayden for his tremendous patience, knowledge, and time invested in helping us find and create all of the new CT images for the third edition And St Alphonsus Regional Medical Center for providing the CT images Mary Pullin from Philips Medical Systems for providing some beautiful MR images Dave Arnold and St Luke’s Regional Medical Center, as well as Kevin Bean and Intermountain Medical Imaging, for providing the majority of the MR images We owe a debt of gratitude to Jeanne Robertson, who provided numerous new illustrations and revised many old drawings in record time Because of her efforts and talent, there is more consistency in the visual presentation of the artwork throughout the text Lorrie L Kelley Connie M Petersen REVIEWERS Becky Britt, MSRS, RT(R)(M) Assistant Professor Northwestern State University Shreveport, Louisiana Gail Faig, BS, RT(R)(CV)(CT) Clinical Coordinator Shore Medical Center School of Radiologic Technology Somers Point, New Jersey Lisa Fanning, MEd, RT(R)(CT) Radiography Program Director Massachusetts College of Pharmacy and Health Sciences Boston, Massachusetts Kelli Haynes, MSRS, RT(R) Director of Undergraduate Studies/ Associate Professor/Graduate Faculty Radiologic Sciences Department Northwestern State University of Louisiana Shreveport, Louisiana Marelene Johnson, MEd, RT(R) Education Director University of Utah Salt Lake City, Utah Kathleen Kienstra, MAT, RT(R)(T) Program Director Radiation Therapy Program Saint Louis University St Louis, Missouri Bob McGee, MEd, RT(R), CCI Assistant Professor/Clinical Coordinator South College/Asheville Asheville, North Carolina Marcia Moore BS, RT(R)(CT) Instructor St Luke’s College Sioux City, Iowa Roger Preston, MSRS, RT(R)(CT) Program Director School of Radiologic Technology Richmond, Indiana Kenneth Roszel, MS, RT(R) Program Director Geisenger Medical Center Danville, Pennsylvania Rebecca Silva, MEd, MPH, RT(R) Department Chair South Texas College McAllen, Texas Karen Tillelli, RT, CT(R) Program Instructor University of Utah Hospital/Clinics Salt Lake City, Utah Diana Werderman, MSEd, RT(R) Assistant Professor Trinity College of Nursing and Health Sciences Rock Island, Illinois Theresa Roberts, MHS, RT(R)(MR) Program Director Radiologic Technology Keiser University Melbourne, Florida v PREFACE This text was written to address the needs of today’s practicing health professional As technology in diagnostic imaging advances, so does the need to competently recognize and identify cross-sectional anatomy Our goal was to create a clear, concise text that would demonstrate in an easy-to-use yet comprehensive format the anatomy the health professional is required to understand to optimize patient care The text was purposely designed to be used both as a clinical reference manual and as an instructional text, either in a formal classroom environment or as a self-instructional volume Included are close to 1000 high-quality MR and CT images for every feasible plane of anatomy most commonly imaged An additional 350 anatomic maps and line drawings related to the MR and CT images add to the learner’s understanding of the anatomy being studied In addition, pathology boxes describe common pathologies related to the anatomy presented, assisting the reader in making connections between the images in the text and common pathologies that will be encountered in clinical practice Tables that summarize muscle group information include points of origin and insertion, as well as functions, for the muscle structures pertinent to the images the reader is studying NEW TO THIS EDITION • • • • vi Nearly 150 new MR and CT images and 30 new line drawings provide more 3D and vascular images to better demonstrate anatomy seen with current technology Chapter Objectives will help readers prepare for the material they will learn in each chapter Addition of full labels to scans will improve usability of the images and allow readers to quickly and efficiently see the anatomy displayed on the scan Addition of Test Bank to Evolve Instructor Resources will provide readers with the tools for an enhanced learning experience CONTENT AND ORGANIZATION The images include identification of vital anatomic structures to assist the health professional in locating and identifying the desired anatomy during actual clinical examinations The narrative accompanying these images clearly and concisely describes the location and function of the anatomy in a format easily understood by health professionals The text is divided into chapters by anatomic regions Each chapter of the text contains an outline that provides an overview of the chapter’s contents, pathology boxes that briefly describe common pathologies related to the anatomy being presented, tables designed to organize and summarize the anatomy contained in the chapter, and reference illustrations that provide the correct orientation for scanning the anatomy of interest ANCILLARIES A Workbook and an Evolve site complement the text When used together, these additional tools create a virtual learning system/reference resource Workbook: The Workbook provides practice opportunities for the user to identify specific anatomy The Workbook includes learning objectives that focus on the key elements of each chapter, a variety of practice items to test the reader’s knowledge of key concepts, labeling exercises to test the reader’s knowledge of the anatomy, and answers to exercises Instructor Resources on Evolve: These resources include a test bank with approximately 500 questions and an image collection with approximately 1000 images Lorrie L Kelley Connie M Petersen CONTENTS 1  Introduction to Sectional Anatomy, Anatomic Positions and Planes, Terminology and Landmarks, Body Cavities, Abdominal and Pelvic Divisions, Image Display, Multiplanar Reformation and 3D Imaging, 2  Cranium and Facial Bones, 15 Cranium, 16 Facial Bones, 51 Temporomandibular Joint, 62 Paranasal Sinuses, 68 Orbit, 75 3  Brain, 89 Meninges, 90 Ventricular System, 93 Cerebrum, 102 Diencephalon, 113 Limbic System, 117 Brainstem, 120 Cerebellum, 128 Cerebral Vascular System, 131 Cranial Nerves, 157 4  Spine, 172 Vertebral Column, 173 Ligaments, 193 Muscles, 201 Spinal Cord, 210 Plexuses, 226 Vasculature, 241 5  Neck, 250 Organs, 251 Muscles, 291 Vascular Structures, 300 6  Thorax, 307 Bony Thorax, 308 Pleural Cavities, 312 Lungs, 313 Bronchi, 318 Mediastinum, 322 Lymphatic System, 326 Heart and Vasculature, 331 Great Vessels, 349 Coronary Circulation, 368 Off-Axis Cardiac Imaging, 377 Azygos Venous System, 386 Muscles, 389 Breast, 395 7  Abdomen, 397 Abdominal Cavity, 398 Liver, 412 Gallbladder and Biliary System, 431 Pancreas, 437 Spleen, 441 Adrenal Glands, 442 Urinary System, 446 Stomach, 453 Intestines, 458 Abdominal Aorta and Branches, 468 Inferior Vena Cava and Tributaries, 485 Lymph Nodes, 488 Muscles of the Abdominal Wall, 490 8  Pelvis, 494 Bony Pelvis, 495 Muscles, 505 Viscera, 517 Vasculature, 550 Lymph Nodes, 561 9  Upper Extremity, 563 Shoulder, 564 Elbow, 601 Wrist and Hand, 621 Neurovasculature, 646 10  Lower Extremity, 654 Hip, 655 Knee and Lower Leg, 682 Ankle and Foot, 714 Neurovasculature, 746 vii This page intentionally left blank CHAPTER Introduction to Sectional Anatomy Acetabulum R L Coccygeus muscle Rectum Femoral head Coccyx Gluteus maximus muscle FIGURE 1.1  ​Axial CT of hips Sectional anatomy has had a long history Beginning as early as the sixteenth century, the great anatomist and artist, Leonardo da Vinci, was among the first to represent the body in anatomic sections In the following centuries, numerous anatomists continued to provide illustrations of various body structures in sectional planes to gain greater understanding of the topographical relationships of the organs The ability to see inside the body for medical purposes has been around since 1895, when Wilhelm Conrad Roentgen discovered x-rays Since that time, medical imaging has evolved from the static 2-dimensional (2D) image of the first x-ray to the 2D cross-section image of computed tomography (CT), and finally to the 3-dimensional (3D) imaging techniques used today These changes warrant the need for medical professionals to understand and identify human anatomy in both 2D and 3D images Sectional anatomy emphasizes the physical relationship between internal structures Prior knowledge of anatomy from drawings or radiographs may assist in understanding the location of specific structures on a sectional image For example, it may be difficult to recognize all the internal anatomy of the pelvis in cross-section, but by identifying the femoral head on the image, it will be easier to recognize soft tissue structures adjacent to the hip in the general location of the slice (Figure 1.1) OBJECTIVES • • • • Define the four anatomic planes Describe the relative position of specific structures within the body using directional and regional terminology Identify commonly used external landmarks Identify the location of commonly used internal landmarks • • • • • Describe the dorsal and ventral cavities of the body List the four abdominal quadrants List the nine regions of the abdomen Describe the gray scale used in CT and MR imaging Describe MPR, CPR, SSD, MIP and VR OUTLINE Anatomic Positions and Planes, Terminology and Landmarks, External Landmarks, Internal Landmarks, Body Cavities, Abdominal and Pelvic Divisions, Quadrants, Regions, Image Display, Multiplanar Reformation and 3D Imaging, Multiplanar Reformation (Reformat) (MPR), Curved Planar Reformation (Reformat) (CPR), Copyright © 2013, Elsevier Inc 3D Imaging, Shaded Surface Display (SSD), 12 Maximum Intensity Projection (MIP), 12 Volume Rendering (VR), 12 382 CHAPTER 6  Thorax S Pulmonary trunk LAD A P Right ventricle Left ventricle Right atrium Coronary sinus Descending aorta I FIGURE 6.132  ​Short axis MRI with pulmonary trunk Sternum A Right lung Pulmonary trunk Ascending aorta R L Left lung Liver Left atrium Descending aorta Vertebral body P FIGURE 6.133  ​Short axis MRI with left atrium  CHAPTER 6  Thorax A Ascending aorta SVC Pulmonary trunk R L Right pulmonary artery Descending aorta Esophagus P FIGURE 6.134  ​Axial CT of pulmonary trunk for planning RVOT images S Pulmonary trunk Aortic root Pulmonary vein RVOT Right ventricle Left ventricle I FIGURE 6.135  CT of right ventricular outflow tract (RVOT) 383 384 CHAPTER 6  Thorax S Left pulmonary artery Pulmonary trunk Left mainstem bronchus Root of aorta A P Left pulmonary veins Right ventricle Left atrium Liver I FIGURE 6.136  MRI of right ventricular outflow tract (RVOT) Ascending aorta Left coronary artery SVC Aortic semilunar valve Right atrium Left ventricle IVC Right coronary artery FIGURE 6.137  ​Coronal CT of heart for planning LVOT images  CHAPTER 6  Thorax Aortic semilunar valve 385 Left atrium Ascending aorta Pulmonary trunk Pulmonary semilunar valve Coronary sinus FIGURE 6.138   CT of left ventricular outflow tract Bicuspid valve Right ventricle Aorta Left ventricle Ascending aorta Pulmonary trunk Left atrium Left ventricular outflow tract Bicuspid valve Right ventricle Left ventricle Descending aorta FIGURE 6.139   MRI of left ventricular outflow tract 386 CHAPTER 6  Thorax AZYGOS VENOUS SYSTEM The azygos venous system, which provides collateral circulation between the inferior and superior venae cavae, can be divided into the azygos and hemiazygos veins (Figure 6.140) Together, they drain blood from most of the posterior thoracic wall and from the bronchi, pericar- dium, and esophagus The azygos vein ascends along the right side of the vertebral column, whereas the hemiazygos vein ascends along the left side The hemiazygos vein crosses to the right behind the aorta to join the azygos vein at approximately T7-T9 The azygos vein then arches over the hilum of the right lung to empty into the posterior superior vena cava (Figures 6.141 through 6.144) Superior vena cava Left superior intercostal vein Azygos vein Posterior intercostal veins Accessory hemiazygos vein Posterior intercostal veins Posterior intercostal veins Hemiazygos vein FIGURE 6.140  ​Anterior view of azygos venous system Left renal vein Inferior vena cava Ascending lumbar vein Lumbar veins S Azygos arch Azygos vein R L Hemiazygos vein Thoracic vertebra I FIGURE 6.141  ​Coronal CT reformat of azygos vein  CHAPTER 6  Thorax 387 S Superior vena cava Azygos arch Right mainstem bronchus A P Right atrium I FIGURE 6.142  ​Sagittal CT reformat of azygos arch A L R Liver IVC Azygos vein P Hemiazygos vein Descending aorta FIGURE 6.143  ​Axial, T1-weighted MRI of abdomen with azygos and hemiazygos veins Spleen 388 CHAPTER 6  Thorax A L R Esophagus Azygos vein P Hemiazygos vein Descending aorta FIGURE 6.144  ​Axial CT of chest with azygos and hemiazygos veins TA B L E Muscles of the Thorax Muscle Origin Insertion Action Intercostal Inferior border of ribs Superior border of ribs below Serratus posterior superior Serratus posterior inferior Levatores costarum Diaphragm Spinous processes and supraspinous ligaments of C7-T2 Spinous processes and supraspinous ligaments of T11-L2 Transverse processes of C-7 and T1-T11 Xiphoid process, costal margin, fascia over the quadratus lumborum, and psoas major muscles Vertebral bodies L1-L3 Posterior aspect of 2nd-5th ribs Fixes intercostal spaces during respiration and aids forced inspiration by elevating ribs Assists forced inspiration Posterior aspect of 9th-12th Assists in forced expiration Rib between tubercle and angle Central tendon of the diaphragm Elevate the ribs Pushes the abdominal viscera inferiorly, increasing the volume of the thoracic cavity for inspiration  CHAPTER 6  Thorax MUSCLES Muscles Associated with Respiration Muscles associated with respiration are the intercostal, serratus posterior superior, serratus posterior inferior, levatores costarum, and the diaphragm (Table 6.5) The spaces between the ribs, or the intercostal spaces, are filled with three layers of intercostal muscles (external, internal, and innermost layer) (Figures 6.145 through 6.147) These muscles act together to elevate the ribs and expand the thoracic cavity, as well as keep the intercostal spaces somewhat rigid The serratus posterior superior muscle spans from C7-T2 to ribs to and acts to assist forced inspiration, whereas the serratus posterior inferior muscle spans from T11-L2 to ribs to 12 and acts (Right side) Anterior membranous portion of external intercostal muscles removed to assist forced expiration (Figures 6.148 through 6.150) The levatores costarum muscles arise from the transverse processes of C7 and T1-T11 They extend obliquely to insert on the rib below, between the tubercle and angle (see Figure 6.148) The levatores costarum muscles act to elevate the ribs The diaphragm is a large dome-shaped muscle that spans the entire thoracic outlet and separates the thoracic cavity from the abdominal cavity (Figure 6.151) It is the chief muscle of inspiration because it enlarges the thoracic cavity vertically as the domes move inferiorly and flatten The muscle fibers of the diaphragm converge to be inserted into a central tendon, which is situated near the center of the diaphragm immediately below the pericardium, with which it is partially blended The diaphragm is attached to the lumbar spine via two External intercostal membrane (Left side) Rib Anterior membranous portion of external intercostal muscles Transversus thoracis muscle Internal intercostal muscle Intercostales intimi muscle (innermost layer) External intercostal muscles External intercostal 10 muscles Muscle fibers of external intercostal muscles in region of vertebral column (posteriorly) FIGURE 6.145  ​Anterior view of intercostal muscles 389 External intercostal muscle Internal intercostal membrane FIGURE 6.146  ​Axial view of intercostal muscles 390 CHAPTER 6  Thorax Carina A Pectoralis major muscle Pectoralis minor muscle Serratus anterior muscle R L Trachea in Intercostal muscle Rhomboid muscle P FIGURE 6.147  ​Axial CT of chest at level of carina with thoracic muscles Levatores costarum Serratus posterior superior Serratus posterior inferior FIGURE 6.148  ​Posterior view of chest with posterior serratus muscles tendinous structures termed crura (see Figures 6.151 through 6.155) The right crus arises from the anterior surfaces of L1-L3, whereas the left crus arises from the corresponding parts of L1-L2 only The left and right crura join together across the ventral aspect of the abdominal aorta to form the medial arcuate ligament Three major openings, or hiatuses, of the diaphragm allow for the passage of vessels and organs from the thorax to the abdomen The aortic hiatus allows for the passage of the descending aorta, azygos vein, and thoracic duct The caval hiatus allows for the passage of the inferior vena cava and the right phrenic nerve (see Figures 6.151 and 6.152) The esophageal hiatus allows for the passage of the esophagus and the vagus nerve  CHAPTER 6  Thorax A Trapezius muscle P Serratus posterior superior muscle Splenius capitis muscle Erector spinae muscles Transversospinal muscles FIGURE 6.149  ​Axial CT of chest with serratus posterior superior muscle A Sternum Serratus anterior muscle Descending aorta R L IVC Serratus posterior inferior muscle Latissimus dorsi muscle Rib Esophagus P Erector spinae muscle Trapezius muscle FIGURE 6.150  ​Axial, T1-weighted MRI of chest with serratus posterior inferior muscle 391 392 CHAPTER 6  Thorax Inferior vena cava in caval hiatus Central tendon Esophagus in esophageal hiatus Diaphragm Aorta in aortic hiatus Right crus Left crus FIGURE 6.151  ​Inferior view of diaphragm S Left brachiocephalic vein Right brachiocephalic vein Aortic arch Pulmonary trunk SVC Serratus anterior muscle Right atrium R L Left ventricle IVC Diaphragm Caval hiatus I FIGURE 6.152  ​Coronal CT reformat of serratus anterior muscle  CHAPTER 6  Thorax 393 S Aorta Thoracic vertebra R L Intercostal muscle Latissimus dorsi muscle Diaphragm Crus of diaphragm Liver Spleen I FIGURE 6.153  ​Coronal CT reformat of diaphragm Inferior vena cava A Descending aorta Right crus Left crus Lumbar vertebra L R P FIGURE 6.154  ​Axial, T1-weighted MRI of abdomen with crura 394 CHAPTER 6  Thorax Right crus Inferior vena cava A Descending aorta L R Intercostal muscle P Left crus R FIGURE 6.155  ​Axial CT of chest with crura Muscles Connecting the Upper Extremity to the Anterior and Lateral Thoracic Walls Muscles of the anterior and lateral thoracic region are pectoralis major, pectoralis minor, subclavius, and serratus anterior Muscles associated with the movement of the upper extremity, such as the pectoralis, subclavius, and serratus anterior, can also function as accessory muscles for respiration (Figure 6.156 and Table 6.6) For example, the pectoralis muscles (major and minor), located on the anterior surface of the chest, primarily aid in the movement of the upper limb, but the pectoralis major muscle can also act to expand the thoracic cavity on deep inspiration (Figures 6.147 and 6.156) The subclavius, a small triangular-shaped muscle located L between the clavicle and first rib, acts alone to stabilize the clavicle and depress the shoulder (Figure 6.5) Conjointly with the pectoralis muscles, the subclavius muscles act to raise the ribs, drawing them upward and expanding the chest, thus becoming important agents in forced inspiration Additionally, the serratus anterior muscles aid in respiration The serratus (sawlike) anterior muscle is visualized on the lateral border of the thorax It extends from the medial border of the scapula to the lateral surface of the first rib through eighth ribs The primary action of the serratus anterior muscle is to laterally rotate and protract the scapula It can, however assist in raising the ribs for inspiration (Figures 152 and 6.156; see also Chapter 9) Sternocleidomastoid muscle Scalene muscles Deltoid muscle Infrahyoid muscles Trapezius muscle Pectoralis minor muscle FIGURE 6.156  ​Anterior view of muscles asso- ciated with thorax Pectoralis major muscle Serratus anterior muscle Latissimus dorsi muscle  CHAPTER 6  Thorax 395 TA B L E Muscles of the Anterior and Lateral Wall of the Thorax Muscle Origin Insertion Action Pectoralis major Bicipital groove of humerus and deltoid tuberosity Flexes, adducts, and medially rotates arm, and accessory for inspiration Pectoralis minor Clavicular head—medial half of clavicle Sternal head—lateral manubrium and sternum, six upper costal cartilages Anterior surface of 3rd-5th ribs Coracoid process of the scapula Subclavius First rib and cartilage Inferior surface of the clavicle Serratus anterior Angles of superior 8th or 9th ribs Medial border of scapula Elevates ribs of scapula, protracts scapula, and assists serratus anterior Depresses the shoulder and assists pectoralis in inspiration Laterally rotates and protracts scapula BREAST Clavicle The female breast, or mammary gland, lies within the subcutaneous tissue overlying the pectoralis major muscle Typically, the breast extends laterally from the sternum to the axilla, and inferiorly from the second to the seventh ribs For examination purposes, the breast can be divided into four quadrants (upper inner, upper outer, lower outer, lower inner) and the tail of Spence (Figures 6.157 and 6.158) The breast consists of three layers of tissue: subcutaneous layer, mammary layer, and retromammary layer (Figure 6.158) The subcutaneous layer contains the skin and all of the subcutaneous fat The mammary layer consists of glandular tissue, excretory (lactiferous) ducts, and connective tissues The glandular tissue consists of 15 to 20 lobes arranged radially around a centrally located nipple The glandular lobes are embedded in connective tissue and fat, which give the breast its size and shape Excretory (lactiferous) ducts extend from each lobe to the nipple, where they terminate as small openings Cords of connective tissue coursing throughout the mammary layer, from the dermis to Tail of Spence Upper inner Lower inner Upper outer Lower outer FIGURE 6.157  ​Anterior view of left breast Pectoralis minor muscle Intercostal muscle Fascia of pectoral muscles Pectoralis major muscle Alveolus Ductule Duct Lactiferous duct Lactiferous sinus Nipple pores Retromammary layer Mammary layer (glandular tissue) Subcutaneous layer Adipose tissue Suspensory ligaments of Cooper FIGURE 6.158  ​Sagittal view of female breast the thoracic fascia, are known as the suspensory ligaments of the breast or Cooper’s ligaments These ligaments provide support for the breasts The retromammary layer contains muscle, deep connective tissue, and retromammary fat (Figures 6.159 and 6.160) Axillary lymph nodes drain the lymphatics from the breast, arm, and integument of the back They are frequently clustered around the axillary vessels, the lower border of the pectoralis major muscle, and the lower margin of the posterior wall 396 CHAPTER 6  Thorax S FIGURE 6.159  ​Sagittal, T1-weighted MRI of female breast A P Pectoralis major muscle Retromammary layer Mammary layer Nipple Glandular I Subcutaneous layer Retromammary layer FIGURE 6.160  ​Axial, T1-weighted MRI of female breast Subcutaneous layer Mammary layer REFERENCES Applegate E: The anatomy and physiology learning system, ed 4, Philadelphia, 2010, Saunders Applegate E: The sectional anatomy learning system, ed 3, Philadelphia, 2009, Saunders Frank: Merrill’s atlas of radiographic positions and radiologic procedures, ed 12, St Louis, 2011, Mosby Cerqueira MD, Weissman NJ, Dilsizian V, et al: Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association, Circulation 105:539, 2002 Sandring S: Gray’s anatomy, ed 40, Philadelphia, 2009, Churchill Livingstone Glandular layer Haaga JR, Lanzieri CF, Gilkeson RC, et al: CT and MRI imaging of the whole body, ed 5, Philadelphia, 2008, Mosby Jacob S: Atlas of human anatomy, Philadelphia, 2002, Churchill Livingstone Larsen WJ: Anatomy: development function clinical correlations, Philadelphia, 2002, Saunders Manning WJ, Pennel DJ: Cardiovascular magnetic resonance, ed 2, Philadelphia, 2010, Saunders Mosby’s medical, nursing, and allied health dictionary, ed 7, St Louis, 2006, Mosby Seidel HM, Ball JW, Dains JE, et al: Mosby’s guide to physical examination, ed 7, St Louis, 2011, Mosby Som PM, Curtin HD: Head and neck imaging, ed 5, St Louis, 2012, Mosby ... Cerebrum, 10 2 Diencephalon, 11 3 Limbic System, 11 7 Brainstem, 12 0 Cerebellum, 12 8 Cerebral Vascular System, 13 1 Cranial Nerves, 15 7 4  Spine, 17 2 Vertebral Column, 17 3 Ligaments, 19 3 Muscles, 2 01. .. Longitudinal magnetization 10 T2 (e g (e , s o g., C wat D er) lid t issue ) TE Time T1 for solid tissue T1 for free water T1 Relaxation T2 Relaxation T1–weighted T2–weighted FIGURE 1. 11 ​MR tissue relaxation... (MIP), 12 Volume Rendering (VR), 12 CHAPTER 1 Introduction to Sectional Anatomy ANATOMIC POSITIONS AND PLANES For our purposes, sectional anatomy encompasses all the variations of viewing anatomy