e-ANATOMY: LYMPH NODES OF THE FACE, NECK, THORAX, ABDOMEN AND PELVIS - HEPATIC SEGMENTATION - ENTIRE BODY SCAN (CT) IN ONCOLOGY

This human anatomy module is devoted to the lymph nodes, ganglionic areas and organs involved in oncological disease spread assessments. It has been produced from a scanner (computed tomography) with iodine injection of a healthy subject, covering the face, neck, thorax, abdomen and pelvis.

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Development of this atlas of oncological anatomy:

We selected a cross-sectional imaging approach usually used in oncological disease spread assessment: a cervico-thoraco-abdomino-pelvic CT scan of a male subject.
The DICOM images were exported in .jpeg format then cropped and redimensioned using Adobe Photoshop. The images were then integrated into a module using Flash.

We have integrated on the left a vector skeleton diagram in order to locate navigation buttons and cross-references.

Niveau-classification-ganglions-lymphatique-cou

Anatomical structures:

We first used the interactive captions to identify anatomical structures commonly used in oncologic imaging, particularly to determine the local and regional expansion and remote pre-treatment (TNM) or acting as limit for the classification of ganglionic areas:
• Bone: hyoid bone, collarbone, spine, vertebrae, sternum, ribs, hip bone, sacrum...
• Respiratory system: nose, nasal cavities, larynx, cricoid cartilage, trachea and lungs.
• Digestive system: oral cavity, tongue, pharynx, oesophagus, stomach, small intestine, colon and rectum.
• Urinary system: kidneys, adrenal glands, ureters, bladder, urethra and prostate.
• Arteries: the thoracic and abdominal aorta and its major branches.
• Veins: jugular veins, subclavian veins, brachiocephalic veins, superior and inferior vena cava, azygos vein, iliac veins and femoral veins and the portal system (portal vein, splenic vein, inferior and superior mesenteric veins).
• NB: Some structures were included in groups to which they do not belong in theory in order to facilitate navigation. For example, the spleen in the digestive system and the thyroid gland in the respiratory system.

Lymph nodes stations on a computed tomography

Lymph nodes:

We have represented lymph nodes by coloured bullets in order to better visualise their position. These are purely hypothetical anatomical locations; most nodes in this module are not visible in this healthy subject.

The nomenclature of lymph nodes varies enormously according to the authors; therefore, we are limited to the nomenclature of Terminologia Anatomica. You will notice that the location and the name of the lymph nodes vary significantly from the nomenclature used for the designation of the ganglionic areas.

Segmentation-hépatique-foie-scanner

Ganglionic areas:

We have outlined the cervical and thoracic lymph nodes. These areas are those used for imaging in oncological disease spread assessment, and those used for irradiation in radiotherapy.
For a shortcut, you will find the infraclavicular and supraclavicular fossa in the ganglionic areas; although this is not strictly speaking the ganglionic areas, but rather the anatomical regions.

The ganglionic areas in the neck are numbered from I to VI including the retropharyngeal area.
This classification is based on Robin's classification.

The thoracic ganglionic areas are numbered from I to XII and associated with their common names based on the Mountain and Dressler classifications. Some unspecified limits in this classification were derived from the article by Chapet O. et al.

ganglions-noeud-lymphatique-pelvis-anatomie

Hepatic segmentation:

We outlined the various hepatic segments by partitioning the segment IV into IVa and IVb. We defined the segments using the sub-hepatic veins.

Human Anatomy: display of anatomical legends

To use this module, you must click on the "anatomical structures" tab.
There you can choose between the different structures for display.
Some structures such as ganglionic areas are shown by delimited areas and interactive legends.
Others, such as the lymph nodes of the thorax, abdomen and pelvis, are shown only by legends.
Finally, the segmentation of the liver is displayed by zones of demarcation designed on a graphics tablet…

The "captioning limited to an area" function permits all the legends in a square that the user imposes on the image to be displayed. On the other hand, it does not permit the display of isolated anatomical areas.

The "full screen" function allows the large-scale display of images from the specific module, but is reserved for Premium IMAIOS members.

The "Regions" tab provides more rapid access to the neck, chest, abdomen or pelvis.

The language menu allows the display of captions in different languages: Latin (Terminologia Anatomica), English, French, Spanish, Portuguese, Czech, Chinese, Japanese...

This module is intended for medical students, including those specialising in e.g. radiology, oncology, oncology, radiotherapy, nuclear medicine and all medical specialties where the preoperative treatment of cancer is paramount.
This atlas of human anatomy will be helpful as an aide-memoire for oncologists, radiotherapists, radiologists, practitioners of nuclear medicine and oncologists disease spread assessment of malignancies, including the study of lymph nodes relating to the TNM classification, but also through ability to recall the segmentation of the liver.
 

References

• Terminologia Anatomica: International Anatomical Terminology - FCAT Federative Committee On Anatomical Terminology, Federative Committee on Anatomical Terminology - Thieme, 1998 - ISBN 3131152516, 9783131152510
• Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience.Grégoire V, Coche E, Cosnard G, Hamoir M, Reychler H. Radiother Oncol. 2000 Aug;56(2):135-50. Review.PMID: 10927132
• CT-based definition of thoracic lymph node stations: an atlas from the University of Michigan.Chapet O, Kong FM, Quint LE, Chang AC, Ten Haken RK, Eisbruch A, Hayman JA.Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):170-8.
• Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy.Madu CN, Quint DJ, Normolle DP, Marsh RB, Wang EY, Pierce LJ.Radiology. 2001 Nov;221(2):333-9.
• Standardizing Neck Dissection Terminology: Official Report of the Academy's Committee for Head and Neck Surgery and Oncology
  K. Thomas Robbins; Jesus E. Medina; Gregory T. Wolfe; Paul A. Levine; Roy B. Sessions; Charles W. Pruet
  Arch Otolaryngol Head Neck Surg. 1991;117(6):601-605.

• 10L-11L : Left hilar and interlobar nodes - 10L-11L
• 10R-11R : Right hilar and interlobar nodes - 10R-11R
• 1L - Left highest mediastinal nodes - 1L
• 1R - Right highest mediastinal nodes - 1R
• 2L - Left upper paratracheal nodes - 2L
• 2R - Right upper paratracheal nodes - 2R
• 3A - Prevascular nodes - 3A
• 3B - Retrotracheal nodes - 3B
• 4L - Left lower paratracheal nodes - 4L
• 4R - Right lower paratracheal nodes - 4R
• 5 - Subaortic (aortic–pulmonary window) - 5
• 6 - Paraaortic nodes - 6
• 7 - Subcarinal nodes - 7
• 8 - Paraeosphageal nodes - 8
• 9 - Lymph nodes of pulmonar ligaments - 9
• Abdomen - Abdomen - Pelvis - Pelvis
• Abdominal aorta - Aorta abdominalis
• Alimentary system - Systema digestorium
• Anatomical structures - Anatomical parts
• Anterior cervical nodes - Nodi cervicales anteriores; Nodi colli anteriores : Superficial nodes; Anterior jugular nodes - Nodi superficiales; Nodi jugulares anteriores
• Anus - Anus
• Aortic arch - Arcus aortae
• Aortic bifurcation - Bifurcatio aortae
• Apical nodes - Nodi apicales
• Appendicular nodes - Nodi appendiculares
• Appendix - Appendix vermiformis
• Arch of azygos vein - Arcus venae azygos
• Arteries - Arteriae - Heart - Cor
• Arytenoid cartilage - Cartilago arytenoidea
• Ascending aorta - Pars ascendens aortae; Aorta ascendens
• Ascending colon - Colon ascendens
• Axillary artery - Arteria axillaris
• Axillary lymph nodes - Nodi lymphoidei axillares
• Azygos vein - Vena azygos
• Bones; Skeletal system - Ossa; Systema skeletale
• Brachiocephalic nodes - Nodi brachiocephalici
• Brachiocephalic trunk - Truncus brachiocephalicus
• Bronchopulmonary nodes - Nodi bronchopulmonales
• Caecum - Caecum
• Central nodes - Nodi centrales
• Central superior mesenteric nodes - Nodi superiores centrales
• Cervical vertebrae [C I-C VII] - Vertebrae cervicales [C I-C VII]
• Clavicle - Clavicula
• Coccyx; coccygeal vertebrae [I-IV] - Os coccygis; Coccyx vertebrae coccygeae [I-IV]
• Coeliac nodes - Nodi coeliaci
• Coeliac trunk - Truncus coeliacus
• Common hepatic artery - Arteria hepatica communis
• Common iliac artery - Arteria iliaca communis
• Common iliac nodes - Nodi iliaci communes
• Common iliac vein - Vena iliaca communis
• Cranium - Cranium
• Cricoid cartilage - Cartilago cricoidea
• Cystic node - Nodus cysticus
• Deep inguinal nodes - Nodi inguinales profundi
• Deep parotid nodes - Nodi parotidei profundi : Infraauricular nodes - Nodi infraauriculares
• Deep parotid nodes - Nodi parotidei profundi : Intraglandular nodes - Nodi intraglandulares
• Deep parotid nodes - Nodi parotidei profundi : Preauricular nodes - Nodi preauriculares
• Descending aorta - Pars descendens aortae; Aorta descendens
• Descending colon - Colon descendens
• Duodenum - Duodenum
• Epiglottis - Epiglottis
• External carotid artery - Arteria carotis externa
• External iliac artery - Arteria iliaca externa
• External iliac nodes - Nodi iliaci externi
• External iliac vein - Vena iliaca externa
• External jugular vein - Vena jugularis externa
• Facial nodes - Nodi faciales : Buccinator node - Nodus buccinatorius
• Facial nodes - Nodi faciales : Malar node - Nodus malaris
• Facial nodes - Nodi faciales : Mandibular node - Nodus mandibularis
• Facial nodes - Nodi faciales : Nasolabial node - Nodus nasolabialis
• False ribs [VIII-XII] - Costae spuriae [VIII-XII]
• Female urethra - Urethra feminina
• Femoral artery - Arteria femoralis
• Femoral vein - Vena femoralis
• Femur; Thigh bone - Femur; Os femoris
• Gallbladder - Vesica biliaris
• Gluteal nodes - Nodi gluteales : Inferior nodes - Nodi inferiores
• Gluteal nodes - Nodi gluteales : Superior nodes - Nodi superiores
• Great saphenous vein - Vena saphena magna
• Head - Caput - Neck - Collum; Cervix
• Heart - Cor
• Hepatic nodes - Nodi hepatici
• Hepatic portal vein - Vena portae hepatis
• Hepatic segmentation: lobes, parts, divisions and segments - Segmentatio hepatis: lobi, partes, divisiones et segmenta
• Hip bone; Coxal bone; Pelvic bone - Os coxae
• Hyoid bone - Os hyoideum
• Ileocolic nodes - Nodi ileocolici
• Ileum - Ileum
• Inferior diaphragmatic nodes - Nodi phrenici inferiores
• Inferior epigastric nodes - Nodi epigastrici inferiores
• Inferior mesenteric artery - Arteria mesenterica inferior
• Inferior mesenteric nodes - Nodi mesenterici inferiores
• Inferior mesenteric vein - Vena mesenterica inferior
• Inferior tracheobronchial nodes - Nodi tracheobronchiales inferiores
• Inferior vena cava - Vena cava inferior
• Infraclavicular fossa - Fossa infraclavicularis
• Intercostal nodes - Nodi intercostales
• Interiliac nodes - Nodi interiliaci
• Intermediate lumbar nodes - Nodi lumbales intermedii
• Internal carotid artery - Arteria carotis interna
• Internal iliac artery - Arteria iliaca interna
• Internal iliac nodes - Nodi iliaci interni
• Internal iliac vein - Vena iliaca interna
• Internal jugular vein - Vena jugularis interna
• Interpectoral nodes - Nodi interpectorales
• Intrapulmonary nodes - Nodi intrapulmonales
• Jejunum - Jejunum
• Juxtaintestinal mesenteric nodes - Nodi juxtaintestinales
• Juxtaoesophageal nodes - Nodi juxtaoesophageales
• Larynx - Larynx
• Lateral aortic nodes - Nodi aortici laterales
• Lateral caval nodes - Nodi cavales laterales
• Lateral cervical nodes - Nodi cervicales laterales; Nodi colli laterales : Inferior deep nodes - Nodi profundi inferiores : Anterior nodes - Nodi anteriores
• Lateral cervical nodes - Nodi cervicales laterales; Nodi colli laterales : Inferior deep nodes - Nodi profundi inferiores : Juguloomohyoid node - Nodus juguloomohyoideus
• Lateral cervical nodes - Nodi cervicales laterales; Nodi colli laterales : Inferior deep nodes - Nodi profundi inferiores : Lateral node - Nodus lateralis
• Lateral cervical nodes - Nodi cervicales laterales; Nodi colli laterales : Superficial nodes - Nodi superficiales
• Lateral cervical nodes - Nodi cervicales laterales; Nodi colli laterales : Superior deep nodes - Nodi profundi superiores : Anterior node - Nodus anterior
• Lateral cervical nodes - Nodi cervicales laterales; Nodi colli laterales : Superior deep nodes - Nodi profundi superiores : Jugulodigastric nod - Nodus jugulodigastricus
• Lateral cervical nodes - Nodi cervicales laterales; Nodi colli laterales : Superior deep nodes - Nodi profundi superiores : Lateral node - Nodus lateralis
• Lateral pericardial nodes - Nodi pericardiaci laterales
• Lateral vesical nodes - Nodi vesicales laterales
• Left atrium - Atrium sinistrum
• Left brachiocephalic vein - Vena brachiocephalica
• Left colic nodes - Nodi colici sinistri (Mesocolic nodes - Nodi mesocolici)
• Left common carotid artery - Arteria carotis communis
• Left inferior pulmonary vein - Vena pulmonalis sinistra inferior
• Left internal jugular vein - Vena jugularis interna
• Left lung - Pulmo sinister
• Left main bronchus - Bronchus principalis sinister
• Left pulmonary artery - Arteria pulmonalis sinistra
• Left renal artery - Arteria renalis
• Left renal vein - Vena renale
• Left subclavian artery - Arteria subclavia
• Left subclavian vein - Vena subclavia
• Left superior pulmonary vein - Vena pulmonalis sinistra superior
• Left suprarenal gland - Glandula suprarenalis
• Left ventricle - Ventriculus sinister
• Level III - III
• Level IIa - IIa
• Level IIb - IIb
• Level IV - IV
• Level Ia - Ia
• Level Ib - Ib
• Level V - V
• Level VI - VI
• Lingual nodes - Nodi linguales
• Liver - Hepar
• Lumbar vertebrae [L I-L V] - Vertebrae lumbales [L I-L V]
• Lymph node - Nodus lymphoideus; Nodus lymphaticus; Lymphonodus
• Lymph node stations - Nodus lymphoideus
• Mandible - Mandibula
• Mastoid nodes - Nodi mastoidei
• Middle colic nodes - Nodi colici medii (Mesocolic nodes - Nodi mesocolici)
• Nasal cavity - Cavitas nasi
• Node of anterior border of omental foramen - Nodus foraminalis
• Node of arch of azygos vein; Lymph node of arch of azygos vein - Nodus lymphaticus arcus venae azygos
• Node of ligamentum arteriosum; Lymph node of ligamentum arteriosum - Nodus lymphaticus ligamenti arteriosi
• Nodes around cardia; Lymph nodes around cardia - Anulus lymphaticus cardiae
• Nose - Nasus
• Obturator nodes - Nodi obturatorii
• Occipital nodes - Nodi occipitales
• Oesophagus - Oesophagus
• Oral cavity - Cavitas oris
• Ostium primum - Ren; Nephros
• Pancreas - Pancreas
• Pancreatic nodes - Nodi pancreatici
• Pancreaticoduodenal nodes - Nodi pancreaticoduodenales
• Paracolic nodes - Nodi paracolici (Mesocolic nodes - Nodi mesocolici)
• Paramammary nodes - Nodi paramammarii
• Pararectal nodes - Nodi pararectales; Nodi anorectales
• Parasternal nodes - Nodi parasternales
• Paratracheal nodes - Nodi paratracheales
• Paratracheal nodes - Nodi paratracheales (Anterior cervical nodes - Nodi cervicales anteriores; Nodi colli anteriores : Deep nodes - Nodi profundi)
• Parotid gland - Glandula parotidea
• Pectoral nodes; Anterior nodes - Nodi pectorales; Nodi anteriores
• Pharynx - Pharynx
• Postaortic nodes - Nodi retroaortici; Nodi postaortici
• Postcaval nodes - Nodi retrocavales; Nodi postcavales
• Postvesical nodes - Nodi retrovesicales; Nodi postvesicales
• Preaortic nodes - Nodi preaortici
• Precaecal nodes - Nodi precaecales
• Precaval nodes - Nodi precavales
• Prelaryngeal nodes - Nodi prelaryngei (Anterior cervical nodes - Nodi cervicales anteriores; Nodi colli anteriores : Deep nodes - Nodi profundi)
• Prepericardial nodes - Nodi prepericardiaci
• Pretracheal nodes - Nodi pretracheales (Anterior cervical nodes - Nodi cervicales anteriores; Nodi colli anteriores : Deep nodes - Nodi profundi)
• Prevertebral nodes - Nodi prevertebrales
• Prevesical nodes - Nodi prevesicales
• Prostate - Prostata
• Pulmonary trunk - Truncus pulmonalis
• Pyloric nodes - Nodi pylorici
• Pylorus - Pylorus
• Rectum - Rectum
• Regions - Regiones
• Respiratory system - Systema respiratorium
• Retrocaecal nodes - Nodi retrocaecales
• Retropharyngeal nodes - Nodi retropharyngeales (Anterior cervical nodes - Nodi cervicales anteriores; Nodi colli anteriores : Deep nodes - Nodi profundi)
• Retropharyngeal nodes - Retropharyngeal nodes
• Right atrium - Atrium dextrum
• Right brachiocephalic vein - Vena brachiocephalica
• Right colic nodes - Nodi colici dextri (Mesocolic nodes - Nodi mesocolici)
• Right inferior pulmonary vein - Vena pulmonalis dextra inferior
• Right lung - Pulmo dexter
• Right main bronchus - Bronchus principalis dexter
• Right pulmonary artery - Arteria pulmonalis dextra
• Right renal artery - Arteria renalis
• Right renal vein - Vena renale
• Right subclavian artery - Arteria subclavia
• Right subclavian vein - Vena subclavia
• Right superior pulmonary vein - Vena pulmonalis dextra superior
• Right suprarenal gland - Glandula suprarenalis
• Right ventricle - Ventriculus dexter
• Right/left gastric nodes - Nodi gastrici dextri/sinistri
• Right/left gastroomental nodes - Nodi gastroomentales dextri/sinistri
• Rigth common carotid artery - Arteria carotis communis
• Root of penis - Radix penis
• Sacral nodes - Nodi sacrales
• Sacrum - Os sacrum
• Scapula - Scapula
• Seminal gland; Seminal vesicle - Glande vesiculosa; Glandula seminalis; Vesicula seminalis
• Sigmoid colon - Colon sigmoideum
• Sigmoid nodes - Nodi sigmoidei
• Spleen - Splen; Lien
• Splenic artery - Arteria splenica; Arteria lienalis
• Splenic nodes - Nodi splenici; Nodi lienales
• Splenic vein - Vena splenica; Vena lienalis
• Sternum - Sternum
• Stomach - Gaster
• Submandibular gland - Glandula submandibularis
• Submandibular nodes - Nodi submandibulares
• Submental nodes - Nodi submentales
• Subscapular nodes; Posterior nodes - Nodi subscapulares; Nodi posteriores
• Superficial inguinal nodes - Nodi inguinales superficiales
• Superficial parotid nodes - Nodi parotidei superficiales
• Superior diaphragmatic nodes - Nodi phrenici superiores
• Superior mesenteric artery - Arteria mesenterica superior
• Superior mesenteric nodes - Nodi mesenterici superiores
• Superior mesenteric vein - Vena mesenterica superior
• Superior rectal nodes - Nodi rectales superiores
• Superior tracheobronchial nodes - Nodi tracheobronchiales superiores
• Superior vena cava - Vena cava superior
• Supraclavicular fossa - Fossa supraclavicularis
• Supraclavicular nodes - Nodi supraclaviculares
• Teeth - Dentes
• Thoracic vertebrae (TI-TXIII) - Vertebrae thoracicae (TI-TXIII)
• Thorax - Thorax
• Thyroid cartilage - Cartilago thyroidea
• Thyroid gland - Glandula thyroidea
• Thyroid nodes - Nodi thyroidei (Anterior cervical nodes - Nodi cervicales anteriores; Nodi colli anteriores : Deep nodes - Nodi profundi)
• Tongue - Lingua
• Trachea - Trachea
• Tracheal bifurcation - Bifurcatio tracheae
• Transverse colon - Colon transversum
• True ribs [I-VII] - Costae verae [I-VII]
• Ureter - Ureter
• Urinary bladder - Vesica urinaria
• Urinary system - Systema urinarium - Male genital system - Systema genitale masculinum
• Veins - Venae
• Vertebral artery - Arteria vertebralis