Bruno Grignon

Recent advances in medical imaging: anatomical and clinical applications

The aim of this paper was to present an overview of the most important recent advances in medical imaging and their potential clinical and anatomical applications. Dramatic changes have been particularly observed in the field of computed tomography (CT) and magnetic resonance imaging (MRI). Computed tomography (CT) has been completely overturned by the successive development of helical acquisition, multidetector and large area-detector acquisition. Visualising brain function has become a new challenge for MRI, which is called functional MRI, currently based principally on blood oxygenation level-dependent sequences, which could be completed or replaced by other techniques such as diffusion MRI (DWI). Based on molecular diffusion due to the thermal energy of free water, DWI offers a spectrum of anatomical and clinical applications, ranging from brain ischemia to visualisation of large fibrous structures of the human body such as the anatomical bundles of white matter with diffusion tensor imaging and tractography. In the field of X-ray projection imaging, a new low-dose device called EOS has been developed through new highly sensitive detectors of X-rays, allowing for acquiring frontal and lateral images simultaneously. Other improvements have been briefly mentioned. Technical principles have been considered in order to understand what is most useful in clinical practice as well as in the field of anatomical applications. Nuclear medicine has not been included.

Teaching medical anatomy: what is the role of imaging today?

PurposeMedical anatomy instruction has been an important issue of debate for many years and imaging anatomy has become an increasingly important component in the field, the role of which has not yet been clearly defined. The aim of the paper was to assess the current deployment of medical imaging in the teaching of anatomy by means of a review of the literature.MaterialsA systematic search was performed using the electronic database PubMed, ScienceDirect and various publisher databases, with combinations of the relevant MeSH terms. A manual research was added.ResultsIn most academic curricula, imaging anatomy has been integrated as a part of anatomical education, taught using a very wide variety of strategies. Considerable variation in the time allocation, content and delivery of medical imaging in teaching human anatomy was identified. Given this considerable variation, an objective assessment remains quite difficult.DiscussionIn most publications, students’ perceptions regarding anatomical courses including imaging anatomy were investigated by means of questionnaires and, regardless of the method of teaching, it was globally concluded that imaging anatomy enhanced the quality and efficiency of instruction in human anatomy. More objective evaluation based on an increase in students’ performance on course examinations or on specific tests performed before and after teaching sessions showed positive results in numerous cases, while mixed results were also indicated by other studies.ConclusionA relative standardization could be useful in improving the teaching of imaging anatomy, to facilitate its assessment and reinforce its effectiveness.

Anatomy and medical imaging: a symbiotic relationship

Keywords Anatomy Cross-sectional Computedtomography Diffusion tensor imaging X-ray Magnetic resonance imaging fMRIIn 1895, the anterior-posterior plain radiograph of the lefthand of Anna Bertha, the wife of Professor WilhelmConrad Roentgen, physicist in Wu¨rstburg (Germany) wasthe first step of medical imaging [8]. For almost one cen-tury, X-ray projection was the unique tool available fordepicting the human body; what is now called medicalimaging was then called radiography. Directly, X-raysallow only accurate imaging of the bones and the lungs.Direct soft tissue depicting by X-ray projection is verypoor, but progressive use of varied contrast media broughtan important contribution to the field. Through theirinjection into the blood or the lymphatic vessels, as well asinto various organs or anatomical spaces, such as the joints,the digestive tract, the subarachnoidal space, etc., thesecontrast media have gradually enlarged the spectrum ofexploration by X-rays.In the 1970’s, the advent of computed tomography (CT)[1–3], paralleled by ultra-sonography (US) [4] and, later,that of magnetic resonance imaging (MRI) [6] opened thefield of cross-sectional imaging and really revolutionizedthe field of radiography by moving it into true medicalimaging. A new era had begun: the anatomy of livinghuman beings could be depicted by this truly new field inthe medical practice [7].Within the last two decades, there have been otherdramatic improvements observed. Today, medical imagingallows for visualizing long fibrous structures such as thebundles of white matter of the brain through diffusiontensor imaging, as well as depicting the human brain inactivity with functional MRI, or imaging motion of thejoints, among others [5].It must be underlined that the tremendous progress in thefield of informatics has paralleled that of imaging tech-nologies. As a unique example, the plain radiograph filmhas almost completely been replaced by digital images.Continuous technical progress is changing the capabilityof medical imaging techniques almost every day, currentlyallowing for more and more accurate anatomical studies ofliving human beings.The aim of this special issue of Surgical and RadiologicAnatomy is to illustrate a large number of the modernmedical imaging techniques as well as how they can beused for proper anatomical applications.It has been composed by an international panel ofauthors and offers particular insights into the main modernimaging methods, by covering a wide range of anatomicaltopics. They include head and neck, central nervous sys-tem, abdomen and pelvis, musculoskeletal system, andvessels. They have been sorted according to the kind ofimaging technique in order to illustrate the spectrum ofimplementation for each of them.A general review purposes an overview of the mainrecent advances in the field of medical imaging especiallyin order to highlight their potential anatomical applications.The pedagogical section is devoted to anatomicaldrawing. Obviously, it has no specificity to medical

Reflections about the cranial nerves destinated to the face: plea for a global approach including nerves and their branches, canals, vessels, distribution and clinical relevance

this global approach may also be justified by the reciprocal impact of the nerves growth, with great effect about the bone growth. Moreover, the embryology supports this parallel development of nerves, bones and vessels, and the importance of the deflexion of the craniocervical junction after birth must also be considered. Nerves I and II are specific sensorial cranial nerves, but nerves V and VII are sensory motor nerves, with nuclei originating from branchial arches 1 and 2, respectively. the true origins (within the brain or brainstem) and the appearing origins (the site where the nerves get out of the brain or brainstem) are not concerned in this compilation of articles, or the courses of the trunks and the ganglia in the cranial cavity. the recent techniques of medical imaging have strongly improved the depiction of the nerves and of their main branches, but the course of the ending branches can present important variations, and may be determined through the visualization of the bone canals they run through, and with evaluation of the accompanying vessels. two aspects of the course of the olfactory nerve are presented, related to the aspect of the cribriform plates the branches will cross and to the possibilities of variations of the olfactory artery. An unusual position of the ophthalmic artery is presented that may go through the superior orbital fissure but not through the optic canal with the optic nerve, and with origin from a branch of the external carotid artery. Distal branches of the Maxillary Nerve V2 and Mandibular Nerve V3 will be evoked with the courses through the canals and their ending zones. the intensive improvements of the plastic surgery lead to a great number of researches and publications in the field of applied and clinical anatomy. We have associated in this issue one article about the innervations of the Corrugator Cranial nerves I, II, V and VII are destinated to the face and carry sensory and motor fibers. they are usually presented through a neuro-anatomical aspect (true origin, appearing origin, course, distribution), and our purpose was to emphasize the interest of a more global approach with giving interest to the canals, the accompanying vessels, the variations in course and distribution, and the clinical relevance. the importance of the depiction of anatomy had been previously supported [1], and we propose in this issue to emphasize the interest of the imaging of the structures

Val M. Runge, Wolfgang R. Nitz, Johannes T. Heverhagen: the physics of clinical MR taught through images

Today, magnetic resonance (MR) imaging stands as a major diagnostic radiology technique, with a perpetual challenge: connecting clinical professionals with ever-advancing tools developed by MR scientists, and vice versa. To teach through images a practical approach to MR physics and imaging quality is the aim of this handy manual. This visual book is divided into eight sections, subsequently devoted to: hardware, basic imaging physics, basic imaging acquisition, advanced imaging acquisition, flow, tissue-specific techniques, artifacts, and technologic innovations. Finally, a very useful appendix offers a handy list of the main acronyms used by the major MR equipment vendors. Each section is composed of concise chapters dealing with an important point relevant to clinical MR, systematically presented on two pages, separately numbered (140 chapters in all), and referred to by an additional index at the end of the book, allowing a very quick and practical access. The topics covered encompass the breadth of the field, as well as discussion of the latest hardware and software innovations (such as MR PET, interventional MR, and 4D flow, among others). In keeping with the title, this work provides more than 700 illustrations, composed of clinical images, anatomical drawings, histologic correlations, charts, and diagrams including in particular pulse sequencing and magnetization curves. This book is the fourth edition of a first version published in 2005. Regarding the authors, Val M. Runge, and Johannes T. Heverhagen, respectively, Practicing Radiologist and Editor-in-Chief of Investigative Radiology, and Professor and Director, work both in the University Institute of Diagnostic, Interventional, and Paediatric Radiology Inselspital, University Hospital, Bern, Switzerland; Wolfgang R. Nitz is Assistant Professor of Experimental Radiology, University Hospital of Regensburg, Regensburg, Germany, and Senior Patent Manager, Siemens GmbH, Erlangen, Germany. An international panel of seven German, Swiss, American, and Canadian contributors has collaborated in writing this book. Richly illustrated, concise, up-to-date, and easy-to-use, this handbook is an interesting tool for learning, leveraging, or mastering the capabilities of MR. As a result, it may be of great interest for all physicians and technologists dealing with MR.

Martin Vahlensieck, Maximilian Reiser: MRI of the musculoskeletal system

This book is the second English edition of an exhaustive review of the most important principles and clinical applica‐ tions of musculoskeletal magnetic resonance (MR) imaging, including the latest advanced techniques. The editors are Martin Vahlensieck, Professor of Radiol‐ ogy in Bonn, Germany, and Maximilian Reiser, Professor of Radiology in Munich, Germany. An international panel of 22 German, Austrian, Swiss and American contributors has collaborated in writing this work. It is divided into 16 chapters, in sequential order devoted to: magnetic resonance imaging technique, the spine, the shoulder, the elbow, the wrist and fingers, the hip and pelvis, the knee, lower leg, ankle and foot, the temporomandibular joint, the muscles, bone marrow, bone and soft tumor, osteo‐ porosis, the sacroiliac joints, the jaws and periodontal appa‐ ratus, and miscellaneous minor topics sorted in an appendix. Each chapter includes: choice of sequences, selection of coils, patient positioning, technical parameters and pro‐ tocols, when/how to use contrast, anatomical and clinical reminders, pathological findings, pitfalls in interpreting the images, comparison of MRI with other imaging modalities, by means of a concise and comprehensive text, numerous pedagogical drawings, tables, some photographs and ana‐ tomical specimens, and, most of all, more than 2,000 MR images, all of high quality and large size. A precise plan including the page number of the corre‐ sponding paragraphs is displayed at the beginning of each chapter, in addition to the main table of contents and the subject index, allowing a practical and quick use of the book. In addition to updated references displayed at the end of each chapter, internet sites have been referred to by the authors, and research tips on more effective use of internet search terms are also given. A short section, entitled “Clini‐ cal Interview”, concludes each chapter with the opinions of a renowned clinical radiologist regarding some debatable issues in the field. Designed to accompany the radiologist at the worksta‐ tion on a daily basis, this updated, complete, and wonder‐ fully illustrated work may be of great value for all physicians responsible for the care of musculoskeletal disorders.

Arteries: anatomy, imaging, clinical, and surgical relevance

The main part of this issue (Surg Radiol Anat 2018, 07) is devoted to the clinical anatomy of “Arteries”. When searching with using the term “artery” in the titles of the submitted manuscripts, it appears that more than 100 submissions to our journal per year are related to this field of anatomical research. The articles included in this issue show the large distribution of these studies: abdominal wall, intra-abdominal cavity, retroperitoneal space, heart and aorta, limbs, head, and neck. The intrastructural aspect of the arterial networks is also presented through the study of vasa-vasorum. The aberrant arteries and the numerous anatomical variations of vessels represent some important risks during medical imaging and surgical procedures, and the knowledge of these unusual aspects and topographies is necessary for specialists in daily practice. In this various and rich part of anatomical studies about the vessels, some specific indications in plastic surgery concern the perforators and perforasomes, the pedicled flaps, and the anatomical basis of techniques of rerouting arteries, and will be grouped in the future Surg Radiol Anat issue devoted to Anatomy and Plastic Surgery.

Hector Ferral, Jonathan M. Lorenz: RadCases Interventional Radiology Second Edition

The aim of the “RadCases” series is to provide case-based radiology review books in all fields of medical imaging, using both printed material and electronic cases, to help the residents for their exams as well as for their daily practice. This volume is specifically devoted to the subspecialty of interventional radiology and offers 100 carefully selected and well-documented of vascular and nonvascular cases (plus additional 250 electronic cases available online). The general organization of this book is similar to that of the other volumes of the series. On the right-hand page, the clinical presentation including one, two, three or four images (radiograph, arteriogram, computed tomography, magnetic resonance imaging and/or Doppler) is displayed. On the back of this page, imaging findings are discussed, the definitive diagnosis and differential diagnoses are presented, and essentials facts, as well as pearls and pitfalls, are highlighted. Case questions and answers are then proposed in a subsequent section. At the end of the book, a list of further readings (including one or two essential references) is proposed for each case. Finally, an alphabetical index allows referring primary diagnoses to case numbers. In addition, the volume includes a code allowing 1 year of access to Thieme’s online database of 350 cases (the 100 cases in the book plus additional 250 cases). As well as the other books of the RadCases series, it combines the portability of printed books with the interactive features of an electronic case-based format. The authors are Hector Ferral and Jonathan M. Lorenz, respectively, Professor of Radiology, Section of Interventional Radiology, University of Chicago, Illinois, USA, and Senior Clinician Educator, Section of Interventional Radiology at NorthShore University HealthSystem, Evanston, Illinois, USA. This volume is the second edition of a previous one published in 2010, providing 100 new cases, and an additional case questions and answers section. This work is attractive by its practical and pedagogical presentation. It offers on two pages the main imaging features, essential facts, pearls and pitfalls, differential diagnoses, with one or two references, covering the most common cases of interventional procedures. The critical remarks that could be made are the small size of several pictures, and the lack of logical order in the presentation of the cases. Mainly devoted to residents in radiology, this book may also be of use to more experienced radiologists and other physicians dealing with interventional radiology.

Friar Leopold Mandic (1866–1942): the computed tomography of the body of a saint

PurposeIn forensic clinical anatomy computed tomography (CT) is used in post-mortem radiological investigation as an objective nondestructive documentation of the body surface and of the interior of the body. This technique is applied also in paleopathology, in particular in mummy studies, with the aim of providing a permanent record of the mummy’s features, investigating the embalming procedure employed and analyzing the extent of the preservation in detail.MethodsFor the Extraordinary Jubilee of Mercy, the mortal remains of Saint Leopold Mandic and Saint Pio da Pietralcina, as examples of Mercy known by everyone, have been brought to Rome in February 2016. During the survey that preceded the preparation for transport to Rome, a whole-body CT was performed on the mummified corpse of Leopold Mandic, Capuchin Saint of Padova, Italy.ResultsThe CT examination demonstrated the presence of osteoarthritis at the level of the vertebral column, of the left knee and of the left hand. Moreover, CT showed the preservation of skeleton and partial preservation of the some viscera, such as remnants of the brain, heart, oesophagus, urinary bladder, plexuses and spinal nerves, ear ossicles, major arterial vessels (aorta and carotid arteries). It is to emphasize the fact that Saint Leopold was not subjected before the CT to any conservative treatment.ConclusionsComputed tomography demonstrated to be a non-destructive method to investigate Saint Leopold, in order to maintain the integrity of the body and to acquire data on his pathologies and on his preservation. CT allows not only the acquisition of sectional images but also, thanks to dedicated software, the post-processing and reconstruction of three-dimensional models, that can be used also for public displays.

Baljendra S. Kapoor, Jonathan M. Lorenz: Digestive disease interventions

Inspired by the enthusiasm and expertise of the meetings organized by the American Society of Digestive Disease Interventions and endorsed by the Society of Interventional Radiology, this work aimed at providing a comprehensive resource covering image-guided gastro-intestinal interventions of a full spectrum of pathologies. It is composed of 30 chapters reviewing the multidisciplinary management of gastro-intestinal disorders with an emphasis on management options offered by interventional radiologists. A first chapter is devoted to recent advances in intraprocedural imaging, including in particular cone-beam computed tomography (CBCT), and navigational tools in practice. The second chapter deals with the role of multidetector computed tomography (MDCT) in two major vascular disorders, namely, acute gastro-intestinal hemorrhage and acute mesenteric ischemia, with a focus on appropriate scan protocols, imaging diagnosis, and diagnosis pitfalls. A more detailed chapter on mesenteric ischemia, including especially treatment options, is subsequently presented. Disease knowledge and management of portal hypertension and its complications are the topic of four succeeding chapters. The management of nonvariceal, respectively, upper and lower hemorrhages is presented in two specific chapters. The treatment of benign biliary strictures, malignant obstructive jaundice, acute cholecystis, cholelithiasis, and choledocholithiasis is the topic of three other chapters. An amount of 11 chapters is devoted to the state-of-the-art management of liver cancer and metastases, cholangiocarcinoma, and pancreatic cancer, including imaging, staging, ablation, tumor embolization, portal vein embolization, liver transplant complications, and Y-30. The interventional management of benign refractory ascites, percutaneous enteral access, colorectal obstruction, and intra-fluid collections is discussed in four specific chapters. Updates on recent advances and future directions such as bariatric embolization and islet cell transplantation are presented in two other chapters. A last chapter is devoted to pediatric gastro-intestinal interventions. The authors are, respectively, Baljendra S. Kapoor, Associate Professor of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA, and Jonathan M. Lorenz, Professor of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois, USA. A panel of 62 American contributors has collaborated in writing this work. Up-to-date, richly illustrated, and clearly presented, this book will be of interest for all practitioners dealing with gastro-intestinal interventional radiology.