Medical Sciences-Radiology Department

CT Brain: Part 2
Anatomy

Dr.Hussein Ali, MD

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Medical Sciences-Radiology Department
Skull Bones
Bones of the skull and skull base:
frontal, parietal, occipital, ethmoid, sphenoid and temporal bones all
ossify separately and gradually become united at the skull sutures.

The skull has inner and outer tables of cortical bone with central
cancellous bone called 'diploe'. By Dr.Hussein Ali, MD 2
Medical Sciences-Radiology Department
CT Brain: Bones-Bone Window

Skull bone structure - CT brain - (bone windows)

By Dr.Hussein Ali, MD 3
Medical Sciences-Radiology Department
Skull Sutures
The sutures are fibrous connections between bones of the skull
Sutures allow for some flexibility of the cranium
Fontanelles (aka “soft spots”) are unfused areas where sutures meet
Sutures ossify at various times throughout life

By Dr.Hussein Ali, MD 4
Medical Sciences-Radiology Department
Skull Sutures
The main sutures of the skull are the coronal, sagittal, lambdoid and
squamosal sutures. The metopic suture (or frontal suture) is variably
present in adults.

Coronal suture - unites the frontal bone with the parietal bones
Sagittal suture - unites the 2 parietal bones in the midline
Lambdoid suture - unites the parietal bones with the occipital bone
Squamosal suture - unites the squamous portion of the temporal bone with the parietal
bones
Metopic suture - (if present) unites the 2 fontal bones
By Dr.Hussein Ali, MD 5
Medical Sciences-Radiology Department
CT Brain: Bones and Sutures-Bone Window

Sagittal Suture
Parietal Bone

Cranial sutures. Axial computed Parietal Bone

tomography of the skull (CT
Brain by bone window) Lambda

By Dr.Hussein Ali, MD Lambdoid Suture 6

Medical Sciences-Radiology Department
CT Brain: Bones and Sutures-Bone Window

Coronal Suture

Bregma

Parietal Bone

Lambdoid Suture
Occipital Bone

Cranial sutures. Axial computed tomography of the skull 7

By Dr.Hussein Ali, MD
Medical Sciences-Radiology Department
CT Brain: Bones and Sutures-Bone Window

Cranial sutures. Axial computed tomography of the skull (a)

showing the metopic suture (MS), sagittal suture (SS), and
(b), the lambdoid suture (LS).
By Dr.Hussein Ali, MD 8
Medical Sciences-Radiology Department
CT Brain: Bones and Sutures-Bone Window

Axial suture evaluation. Bone algorithm axial CT images of a

6-month-old head (A) at 5-mm intervals, demonstrating
sample measurements of the sagittal suture and of a 0-
month- old head (B) at 5-mm intervals, demonstrating
sample measurements of the coronal suture. 9
By Dr.Hussein Ali, MD
Medical Sciences-Radiology Department
CT Brain: Bones and Sutures-Bone Window

Skull bone structure - CT brain - (bone windows)

By Dr.Hussein Ali, MD 10
Medical Sciences-Radiology Department
Skull Borders

Cranial fossae
At the skull base the bones of the cranial vault form the cranial fossae
which accommodate and support the brain.
By Dr.Hussein Ali, MD 11
Medical Sciences-Radiology Department
Skull Borders
The anterior cranial fossae
consists of three bones:
1. The frontal bone.
2. The ethmoid bone.
3. The sphenoid bone.
The middle cranial fossae
consists of three bones:
1. The sphenoidbone.
2. The temporal bone.
3. The parietal bones
The posterior cranial fossae
consists of two bones:
1. The occipital bone.
2. The parietal bone.

By Dr.Hussein Ali, MD 12
Medical Sciences-Radiology Department
CT Brain: Cranial Fossae-Bone Window

• Anterior cranial fossae - accommodates the anterior part of the

frontal lobes
• Middle cranial fossae - accommodate the temporal lobes
• Posterior cranial fossae - accommodates the cerebellum and brain
stem
• Pituitary fossa (PF) - accommodates the pituitary gland 13
By Dr.Hussein Ali, MD
Medical Sciences-Radiology Department
Brain Meninges
Meninges
• The meninges are thin layers of tissue found between the brain
and the inner table of the skull. The meninges comprise the dura
mater, the arachnoid, and the pia mater. The dura mater and
arachnoid are an anatomical unit, only separated by pathological
processes

By Dr.Hussein Ali, MD 14
'.
Medical Sciences-Radiology Department
CT Brain: The meninges-Soft Tissue Window
• The falx cerebri and the tentorium cerebelli are thick infoldings of the meninges
which are visible on CT imaging. Elsewhere the meningeal layers are not visible
on CT as they are closely applied to the inner table of the skull.

• Dura mater = tough outermost layer, closely applied to the inner table of the skull
• Arachnoid = thin layer closely applied to the dura mater
• Subarachnoid space = space between the arachnoid mater and the pia mater which
contains delicate trabeculated connective tissue and CSF
• Pia mater = very thin layer applied to the surface of the brain By Dr.Hussein Ali, MD15
Medical Sciences-Radiology Department
Brain Lobes
Brain lobes
The brain has paired, bilateral anatomical areas or 'lobes'. These do not exactly
correlate with the overlying bones of the same names

By Dr.Hussein Ali, MD 16
Medical Sciences-Radiology Department
CT Brain: Brain Lobes-Soft Tissue Window

Brain lobes - CT brain (superior slice)

• On both sides the frontal lobes are separated from the parietal
lobes by the central sulcus (arrowheads)
• The frontal lobes are large and the parietal and occipital lobes are
relatively small By Dr.Hussein Ali, MD 17
Medical Sciences-Radiology Department
CT Brain: Brain Lobes-Soft Tissue Window

By Dr.Hussein Ali, MD
Brain lobes - CT brain (inferior slice)
• The most anterior parts of the frontal lobes occupy the anterior
cranial fossae
• The temporal lobes occupy the middle cranial fossae
• The cerebellum and brain stem occupy the posterior fossa 18
Medical Sciences-Radiology Department
CT Brain: Brain Lobes-Soft Tissue Window
Lobes v 'regions'
• CT does not clearly show the anatomical borders of the lobes of the brain. For
this reason we refer to 'regions', such as the 'parietal region' or 'temporal
region', rather than lobes.
• If more than one adjacent region needs to be described then conjoined terms
can be used such as 'temporo-parietal region' or 'parieto-occipital region'

• The parietal lobe is not clearly delineated

By Dr.Hussein Ali, MD 19
from the temporal or occipital region
Medical Sciences-Radiology Department
Grey matter Vs White matter
Brain parenchyma and lobes
The brain consists of grey and white matter structures which are
differentiated on CT by differences in density. White matter has a high
content of myelinated axons. Grey matter contains relatively few axons and a
higher number of cell bodies. As myelin is a fatty substance it is of relatively
low density compared to the cellular grey matter. White matter, therefore,
appears blacker than grey matter.

• White matter is
located centrally
and appears
blacker than grey
matter due to its
relatively low
density

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By Dr.Hussein Ali, MD
Medical Sciences-Radiology Department
Grey matter Structure
Important grey matter structures visible on CT images of the
brain include the cortex, insula, basal ganglia, and thalamus.
Cerebral cortex
• The cerebral cortex is a layer of grey matter formed
in gyri(folds) over the entire brain surface.
Basal ganglia and thalamus
• The basal ganglia and the thalamus are important grey
matter structures which are located deep to the insula.

By Dr.Hussein Ali, MD 21
Medical Sciences-Radiology Department
Grey matter Structure
Insula/insular ribbon
• The insula is one of the five cerebral cortices (frontal, parietal,
temporal, occipital, insular) and is located deep to the frontal,
parietal, and temporal lobes. Function is to integrate autonomic
functions.

By Dr.Hussein Ali, MD 22
Medical Sciences-Radiology Department
CT Brain: Cortical Grey matter

• The grey matter of the cerebral cortex is formed in folds called gyri
• Note that the cortex appears whiter (denser) than the underlying white
matter By Dr.Hussein Ali, MD 23
Medical Sciences-Radiology Department
CT Brain: Insula

The insula forms an inner surface of the cerebral cortex found deep
to the Sylvian fissure
By Dr.Hussein Ali, MD 24
Medical Sciences-Radiology Department
White matter Structure
Thalamus
• The thalamus is the central relay station for sensory fibers
(except olfactory)thalamus
• Cerebral cortex communicates with thalamus
• Responsible for primitive emotional responses
➢ Fear
➢ Pleasant vs. unpleasant stimuli

Thalamus

By Dr.Hussein Ali, MD 25
Medical Sciences-Radiology Department
CT Brain: Basal Ganglia and Thalamus-ST Window

• The thalamus and the basal ganglia are readily identifiable with
CT
• Basal ganglia = lentiform nucleus + caudate nucleus
By Dr.Hussein Ali, MD 26
Medical Sciences-Radiology Department
CT Brain: Basal Ganglia and Thalamus-ST Window

• Th Basal ganglia = lentiform nucleus (Putamen & Globus

Pallidus) + caudate nucleus
By Dr.Hussein Ali, MD 27
Medical Sciences-Radiology Department
White matter Structure
• White matter of the brain lies deep to the cortical grey matter.
• The internal capsules are white matter tracts which connect with
the corona radiata and white matter of the cerebral hemispheres
superiorly, and with the brain stem inferiorly.
• The corpus callosum is a white matter tract located in the
midline. It arches over the lateral ventricles and connects white
matter of the left and right cerebral hemispheres.

By Dr.Hussein Ali, MD 28
Medical Sciences-Radiology Department
CT Brain: Corpus Callosum-ST Window

Corpus callosum
• Sagittal CT images show the corpus callosum as a midline
structure arching from anterior to posterior
By Dr.Hussein Ali, MD 29
Medical Sciences-Radiology Department
White matter Structure
Internal capsule
• Collection of axons that carry sensory information to the cortex
and motor information to the cord.
• The internal capsule is very sensitive to stroke

By Dr.Hussein Ali, MD 30
Medical Sciences-Radiology Department
CT Brain: Internal Capsule-ST Window

Internal capsules
• The internal capsules are narrow white matter tracts which
contain a high number of axons connecting the corona radiata
and cerebral hemisphere white matter superiorly to the brain
stem inferiorly
• Each internal capsule has an anterior limb and a posterior
limb connected at the 'genu' (asterisks) By Dr.Hussein Ali, MD 31
Medical Sciences-Radiology Department
CT Brain: Corpus Callosum& Corona Radiata-ST W

Corpus callosum and corona radiata

• Superior to the internal capsule the white matter widens out into the corona
radiata and then into the white matter of the cerebral hemispheres
• The corona radiata of each side is interconnected via the corpus callosum
• The anterior part of the corpus callosum is called the genu and the posterior
part is called the splenium By Dr.Hussein Ali, MD 32
Medical Sciences-Radiology Department
Tentorium Cerebelli
• A tough, fibrous structure separating the cerebrum above and
the cerebellum and brain stem below
• Provides support for the cerebrum
• Structures above the tentorium are known as supratentorial or
anterior fossa
• Structures below the tentorium are known as infratentorial or
posterior fossa

By Dr.Hussein Ali, MD 33
Medical Sciences-Radiology Department
Tentorium Cerebelli

'.

By Dr.Hussein Ali, MD 34
Medical Sciences-Radiology Department
CT Brain: Tentorium Cerebelli-Soft Tissue Window

• The tentorium cerebelli - an infolding of the dura mater - forms a tent-like sheet
which separates the cerebrum (brain) from the cerebellum
• The tentorium is anchored by the petrous bones
By Dr.Hussein Ali, MD 35
Medical Sciences-Radiology Department
CT Brain: Tentorium Cerebelli-Soft Tissue Window

• On axial slice CT images of the brain the tentorium is faintly visible passing over
the cerebellum
By Dr.Hussein Ali, MD 36
Medical Sciences-Radiology Department
Falx Cerebri
A reflexion of the dura mater located between the cerebral
hemispheres. Function is to provide support to the cerebral
hemispheres.

White matter is located centrally and

appears blacker than grey matter due to
its relatively low density

By Dr.Hussein Ali, MD 37
Medical Sciences-Radiology Department
CT Brain: Falx Cerebri-Soft Tissue Window

• The falx is an infolding of the meninges which lies in the midline

and separates the left and right cerebral hemispheres

By Dr.Hussein Ali, MD 38
Medical Sciences-Radiology Department
CT Brain: Falx & Tentorium-Soft Tissue Window

• Coronal slice CT images show that the tentorium cerebelli is

continuous with the falx cerebri

By Dr.Hussein Ali, MD 39
Medical Sciences-Radiology Department
Sulci and Gyri
• The brain surface is formed by folds of the cerebral cortex known as gyri. Between
these gyri there are furrows, known as sulci, which contain CSF.
Gyrus
• The rounded, elevated convolutions on the surfaces of the cerebral hemispheres.
Sulcus
• Lain – “groove” or “trench”
• Pleural – “sulci” (sul-sigh)
• The small cracks or dimples on the surface of the brain

By Dr.Hussein Ali, MD 40
Medical Sciences-Radiology Department
CT Brain: Sulci & Gyri-Soft Tissue Window

• Gyrus = a fold of the brain surface (plural = gyri)

• Sulcus = furrow between the gyri which contains CSF (plural
= sulci)
By Dr.Hussein Ali, MD 41
Medical Sciences-Radiology Department
CT Brain: Sulci & Gyri-Soft Tissue Window

Normal brain anatomy in the transversal plane.

By Dr.Hussein Ali, MD 42
Medical Sciences-Radiology Department
Fissures
The fissures are large CSF-filled clefts which separate structures of
the brain.

• Deep, mostly horizontal

By Dr.Hussein Ali, MD
• Insula is buried within it
• Separates temporal lobe from parietal and frontal lobes 43
Medical Sciences-Radiology Department
CT Brain: Fissures-Soft Tissue Window

• The interhemispheric fissure separates the cerebral

hemispheres - the two halves of the brain
• The Sylvian fissures separate the frontal and temporal lobes
By Dr.Hussein Ali, MD 44
Medical Sciences-Radiology Department
CSF = Cerebro-spinal fluid
CSF spaces
• The brain is surrounded by cerebrospinal fluid (CSF) within the
sulci, fissures and basal cisterns. CSF is also found centrally
within the ventricles. The sulci, fissures, basal cisterns and
ventricles together form the 'CSF spaces', also known as the
'extra-axial spaces'.
• CSF is of lower density than the grey or white matter of the brain,
and therefore appears darker on CT images.
• An appreciation of the normal appearances of the CSF spaces is
required to allow assessment of brain volume.

By Dr.Hussein Ali, MD 45
Medical Sciences-Radiology Department
CSF = Cerebro-spinal fluid
Subarachnoid Cistern(s)
• Cistern From Latin (“box”).
• The subarachnoid space is enlarged in certain places; the
subarachnoid cisterns.
• A well defined collection of CSF within the subarachnoid space
(located between the pia and arachnoid membranes).
• And also Cisterns in some places also surround
arteries/veins/cranial nerves.
• A few important subarachnoid cisterns include:
1. Suprasellar - (Star-shaped) Location of the Circle of Willis
2. Quadrigeminal - W-shaped at top of midbrain
3. Sylvian fissure; space between the temporal and frontal lobes.
4. Prepontine cisterns (transversal moon shape).
5. Cisterna magna (cerebellomedularis); caudal of the cerebellum and
dorsal of the medulla oblongata. By Dr.Hussein Ali, MD 46
Medical Sciences-Radiology Department
CSF = Cerebro-spinal fluid
Subarachnoid Cistern(s)

Overview of a number of important subarachnoid

cisterns in the sagittal plane.
By Dr.Hussein Ali, MD 47
Medical Sciences-Radiology Department
CSF = Cerebro-spinal fluid
Subarachnoid Cistern(s)

Sylvian fissure and quadrigeminal cistern (W shape) in the transversal plane.

By Dr.Hussein Ali, MD 48
Medical Sciences-Radiology Department
CSF = Cerebro-spinal fluid
Subarachnoid Cistern(s)

Suprasellar cistern (pentagon) in the transversal plane.

By Dr.Hussein Ali, MD 49
Medical Sciences-Radiology Department
CSF = Cerebro-spinal fluid
Subarachnoid Cistern(s)

Prepontine cisterns (moon shape) in the transversal plane. Fourth ventricle (IV).

By Dr.Hussein Ali, MD 50
Medical Sciences-Radiology Department
Ventricles
• The ventricles are spaces located deep inside the brain which
contain CSF.
• The ventricles are CSF-containing cavitiesventricles CSF produced
in roof of ventricles (choroid plexes)
• Circulation of CSF through ventricles and around the brain
(subarachnoid space) and cord (central canal) with reabsorption
in arachnoid villi

By Dr.Hussein Ali, MD 51
Medical Sciences-Radiology Department
Ventricles
Brainstem
• Located between the cerebrum and the spinal cord
• Provides a pathway for tracts running between higher and lower
neural centres.
• Consists of the midbrain, pons, and medulla oblongata.
• Each region is about an inch in length.

1-Midbrain
2-Pons
By Dr.Hussein Ali, MD
3-Medulla oblongata 52
Medical Sciences-Radiology Department
Ventricles
Pons
• The pons sits between the brainstem and medulla
• Controls rate and depth of breathing
• Relays impulse from medulla to cerebrum
• Clinical pathology results in:
➢ Bilateral, fixed, pinpoint pupils (comatose patient)
➢ Cheyne-Stokes breathing
▪ Hyperventialtion followed by apnea

By Dr.Hussein Ali, MD 53
Medical Sciences-Radiology Department
CT Brain: Lat. Ventricle-Soft Tissue Window

By Dr.Hussein Ali, MD
Lateral ventricles
• The paired lateral ventricles are located on either side of the brain
• The lateral ventricles contain the choroid plexus which produces CSF
• The choroid plexus is almost always calcified in adults 54
Medical Sciences-Radiology Department
CT Brain: Third Ventricle-Soft Tissue Window

Third ventricles
• The third ventricle is located centrally
• The lateral ventricles communicate with the third ventricle via small holes
(foramina of Monro).
By Dr.Hussein Ali, MD 55
Medical Sciences-Radiology Department
CT Brain: Fourth Ventricle-Soft Tissue Window

Fourth ventricles
• The fourth ventricle is located in the posterior fossa between the brain stem and
cerebellum
• It communicates with the third ventricle above via a very narrow canal, the
aqueduct of Sylvius (not shown)
Basal cisterns By Dr.Hussein Ali, MD
• CSF in the basal cisterns surrounds the brain stem structures 56
Medical Sciences-Radiology Department
CT Brain: Posterior Fossa at level of pons-ST W
The posterior fossa accommodates the cerebellum and brain stem.
Superiorly the cerebellum is separated from the cerebral
hemispheres.

Axial-The brain stem and cerebellum occupy the posterior fossa

By Dr.Hussein Ali, MD 57
Medical Sciences-Radiology Department
CT Brain: Posterior Fossa- Soft Tissue Window
The posterior fossa accommodates the cerebellum and brain stem.
Superiorly the cerebellum is separated from the cerebral hemispheres.

Sagittal CT Brain By Dr.Hussein Ali, MD

• Imaging software allows visualisation of the structures of the brain in different
planes (sagittal image reconstructed by axial cuts of CT Brain)
• The sagittal plane can be useful to show the anatomy of the brain stem
• MRI may be required if there is specific concern regarding brainstem pathology 58
Medical Sciences-Radiology Department
CT Brain: Cerebral vascular territories-ST W
• Different areas of the brain are supplied by
the anterior, middle and posterior cerebral arteries in a
predictable distribution. The posterior fossa structures are
supplied by the vertebrobasilar arteries.
• The arteries of the brain are not well visualised on conventional CT,
but a knowledge of the areas of the brain they supply is helpful in
determining the source of a vascular insult.

By Dr.Hussein Ali, MD 59
Medical Sciences-Radiology Department
CT Brain: vascular territories(above lat. Ventricle)

• The anterior cerebral arteries supply a narrow band of the cerebral

hemispheres adjacent to the midline
• The middle cerebral artery supplies the largest area of the brain60
By Dr.Hussein Ali, MD
Medical Sciences-Radiology Department
CT Brain: vascular territories(at level of insula)

• Multiple tiny perforating branches of the middle cerebral artery

supply the region of the basal ganglia and insula 61
By Dr.Hussein Ali, MD
Medical Sciences-Radiology Department
CT Brain: vascular territories(at level of Cerebellum )

• The vertebrobasilar arteries supply the cerebellum and brain stem

By Dr.Hussein Ali, MD 62
Medical Sciences-Radiology Department
CT Brain: Basilar Artery & Circle of Willis
The basilar artery
It provides blood to the posterior aspect of the Circle of Willis and is
formed from the paired vertebral arteries. Supplies blood to the pons,
cerebellum, and posterior cerebrum.
Circle of Willis
The circle of Willis is a term used to describe the arterial supply for
the brain. The circle is derived from the two internal carotid arteries
as well as the basilar artery, the latter being the continuation of the
two vertebral arteries.

By Dr.Hussein Ali, MD 63
Medical Sciences-Radiology Department
CT Brain: Basilar Artery & Circle of Willis

The basilar artery

& Circle of Willis

By Dr.Hussein Ali, MD 64
To be continued….
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