Biomedical subjects
Publications and source records attributed to L A Hayman.
This article is the first in a series of three that organizes the complex anatomy of the cervical, thoracic, and lumbar spinal ligaments. It describes and color-codes the anatomy and nomenclature of the dorsal ligaments. The following articles will describe the ventral ligaments, and the capsular membranes and minor ligaments.
This paper is the second in a series of three that organizes the complex anatomy of the cervical, thoracic, and lumbar spinal ligaments. It describes and colorcodes the anatomy and nomenclature of the ventral ligaments. A prior article has described the dorsal ligaments, and a future article will illustrate the capsular joints and minor spinal ligaments.
This paper is the third in a series of three that organizes the complex anatomy of the cervical, thoracic, and lumbar spinal ligaments. It describes and color-codes the anatomy and nomenclature of the capsular membranes and minor spinal ligaments. The first two articles describe the dorsal and ventral ligaments, respectively.
This series of three articles is structured to provide anatomically accurate functional schematics of the motor and sensory innervation of the shoulder and upper limb. This first paper provides radiographically oriented sagittal sections through the brachial plexus to assist in directly identifying a plexal lesion. A coronal schematic of the brachial plexus and summary table allows prediction of unique patterns of denervation from 19 lesion sites. Correlation between the lesion and the denervation pattern ensures the lesion is, in fact, clinically significant. The next two articles will present a color-coded atlas that allows the radiologist to quickly assess patterns of denervated muscles and thereby indirectly localize the lesion site. Thus, the three articles can be used together to predict the clinical picture for a given nerve lesion or extrapolate lesion location when a constellation of denervated muscles are seen on an upper limb magnetic resonance imaging or electromyographic study.
This article is the second in a series of three that presents an anatomic functional guide to the peripheral innervation of the shoulder and upper limb. It illustrates the axial anatomy of the shoulder and upper arm. The next article continues this format for the lower arm and hand. Together, all three papers can be used to rapidly identify each upper limb muscle and its innervation(s). They can also be used to locate the peripheral nerve trunks, and correlate lesions with the classic pattern(s) of muscle denervation and altered sensation.
This paper is the last of three articles that describe the functional anatomy of the upper limb. It extends the series by presenting the axial anatomy of the forearm and hand. In addition, it provides a table that defines the patterns of muscle denervation specific to six representative sites. This set of articles is clinically useful because it can be used to rapidly identify and describe the innervation of the muscles and skin of the upper limb.
The mediastinum is a complex region that is variously subdivided by radiologists, surgeons and anatomists. This paper describes the most popular of these classifications and color-codes the radiologic and surgical divisions on 22 labeled axial sections of the chest. This allows the reader to quickly name the appropriate location of a lesion on any section.
This series of two articles is structured to provide anatomically accurate functional schematics of the motor and sensory innervation of the lower back, hip, and lower limb. This first paper provides radiographically oriented schematic axial sections of the lower back and hip in which the muscles are appropriately color-coded to match the peripheral nerves. A companion color-coded summary table allows prediction of unique patterns of denervation from 25 lesion sites. These are divided into three categories (roots T12 to S4, four plexal quadrants, and 11 sectional levels). Correlation between an imaging abnormality at one of these lesion sites and the predicted denervation pattern ensures the lesion is, in fact, clinically significant. The next article will continue this color-coded approach into the lower limb.
The authors have produced a pair of articles that can be used to rapidly identify back, hip, and lower limb muscles and their innervation(s). This article presents the motor and sensory innervation of the lower limb by color-coding structures to match their peripheral nerves. It provides a companion summary table that allows prediction of unique patterns of denervation from 12 lesions sites.
The purpose of this article is to describe the complex anatomy of the pelvic ligaments. It uses schematics to display 10 color-coded ligaments in relation to the bony architecture. This atlas and the accompanying summary of the classification of pelvic ligamentous injuries is designed to encourage the use of magnetic resonance imaging in cases of pelvic ring trauma.
High-resolution magnetic resonance (MR) imaging of the orbit has become widely accepted as a valuable diagnostic technique. However, there are a number of artifacts and pitfalls associated with orbital MR imaging. Chemical shift artifacts may be induced by orbital fat or silicone oil used to treat retinal detachment. Motion artifacts are caused primarily by unavoidable globe motion during imaging. Artifacts due to a nonuniform magnetic field are particularly noticeable at air-tissue interfaces but may also be caused by incomplete fat saturation or highly magnetic materials near the orbit. Protocol errors may cause artifacts such as saturation, phase wraparound, truncation, shading, and partial-volume artifacts. This information can be used to improve orbital image quality and avoid misinterpretation of image artifacts. Use of fat saturation, silicone saturation, and careful patient screening for metal near the eyes and instruction to reduce motion can help reduce the occurrence of artifacts. In addition, optimal imaging technique is essential and should include use of proper surface coils, plane of section, and pulse sequences.
Magnetic resonance (MR) imaging of the spine has become widely accepted as a valuable diagnostic tool. However, there are a number of artifacts and pitfalls associated with spinal MR imaging. Chemical shift artifacts may be induced by bone marrow, epidural fat, or intradural fat. Motion artifacts arise from several sources, which include respiration, flow of fluids, and swallowing. Artifacts due to a nonuniform magnetic field are particularly noticeable within trabecular bone or at bone-soft tissue interfaces but may also be caused by incomplete fat saturation or the presence of metal near the spine. Protocol errors may cause artifacts such as saturation, phase wraparound, truncation, radio-frequency interference, shading, and partial volume averaging. Use of fat saturation, use of motion and flow compensation, and careful screening of patients for metal in clothing can help reduce the occurrence of artifacts. In addition, use of an optimal imaging technique is essential and should include use of the proper surface coil, field of view, and pulse sequence.
An anatomic and imaging atlas was created to provide detailed information about the six pairs of thoracic nerves (phrenic nerves, vagus nerves, recurrent laryngeal nerves, sympathetic trunks, costal nerves, long thoracic nerves). Serial axial computed tomographic (CT) scans of the normal thorax were obtained and included in the atlas, along with drawings showing the proper location of each nerve relative to adjacent anatomic structures. CT scans obtained in both symptomatic and asymptomatic patients with various thoracic diseases were paired with appropriate drawings and normal CT scans in the atlas. This format was designed to help determine the presence and severity of related disease, including injury from surgery, trauma, or penetrating injury, metastatic disease involvement, and, rarely, primary tumor. Although the nerves of the thorax are rarely identified at cross-sectional imaging, their location can be inferred by localizing easily identified anatomic landmarks. Familiarity with the functional anatomy and clinical significance of the nerves of the thorax is important for the correct interpretation of thoracic images.
Non-invasive methods are described for estimating local cerebral blood flows (LCBF) and partition coefficients (L lambda) during inhalation of 35% stable xenon gas (Xes) in oxygen during CT scanning. After denitrogenation by 100% oxygen breathing, 35% Xes is breathed for 7-8 minutes to minimize subanesthetic effects. Mean changes in brain Hounsfield units extrapolated to 15 minutes were 7.7 units for white matter and 5.3 units for gray matter. They were measured from volumes 80 cubic mm (10 mm2 area x 8 mm), or larger with an EMI 1010 scanner at 1 minute intervals. These data were used for computing LCBFs and L lambdas. Irradiation measured at the center of brain slices was 1 rad per minute. To calculate L lambdas about 6 exposures are necessary, thereafter, each 1 minute scan provides LCBF measurements for 2 adjacent 8 mm slices. Reproducibility for LCBF was r = 0.85 (P less 0.001). Mean L lambdas were 0.86 +/- 0.08 for gray and 1.34 +/- 0.10 for white matter. Normative mean flows (mls/100 g brain/min) were: basal ganglia = 79.6 +/- 9.3, cortex = 82.3 +/- 8.5, white matter = 29.2 +/- 5.9, midbrain tegmentum = 94.3 +/- 14.8, cerebellar cortex = 80.1 +/- 10.9, dorsal pons = 89.3 +/- 4.7, brachium pontis = 35.0 +/- 4.2. Subject finger exercises produced increases of LCBF in contralateral pre-central and post-central gyri. Eye closure decreased flow values limited to the visual system. Gray matter flow values diffusely decreased in non-REM sleep but increased above normal in REM sleep. Cerebral infarction and hemorrhage resulted in zones of zero flow with borders having reduced lambdas and low flows attributed to edema.
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We reviewed the current literature and theories pertaining to the appearance of hemorrhage on MR images. New theories were formulated to explain the etiology of spin-echo (SE) and gradient-echo contrast on clinical MR images of hematomas at low and intermediate field strengths. It is our hope that these theories will prompt further experiments to prove or disprove their validity. The discussion of SE contrast focuses on the powerful MR effects mediated by changes in protein concentration. These changes are postulated to occur as a result of (1) clot matrix formation; (2) settling of RBCs, which increases the number of RBCs per unit volume and the total protein concentration; and (3) alterations in intracellular protein concentration caused by changes in RBC hydration. The contribution of acid methemoglobin to image contrast via the proton electron dipole-dipole mechanism is also included. The discussion of gradient-echo contrast focuses on the inhomogeneity that may be present within voxels that contain a blood clot. This inhomogeneity results when the voxel contains regions with different magnetic susceptibilities (i.e., clumped RBCs and serum). Two temporally arranged schemata for T2-weighted and T1-weighted SE scans are presented that illustrate how these factors might interact to explain the diverse appearance of hematomas on clinical SE images. The signal intensity on T2-weighted SE scans appears to be dependent primarily on the state of hydration of the RBC. This factor and the presence or absence of methemoglobin appear to be the major factors that govern contrast on T1-weighted SE images.
MR scans were obtained at 0.5 and 1.0 T in 40 patients with 46 intracerebral hematomas categorized as hyperacute (0-2 days), acute (3-7 days), subacute (8-14 days), and chronic (15 days to 6 years). In a retrospective review, the signal intensity of the lesions was compared with that of normal white matter of the brain on spin-density, T1-, and T2-weighted spin-echo and T1-weighted gradient-echo sequences. The classic appearance and evolution of hematomas described in the literature at 1.5 T were not found in a significant number of the cases reviewed. In the hyperacute group, only five of eight hematomas had signal intensities that were hypointense relative to brain on T2-weighted images. Two of eight hyperacute hematomas were hyperintense relative to brain on the T1-weighted spin-echo images. However, T1-weighted gradient-echo images reliably demonstrated a hypointense signal in some portion of the hematoma in 45 of 46 cases. We conclude that while there is no constant temporal pattern on spin-echo or gradient-echo sequences, there are signal-intensity changes suggestive of hemorrhage in nearly all hematomas imaged at 0.5 and 1.0 T. Although the inconsistency may be frustrating from a diagnostic standpoint, this variability may reveal important individual differences in hematomas and the brain that surrounds them, and thus be clinically significant. Before these data can be mechanistically analyzed, the reason for contrast on MR scans of hematoma must be better understood.
A multicenter prospective study was performed in 49 patients with 77 regions of cerebral infarction. Each patient was evaluated in the acute (0-5 days) and subacute (6-17 days) phases by (1) clinical neurologic examination, (2) CT scans, and (3) N-isopropyl-p-123I-iodoamphetamine (123IMP) single-photon emission CT (SPECT) scans. The abilities of the scans to (1) detect a lesion and (2) predict the clinical outcome were assessed. For lesion detection, 123IMP-SPECT was superior to CT in the first 2 days, but the scans were equally effective 3-5 days after onset. In the subacute phase, IV contrast-enhanced CT was superior to 123IMP-SPECT and unenhanced CT. The clinical outcome was only mildly correlated with the results of the acute and subacute 123IMP-SPECT and the acute CT scans. Reduction in lesion size on the subacute scans did not correlate with clinical improvement. We conclude that the parameters measured by CT and 123IMP-SPECT in patients with acute cerebral infarction cannot reliably be used to predict clinical outcome. 124I contamination of 123IMP and the use of low-energy collimators may have decreased lesion detectability.