Brain Anatomy on CT - Axial Landmarks

            Normal brain CT. This is an "XXX" slide - look for the bony "X", the CSF "X" just above that, and the "X" formed by the lateral ventricles. These landmarks are:

Top row:

1. The bony "X" formed by the sphenoid wings anteriorly and the petrous temporal bones posteriorly marks the margins of the anterior, middle and posterior cranial fossae. This is where to look for contusions (basal frontal lobe), HSV encephalitis (medial temporal lobes) and coning (prepontine cistern patency). The centre of this "X" is the location of the pituitary fossa and gland.

2. Just above the bony "X" is a "CSF X", formed by the Sylvian fissures, the central (suprasellar) cistern, and the prepontine and interpeduncular cisterns. This is where to look for aneurysmal SAH and the "dense MCA sign" of early MCA infarction.

Middle row:

1. The lentiform nuclei (putamen and globus pallidus), caudate nucleus and internal capsule on each side lie between the anterior and posterior horns of the lateral ventricles. In front of the anterior horns is the genu of the corpus callosum (forceps major), while behind the posterior horns is the splenium of the corpus callosum (forceps minor).

2. An "X" drawn connecting the four horns to the closest cortical grey matter roughly marks out the watershed zones between the ACA, MCA and PCA territories. The insular cortex and basal ganglia are the place to look for loss of grey-white differentiation in early large MCA infarcts. The third ventricle (in the midline) is surrounded by the thalami. 

3. Posteriorly, in the midline, the falx can be seen progressively extending anteriorly from the occipital protuberance (leftmost image) towards the pineal region (rightmost image). Where the falx is seen, the adjacent brain parenchyma must be the occipital lobes; where it isn't, it's the cerebellum. The anterior limit of this falx marks the apex of the U-shaped attachment of the tentorium, which is sloped.

WHXR Sunshine ED Brain CT 071001.007-001.jpg

Taken on: December 26, 2007

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