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Lymph nodes of the face, neck, thorax, abdomen and pelvis - hepatic segmentation - entire body scan (CT) in oncology

Antoine Micheau - MD, Denis Hoa - MD

Published on Tuesday 31 March 2009

SECTION: Anatomy of the thorax, abdomen, and pelvis

Images and anatomical references

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

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.

 

 

Nodal classifcation of  lymph nodes of the thorax for cancer staging (lung TNM classification)

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

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

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

 


Anatomical parts

Neck node levels (Robbin)

Level

Name

Cranial

Caudal

Anterior

Posterior

Lateral

Medial

Ia Submental nodes Geniohyoid m. Platysma m. Platysma m. Symphysis menti; Body of hyoid bone

Medial edge of anterior

belly of digastric m.

Midline
Ib Submandibular nodes

Mylohyoid m., cranial

edge of submandibular

gland or caudal edge of

medial pterygoid m.

Platysma m. Symphysis menti

Body of hyoid bone;

posterior edge of

submandibular gland

Basilar edge of

mandible; platysma m.

Lateral edge of anterior belly of digastric m.
II Upper jugular nodes

Bottom edge of the body

of C1

Bottom edge of the body

of hyoid bone

Posterior edge of

submandibular gland;

posterior edge of

posterior belly of

digastric m.

Posterior border of

sternocleidomastoid m.

Medial edge of

sternocleidomastoid m.

Internal edge of internal carotid artery, paraspinal

(levator scapulae) m.

III Middle jugular nodes

Bottom edge of the body

of hyoid bone

Bottom edge of cricoid

cartilage

Posterolateral edge of

sternohyoid m.

Posterior edge of

sternocleidomastoid m.

Medial edge of

sternocleidomastoid m.

nternal edge of carotid artery, paraspinal

(scalenius) m.

IV Lower jugular nodes

Bottom edge of cricoid

cartilage

Cranial border of

clavicle

Posterolateral edge of

sternohyoid m.

Posterior edge of

sternocleidomastoid m.

Medial edge of

sternocleidomastoid m.

Internal edge of internal carotid artery, paraspinal

(scalenius) m.

V Posterior cervical nodes Skull base

Cranial border of

clavicle

Posterior edge of

sternocleidomastoid m.

Anterior border of

trapezius m.; scalenius m.

Platysma m.; skin

Paraspinal (levator

scapulae, splenius

capitis) m.

VI Anterior cervical nodes

Bottom edge of the body

of hyoid bone

Sternal manubrium Skin; platysma m. Posterolateral edge of sternohyoid m.

Medial edge of common

carotid artery, skin and

anterior±medial edge of

sternocleidomastoid m.

Midline
  Retropharyngeal nodes Base of skull

Cranial edge of the body

of hyoid bone

Levator veli palatini m.

Prevertebral m. (longus

colli, longus capitis)

Medial edge of internal

carotid artery

Midline
Illustration of cervical lymph nodes : based on nodal classification of head and neck by Robin

Classification of the nodes of the neck : illustration by A. MIcheau based on a CT-3D volume rendering of head and neck - Copyright Imaios

 

 

Thoracic Lymph Node Map Definitions (Mountain and Dressler)

Nodal station

Name

Anatomic landmarks

1R- 1L Highest mediastinal nodes Nodes lying above a horizontal line at the upper rim of the bracheocephalic (left innominate) vein where it ascends to the left, crossing in front of the trachea at its midline
2R-2L Upper paratracheal nodes Nodes lying above a horizontal line drawn tangential to the upper margin of the aortic arch and below the inferior boundary of No. 1 nodes
3A-3B Prevascular and retrotracheal nodes Prevascular and retrotracheal nodes may be designated 3A and 3P; midline nodes are considered to be ipsilateral
4R-4L Lower paratracheal nodes

The lower paratracheal nodes on the right lie to the right of the midline of the trachea between a horizontal line drawn tangential to the upper margin of the aortic arch and a line extending across the right main bronchus at the upper margin of the upper lobe bronchus, and contained within the mediastinal pleural envelope; the lower paratracheal nodes on the left lie to the left of the midline of the trachea between a horizontal line drawn tangential to the upper margin of the aortic arch and a line extending across the left main bronchus at the level of the upper margin of the left upper lobe bronchus, medial to the ligamentum arteriosum and contained within the mediastinal pleural envelope

Researchers may wish to designate the lower paratracheal nodes as No. 4s (superior) and No. 4i (inferior) subsets for study purposes; the No. 4s nodes may be definedby a horizontal line extending across the trachea and drawn tangential to thecephalic border of the azygos vein; the No. 4i nodes may be defined by the lower boundary of No. 4s and the lower boundary of No. 4, as described above

5 Subaortic (aorto-pulmonary window) Subaortic nodes are lateral to the ligamentum arteriosum or the aorta or left pulmonary artery and proximal to the first branch of the left pulmonary artery and lie within the mediastinal pleural envelope
6 Para-aortic nodes (ascending aorta or phrenic) Nodes lying anterior and lateral to the ascending aorta and the aortic arch or the innominate artery, beneath a line tangential to the upper margin of the aortic arch
7 Subcarinal nodes Nodes lying caudal to the carina of the trachea, but not associated with the lower lobe bronchi or arteries within the lung
8 Paraesophageal nodes (below carina) Nodes lying adjacent to the wall of the esophagus and to the right or left of the midline, excluding subcarinal nodes
9 Pulmonary ligament nodes Nodes lying within the pulmonary ligament, including those in the posterior wall and lower part of the inferior pulmonary vein
10R-10L Hilar nodes The proximal lobar nodes, distal to the mediastinal pleural reflection and the nodes adjacent to the bronchus intermedius on the right; radiographically, the hilar shadow may be created by enlargement of both hilar and interlobar nodes
11R-11L Interlobar nodes Nodes lying between the lobar bronchi
12R-12L Lobar nodes Nodes adjacent to the distal lobar bronchi
13R-13L Segmental nodes Nodes adjacent to the segmental bronchi
14R-14L Subsegmental nodes Nodes around the subsegmental bronchi
Definition of thoracic lymph node stations : medical anatomical diagram

Illustraion of the thoracic lymph nodes based on Mountain and Dresler classification system - Illustration by A. Micheau - Copyright Imaios

 

Thoracic Lymph Node Map Definitions (IASLC)

 

IASCL-Lung-Node-Map

IASCL-Lung-Node-Map

 

Liver segmentation

Classification

Segments*

Other names**

Lobes (Godsmith et Woodburne)

Parts (Couinaud)

Divisions*

Hepatic parts*

I Posterior segment; Caudate lobe; Spigel lobe Caudate lobe     Posterior liver; Posterior part of liver;
II Left posterior lateral segment Latéral supérior Left lobe Left lateral Left lateral division Left liver; Left part of liver
III Left anterior lateral segment Latéral inférior, left paramédian Left paramedian
IV Left medial segment

Quadrate lobe

IVa : left superomedial

IVb : left inferomedial

Left medial division
V Anterior medial segment Anteroinferior Right lobe Right paramedian Right medial division Right liver; Right part of liver
VIII Posterior medial segment Anterosuperior
VI Anterior lateral segment Posteroinferior Right lateral Right lateral division
VII Posterior lateral segment; Posterosuperior

* Segments, divisions and parts from Terminologia Anatomica

** Other names commonly used (Couinaud Segments)

The segments of the liver on a medical illustration ; anterior and posterior view

Anterior and posterior view of the liver segments : illustration by A. Micheau - MD - Imaios

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