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Normal Cortical Anatomy MGH Massachusetts General Hospital Harvard Medical School NORMAL CORTICAL ANATOMY • Sagittal • Axial • Coronal • The Central Sulcus NP/MGH Sagittal Neuroanatomy NP/MGH Cingulate sulcus Superior frontal gyrus Marginal ramus of Cingulate sulcus Cingulate gyrus Paracentral lobule Superior parietal lobule Parietooccipital sulcus Cuneus Calcarine sulcus Lingual gyrus Subcallosal gyrus Gyrus rectus Fastigium, fourth ventricle NP/MGH Superior frontal gyrus Cingulate sulcus Precentral gyrus Marginal ramus of Cingulate gyrus Central sulcus Cingulate sulcus Superior parietal lobule Precuneus Parietooccipital sulcus Cuneus Calcarine sulcus Frontomarginal gyrus Lingual gyrus Caudothallamic groove Gyrus rectus NP/MGH Precentral sulcus Central sulcus Superior frontal gyrus Marginal ramus of Corona radiata Cingulate sulcus Superior parietal lobule Precuneus Parietooccipital sulcus Calcarine sulcus Inferior occipital gyrus Lingual gyrus NP/MGH Central sulcus Superior parietal lobule Parietooccipital sulcus Frontopolar gyrus Frontomarginal gyrus Superior occipital gyrus Middle occipital gyrus Medial orbital gyrus Lingual gyrus Posterior orbital gyrus Inferior occipital gyrus Inferior temporal gyrus Temporal horn, lateral ventricle NP/MGH Central sulcus Superior Temporal gyrus Middle Temporal gyrus Inferior Temporal gyrus NP/MGH Central sulcus Superior parietal gyrus Inferior frontal gyrus Frontomarginal gyrus Anterior orbital gyrus Superior occipital gyrus Middle occipital Posterior orbital gyrus gyrus Superior Temporal gyrus Inferior occipital gyrus Middle Temporal gyrus Inferior Temporal gyrus Lingual gyrus NP/MGH Precentral sulcus Superior frontal sulcus Central sulcus Postcentral sulcus Lateral fissure, Inferior frontal gyrus, posterior segment pars triangularis Inferior frontal gyrus, Angular gyrus pars orbitalis Superior Temporal gyrus Superior Temporal sulcus Middle occipital gyrus Middle Temporal gyrus Anterior occipital sulcus Inferior Temporal gyrus Inferior occipital gyrus NP/MGH Axial Neuroanatomy NP/MGH Fusiform gyrus Superior Temporal gyrus Middle Temporal gyrus Inferior Temporal gyrus NP/MGH Parahippocampal gyrus Superior Temporal gyrus Middle Temporal gyrus Inferior Temporal gyrus Hippocampal gyrus NP/MGH Amygdala Hippocampus Superior Temporal gyrus Middle Temporal gyrus Temporo-occipital fissure Inferior occipital gyrus Inferior Temporal gyrus Gyrus descendens Lingual gyrus NP/MGH Gyrus rectus Medial orbital gyrus Olfactory sulcus Subcallosal gyrus Posterior orbital gyrus Superior Temporal gyrus Amygdala Middle Temporal gyrus Hippocampus Inferior Temporal gyrus Temporo-occipital fissure Middle occipital gyrus Gyrus descendens Lingual gyrus NP/MGH Gyrus rectus Olfactory sulcus Medial orbital gyrus Anterior orbital gyrus Superior Temporal gyrus Posterior orbital gyrus Middle Temporal gyrus Parahippocampal gyrus Lingual gyrus Temporo-occipital fissure Calcarine sulcus Middle occipital gyrus Gyrus descendens Cuneus Intra-occipital sulcus NP/MGH Frontomarginal gyrus Superior frontal gyrus Anterior orbital gyrus Posterior orbital gyrus Cingulate gyrus Middle occipital gyrus Intra-occipital sulcus Superior occipital gyrus NP/MGH Superior frontal gyrus Middle frontal gyrus Inferior frontal gyrus, pars orbitalis Lateral fissure Inferior frontal gyrus, pars opercularis Inferior parietal gyrus Insula Lateral fissure Cingulate gyrus Superior temporal gyrus Parieto-occipital fissure Superior temporal sulcus Middle temporal gyrus Calcarine sulcus Middle occipital gyrus Cuneus Superior occipital gyrus Intra-occipital sulcus NP/MGH Superior frontal gyrus Middle frontal gyrus Inferior frontal gyrus Central sulcus Postcentral gyrus Lateral fissure Inferior parietal gyrus Superior temporal gyrus Lateral fissure Superior temporal sulcus Middle occipital gyrus Intra-occipital sulcus Parieto-occipital sulcus Superior occipital gyrus NP/MGH Precentral sulcus Precentral gyrus Central sulcus Central sulcus Middle occipital gyrus Cuneus Intra-occipital sulcus Superior occipital gyrus NP/MGH Superior frontal gyrus Middle frontal gyrus Superior frontal sulcus Inferior frontal gyrus Centrum semiovale Central sulcus Central sulcus Postcentral sulcus Postcentral sulcus Supramarginal gyrus Intraparietal sulcus Angular gyrus Parietooccipital sulcus Superior parietal gyrus Precuneus NP/MGH Superior frontal gyrus Middle frontal gyrus Superior frontal sulcus Central sulcus Central sulcus Supramarginal gyrus Postcentral sulcus Intraparietal sulcus Angular gyrus Pars marginalis Intraparietal sulcus Superior parietal gyrus NP/MGH Superior frontal gyrus Middle frontal gyrus Superior frontal sulcus Precentral gyrus Precentral sulcus Central sulcus Postcentral gyrus Postcentral sulcus Supramarginal gyrus Intraparietal sulcus Angular gyrus Pars marginalis Superior parietal gyrus NP/MGH Superior frontal gyrus Superior frontal sulcus Middle frontal gyrus Precentral sulcus Central sulcus Precuneus Postcentral sulcus Paracentral lobule Superior parietal gyrus Intraparietal sulcus Pars marginalis NP/MGH Coronal Neuroanatomy NP/MGH Interhemispheric Fissure Superior Frontal gyrus Inferior Frontal gyrus Middle Frontal gyrus Inferior Frontal gyrus Gyrus rectus Medial Orbital gyrus Olfactory bulb NP/MGH Superior Frontal gyrus Forceps Superior Frontal sulcus minor Middle Frontal gyrus Inferior Frontal gyrus Lateral orbital sulcus Medial Orbital gyrus Gyrus rectus Anterior Orbital gyrus Lateral orbital gyrus Olfactory Sulcus NP/MGH Circular insular sulcus Cingulate gyrus Superior Frontal gyrus Middle Frontal gyrus short insular gyrus Inferior Frontal sulcus Inferior Frontal gyrus pars opercularis Sylvian Fissure Posterior Orbital gyrus Middle Temporal gyrus Olfactory Sulcus Superior Temporal gyrus Medial Orbital gyrus Inferior Temporal gyrus Gyrus rectus NP/MGH Superior Frontal gyrus Superior Frontal sulcus Cingulate sulcus Middle Frontal gyrus Precentral sulcus Precentral gyrus Sylvian Fissure Superior Temporal gyrus Superior Temporal Sulcus Middle Temporal gyrus Amygdala Inferior Temporal gyrus Anterior commissure NP/MGH Superior Frontal Superior Frontal gyrus sulcus Cingulate gyrus Middle Frontal gyrus Precentral sulcus Precentral gyrus Sylvian Fissure Superior Temporal gyrus Superior Temporal Sulcus Heschl’s gyrus Middle Temporal gyrus Inferior Temporal sulcus Ambient gyrus Entorhinal area Amygdala Inferior Temporal gyrus NP/MGH Superior Frontal gyrus Middle Frontal gyrus Central Sulcus Superior Temporal gyrus Hippocampus Middle Temporal gyrus Inferior Temporal gyrus Parahippocampal gyrus CA1, cornu ammonis Fusiform gyrus NP/MGH Postcentral gyrus Paracentral lobule Intraparietal sulcus Intraparietal sulcus Central Sulcus Cingulate gyrus Supramarginal gyrus Superior Temporal gyrus Middle Temporal gyrus Inferior Temporal gyrus Fusiform gyrus Collateral sulcus Parahippocampal gyrus NP/MGH Paracentral lobule Central sulcus Superior Temporal gyrus Middle Temporal gyrus Inferior temporal gyrus Fusiform gyrus NP/MGH Paracentral lobule Postcentral gyrus Central sulcus Intraparietal sulcus Supramarginal gyrus Middle temporal gyrus Inferior temporal gyrus Fusiform gyrus Calcarine sulcus Cingulate gyrus Lingual gyrus NP/MGH Superior parietal lobule precuneus Inferior parietal lobule Cingulate gyrus Lingual gyrus Middle occipital gyrus Calcarine sulcus Collateral sulcus Fusiform gyrus Inferior occipital gyrus Lingual gyrus Tentorium cerebelli NP/MGH The Central Sulcus NP/MGH The Central Sulcus (CS)* • superior frontal sulcus - pre CS sign • sigmoidal Hook sign • pars bracket sign • Bifid post-CS sign • thin postcentral gyrus sign • intraparital sulcus - post-CS • midline sulcus sign *Naidich & Brightbill. Int J Neurorad 1996;2:313-338 NP/MGH The Central Sulcus (CS) • Superior frontal sulcus - preCS sign – the posterior end of the superior frontal sulcus joins the precentral sulcus in 85% Superior frontal gyrus Superior frontal sulcus Superior frontal sulcus Precentral sulcus Precentral sulcus Precentral gyrus Precentral gyrus Central sulcus NP/MGH The Central Sulcus (CS) • Sigmoid “Hook” – hooklike configuration of the posterior surface of the Precentral sulcus precentral gyrus – the “hook” corresponds to the motor hand area. – The “hook” is well seen on CT (89%) and MRI (98%). Central sulcus NP/MGH The Central Sulcus (CS) Precentral gyrus • pars bracket sign Superior frontal – The paired pars sulcus marginalis form a “bracket” to each Precentral sulcus side of the interhemispheric fissure at or behind the central sulcus Central sulcus (96%). Pars bracket Paracentral lobule NP/MGH The Central Sulcus (CS) Precentral gyrus • pars bracket sign Superior frontal sulcus Precentral sulcus Central sulcus Pars bracket Pars bracket NP/MGH The Central Sulcus (CS) • Bifid post-CS sign – the post-CS is bifid (85%). – The bifid post-CS encloses the lateral end of the pars marginalis (88%). Precentral sulcus Central sulcus Precentral gyrus Postcentral sulcus Pars bracket NP/MGH Central sulcus Central sulcus Central sulcus Postcentral sulcus Postcentral sulcus Postcentral sulcus Pars bracket Pars bracket NP/MGH The Central Sulcus (CS) Precentral gyrus • Thin post-CG sign – the postcentral gyrus is thinner than the precentral gyrus (98%). Postcentral gyrus NP/MGH The Central Sulcus (CS) • Intraparietal Sulcus (IPS) and the post-CS – in axial MRI, the IPS intersects the post-CS (99%). Postcentral sulcus IPS IPS Pars bracket Pars bracket NP/MGH IPS IPS IPS Postcentral sulcus Postcentral sulcus Postcentral sulcus NP/MGH The Central Sulcus (CS) Superior frontal gyrus • Midline Sulcus sign – the most prominent Superior frontal sulcus convexity sulcus that reaches the midline interhemispheric fissure is the CS (70%). Precentral sulcus Precentral gyrus Central sulcus NP/MGH The Central Sulcus (CS) NP/MGH The Central Sulcus (CS) SFS-preCS sign Hook sign Thin postcentral gyrus sign Bifid post-CS sign IPS - postCS sign Pars bracket sign NP/MGH .
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