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PET-CT atlas of the whole body

Antoine Micheau - MD, Denis Hoa - MD

Published on Friday 24 February 2012

SECTION: Anatomy of the thorax, abdomen, and pelvis

Images and anatomical references

PET-CT images provided by G. Chuto - MD

 

This module is devoted to the anatomy of the human body as studied when performing a PET scan with FDG injection.
It contains 280 images in axial section, ranging from cranial base to the root of the thighs, with over 250 anatomical structures captioned, with 4 selectable image types (PET, scanner, or PET-CT)
It is particularly aimed at doctors and nuclear medical technicians, radiologists and oncologists, including the disease spread assessment of cancers.

 

PET-scanner images with FDG

 

The PET-CT images, which pertain to a healthy male subject, were provided by Dr. William Chuto. There are four types of images, typically composed of a positron emission tomography combined with a scanner:

  • PET-CT fusion: combining image scanner data and FDG tracer scintigraphy. These images are often very educational but are not used routinely.

 

 

PET-CT : anatomy of the neck, thorax, abdomen and pelvis

PET-CT : anatomy of the neck, thorax, abdomen and pelvis

 

 

  • CT (abdomen-mediastinum): whole body scanner images without injection with window function permitting the study of the soft tissues, including lymph node structures, mediastinum and abdomen.
  • CT (lung-bone): stronger window function, allowing a better visualisation of the pulmonary parenchyma and the lungs.
  • PET: tomographic images with attenuation factor correction, allowing the visualisation of areas fixing the tracer (e.g. heart, brain, urinary tract).

 

 

Positron emission tomography: Pelvis - Urinary bladder

Positron emission tomography: Pelvis - Urinary bladder

 

 

Anatomical structures captioned by single-photon emission computed tomography (SPECT)

 

250 anatomical structures of the neck and trunk have been captioned, using only the structures visible and studied through praxis on a PET scanner:

  • The general anatomy presents the principle regions of human body, useful in locating a tumoral process: axilla, quadrants of the abdomen ... etc.
  • The bone (skeletal system) presents the different bones of the neck, trunk and root of the lower limbs fairly approximately to avoid overloading the module.
  • The articular system presents the large joints of the human body, with particular focus on the spine.
  • The muscles (muscular system) have been exhaustively annotated, apart from the erector spinae muscles and certain muscles of the pelvic floor that are not identifiable on this scanner.

 

 

Positron emission Tomography - Computed tomography: IASLC - Lymph node stations

Positron emission Tomography - Computed tomography: IASLC - Lymph node stations

 

 

  • The respiratory system includes the main structures from the nasal cavity to the bronchi.
  • The bronchopulmonary segments have been identified by captioned areas with the help of the classification of the Terminologia Anatomica (numbers vary depending on the source areas, e.g. Boyden).

 

 

Positron emission tomography with Computed Tomography (PET-CT): Bronchopulmonary segments

Positron emission tomography with Computed Tomography (PET-CT): Bronchopulmonary segments

 

 

  • The thoracic cavity contains the large mediastinal regions and the cardiac structures.
  • The digestive system includes the oral cavity, pharynx, oesophagus, stomach, large and small intestines, liver and pancreas. We have here included the spleen, which, however, is a lymphoid and not digestive organ.
  • The hepatic segmentation represents the 7 segments of the liver by means of zones and legends.

 

 

PET-CT fusion images: Hepatic segmentation - Peritoneal Cancer Index

PET-CT fusion images: Hepatic segmentation - Peritoneal Cancer Index

 

 

  • The abdominal cavity includes the different spaces (peritoneal, retroperitoneal, retropubic) and mesenteries (mesentery, mesocolon).
  • The Peritoneal Cancer Index is presented in the form of zones numbered 1 through 12 of the different possible locations of peritoneal carcinomatosis. A diagram of this index is available in the classifications tab. This index is still not officially recognised but is widely used in clinical practice.
  • The urinary system is comprised chiefly of the kidneys and bladder.
  • The male reproductive system was captioned so simply in order to be able to quickly locate structures such as the seminal vesicles or the prostate.
  • The endocrine glands include the thyroid, the thymus (illustrated despite its atrophying into adulthood) and the adrenal glands.
  • The arteries have been cursorily captioned, primarily as they form basic anatomical landmarks.
  • The veins include the upper and lower vena cava system as well as the portal system.
  • The lymph nodes tab describes the lymph nodes as described in the Terminologia Anatomica – names often not used in current practice.
  • The ganglionic areas pick up the classifications used in oncology and surgery (cervical and thoracic lymph nodes (IASLC)) in the form of differently coloured regions.
  • The nervous system is not easy to study on CT scan without injection.

 

The Details tab

 

This will allow all the structures to be displayed, or only those images having a low level of detail.

 

Language and anatomical terminology

 

We have used the Terminologia Anatomica to caption for all the anatomical structures, with translations into English, French, Japanese, German, Chinese, Portuguese, Russian, Czech and Spanish.


Anatomical parts

Lymph node levels of the neck

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 anteriorbelly of digastric m. Midline
Ib Submandibular nodes Mylohyoid m., cranialedge of submandibulargland or caudal edge ofmedial pterygoid m. Platysma m. Symphysis menti Body of hyoid bone;posterior edge ofsubmandibular gland Basilar edge ofmandible; platysma m. Lateral edge of anterior belly of digastric m.
II Upper jugular nodes Bottom edge of the bodyof C1 Bottom edge of the bodyof hyoid bone Posterior edge ofsubmandibular gland;posterior edge ofposterior belly ofdigastric m. Posterior border ofsternocleidomastoid m. Medial edge ofsternocleidomastoid m. Internal edge of internal carotid artery, paraspinal(levator scapulae) m.
III Middle jugular nodes Bottom edge of the bodyof hyoid bone Bottom edge of cricoidcartilage Posterolateral edge ofsternohyoid m. Posterior edge ofsternocleidomastoid m. Medial edge ofsternocleidomastoid m. nternal edge of carotid artery, paraspinal(scalenius) m.
IV Lower jugular nodes Bottom edge of cricoidcartilage Cranial border ofclavicle Posterolateral edge ofsternohyoid m. Posterior edge ofsternocleidomastoid m. Medial edge ofsternocleidomastoid m. Internal edge of internal carotid artery, paraspinal(scalenius) m.
V Posterior cervical nodes Skull base Cranial border ofclavicle Posterior edge ofsternocleidomastoid m. Anterior border oftrapezius m.; scalenius m. Platysma m.; skin Paraspinal (levatorscapulae, spleniuscapitis) m.
VI Anterior cervical nodes Bottom edge of the bodyof hyoid bone Sternal manubrium Skin; platysma m. Posterolateral edge of sternohyoid m. Medial edge of commoncarotid artery, skin andanterior±medial edge ofsternocleidomastoid m. Midline
  Retropharyngeal nodes Base of skull Cranial edge of the bodyof hyoid bone Levator veli palatini m. Prevertebral m. (longuscolli, longus capitis) Medial edge of internalcarotid artery Midline
Lymph nodes of head and neck

Lymph nodes of head and neck

 

 

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)

 

IASLC - Lymph node stations

IASLC - Lymph node stations

 

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)

Hepatic segmentation

Hepatic segmentation

 

Peritoneal Cancer Index

Peritoneal Cancer Index

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