Normal Brain
Anatomy on Magnetic
R e s o n a n c e Im a g i n g
Bryan Pukenas, MD
KEYWORDS
 Brain anatomy  Magnetic resonance imaging  Sagittal
 Axial
Brain magnetic resonance (MR) imaging studies
provide multiple different imaging sequences in at
least 2, and often 3, imaging planes. The different
tissue signal characteristics and anatomic view-
points are often complementary, and interpreting
an MR imaging study of the brain can be a daunting
task. The variety of pulse sequences and imaging
planes makes understanding normal anatomy
a necessity. Admittedly, many different approaches
can be taken when interpreting images, but in this
article just one approach to understanding normal
anatomy is described. The normal anatomy of the
brain has filled many textbooks, and a sincere effort
has been made to provide a pertinent and concise
reference suitable for review. Textbooks cited
within the article serve as excellent references for
those who wish to further their knowledge of brain
anatomy.
PROTOCOL
The overwhelming advantage of MR imaging is its
ability to provide images with increased signal to
noise ratios. Tissue characteristics with respect to
different imaging sequences provide valuable clues
when interpreting an MR image of the brain. There-
fore, it is important to understand the accentuated
tissue features on each scan. T1-weighted images
provide good tissue discrimination and, in conjunc-
tion with the postcontrast scans, allow assessment
for tissue enhancement. Precontrast and postcon-
trast scans must be obtained with identical imaging
parameters to truly assess contrast enhancement
(Table 1). T1-weighted and T2-weighted images
are complementary to each other because the
The author has nothing to disclose.
Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce
Street, Philadelphia, PA 19104, USA
E-mail address: Bryan.Pukenas@uphs.upenn.edu
Magn Reson Imaging Clin N Am 19 (2011) 429–437
doi:10.1016/j.mric.2011.05.015
1064-9689/11/$ – see front matter Ó 2011 Elsevier Inc. All rights reserved.
T2-weighted images are sensitive to increased
water content within tissues and to differences in
susceptibility between tissues. Gradient echo
images are susceptible to inhomogeneities in the
magnetic field, accentuating blood products, iron,
calcium, and manganese within tissues. This
sequence is routinely performed during evaluation
for stroke and trauma because hemorrhage is well
seen. Fluid-attenuated inversion recovery (FLAIR)
sequence can be used to obtain T2-weighted
contrast while voiding the signal from cerebrospinal
fluid, allowing a pathologic process to be identified
with more confidence. Diffusion-weighted (DW)
imaging assesses for the ability of water to diffuse
in the local cell environment, which is particularly
important in stroke and tumor imaging because
areas of restricted diffusion demonstrate increased
signal intensity. It is paramount to compare the DW
images with the source apparent diffusion co-
efficient (ADC) images. Areas of restricted diffusion
appear dark on the ADC maps, whereas areas of
facilitated diffusion appear bright.1 Susceptibility-
weighted images highlight differences in inher-
ent tissue magnetic susceptibility and can be
used for evaluation of deoxyhemoglobin in veins,
hemorrhage, iron-containing tissues, and calcium
deposition.2
IDENTIFYING THE LOBES OF THE BRAIN
The frontal lobes are located anteriorly and extend
posteriorly to the central (rolandic) sulcus, which
partitions the frontal and parietal lobes. Several
techniques can be used to identify the central
sulcus, a universal point of reference. On the axial
mri.theclinics.com
430 Pukenas

Table 1
Hospital of the University of Pennsylvania imaging parameters

Repetition Echo Inversion Flip Angle

Scan Time (ms) Time (ms) Time (ms) (degrees)
1.5-T Brain MR Imaging
Sagittal T1 spin echo 450 10 NA 90
Axial T2 turbo spin echo 5490 73 NA 150
Axial gradient echo 800 26 NA 20
Axial FLAIR 8900 141 2500 180
Axial diffusion echo planar spin echo 4000 83 NA NA
Axial T1 precontrast spin echo 500 17 NA 90
Axial T1 postcontrast spin echo 500 17 NA 90
Coronal T1 postcontrast spin echo 500 17 NA 90
3.0-T Brain MR Imaging
Sagittal T1 FLAIR 2100 9 896.2 150
Axial FLAIR 9000 119 2500 150
Axial T1 precontrast spin echo 700 12 NA 90
Axial T2 gradient echo 700 19.9 NA 20
Axial T2 susceptibility weighted 27 20 NA 15
Axial T2 turbo spin echo 5440 96 NA 150
Axial diffusion echo planar spin echo 6400 109 NA NA
Axial T1 postcontrast spin echo 700 12 NA 90
Coronal T1 postcontrast spin echo 700 8.9 NA 90

Abbreviations: FLAIR, fluid-attenuated inversion recovery; NA, not available; TE, echo time; TI, inversion time; TR, repe-
tition time.

T2-weighted images near the vertex, the central
sulci can be seen as a pair of mirror image trans-
verse grooves (Fig. 1), with the motor cortex
always located anterior to this sulcus.3 The supe-
rior frontal sulcus is a horizontally oriented sulcus
that terminates in the obliquely oriented precentral
sulcus,4 and one can find the central sulcus as the
sulcus posterior to the precentral sulcus. The pre-
central knob, the cortical location for hand func-
tion, is identified sitting just anterior to the central
sulcus (Fig. 2).5 The inferior central sulcus does
not intersect the sylvian (lateral) fissure, rather it
is contained by the junction of the precentral and
postcentral gyri.6 On midline sagittal MR images,
the central sulcus is somewhat more difficult to
identify, but it is located anterior to the marginal
ramus of the cingulate sulcus (Fig. 3).7
Inferiorly, the frontal lobe is separated from the
temporal lobe by the sylvian fissure, which is easily
seen on both axial and sagittal images (Fig. 4). The
middle cerebral arteries are located within the
sylvian fissure and are seen as flow voids on
T2-weighted images (Fig. 5). The parietal lobes
are bound anteriorly by the central sulcus. Super-
ficially, there is no anatomic landmark separating
the parietal and occipital lobes. However, toward
the midline, the parietooccipital sulcus is well
seen (Fig. 6), demarcating their boundary.8
Superficial Surface Anatomy
Although there are variations of normal anatomy,
the superficial surface of the brain follows a general
pattern, identified best on sagittal images. Nai-
daich and colleagues6 provide a thorough descrip-
tion of the superficial frontal and temporal lobes.
The frontal lobe contains 3 horizontal gyri and
the obliquely oriented precentral gyrus. The supe-
rior frontal gyrus runs horizontally, parallel to the
falx and interhemispheric fissure. The middle
frontal gyrus is the largest of the horizontal gyri,
running parallel to the superior frontal gyrus and
undulating posteriorly, where it fuses with the pre-
central gyrus. The superior frontal sulcus divides
the superior frontal gyrus and middle frontal gyrus,
and the inferior frontal sulcus divides the middle
frontal gyrus and inferior frontal gyrus. The inferior
frontal gyrus is triangular and is separated from
the frontal pole by the frontomarginal sulcus. The
superior border of the inferior frontal gyrus is

Fig. 1. Axial T2-weighted (repetition time, 3000 ms;
echo time, 100 ms) image near the vertex demon-
strates 2 mirror image horizontal sulci (long black
arrows) demarcating the central sulcus. The precentral
sulcus is thicker than the postcentral sulcus, a normal
finding. Note the falx (short black arrow) and flow
void within the superior sagittal sinus (SSS).
Fig. 2. Axial T2-weighted (repetition time, 3000 ms;
echo time, 100 ms) image more inferior to Fig. 1,
demonstrating the omega-shaped precentral knob
(arrows).
Normal Brain MRI 431
Fig. 3. Sagittal T1-weighted (repetition time, 442 ms;
echo time, 9.3 ms) image in a paramidline location
demonstrating the marginal sulcus (white arrow),
cingulate sulcus (CS), callosal sulcus (cal sul), and
cingulate gyrus (CING). The straight sinus flow void
is also present (StS). Note also the tentorium cerebelli
(black arrow), fornix (f), and optic tract (OT).
horizontal, whereas the inferior surface is trian-
gular and divided into 3 parts: the pars orbitalis,
pars triangularis, and pars opercularis.
The superficial temporal lobe contains 3 superfi-
cial gyri: the superior temporal gyrus, middle
temporal gyrus, and inferior temporal gyrus. The
Fig. 4. Sagittal T1-weighted (repetition time, 442 ms;
echo time, 9.3 ms) far-lateral image demonstrating
the sylvian fissure (SF) as well as the superior temporal
(STG) and middle temporal gyri (MTG). The anterior
(Ant) and posterior (Post) lobes of the cerebellum
are separated by the primary fissure (white arrow).
432 Pukenas
Fig. 5. Axial T2-weighted image (repetition time,
3000 ms; echo time, 100 ms) at the level of the
midbrain demonstrates flow voids of the middle cere-
bral arteries (vertical white arrows) within the sylvian
fissures. The optic nerve (ON), optic chiasm (CHIASM),
and optic tract (OT) are well seen at this level. The in-
terpeduncular cistern (IPC) is bounded by the crus cer-
ebri (CR). The basal veins of Rosenthal (white arrow,
BVR) travel around the brain stem in the ambient
cistern. Note also the hippocampus (HIP), mammillary
bodies (white arrow, MB), uncus (UNCUS), and amyg-
dala (AMY). More posteriorly, the cerebral aqueduct
(black circle) and inferior colliculi (ic) can be seen.
superior temporal sulcus separates the superior
and middle temporal gyri and courses parallel
with the superior fontal gyrus until posteriorly,
where it angles superiorly and is called the angular
sulcus. The inferior temporal sulcus separates the
middle temporal and inferior temporal gyri.6
The postcentral gyrus demarcates the anterior
border of the parietal lobe and is parallel to the
precentral sulcus. The intraparietal sulcus divides
the parietal lobe into superior and inferior lobes.
The inferior lobe is divided into the supramarginal
gyrus and the appropriately named angular gyrus,
which envelopes the angular sulcus and repre-
sents the posterior aspect of the inferior parietal
lobe. The inferior parietal lobe can show marked
left to right asymmetry.6
The occipital pole can be seen along the poste-
rior superficial surface, but most occipital lobe
Fig. 6. Sagittal T1-weighted (repetition time, 442 ms;
echo time, 9.3 ms) midline image. The rostrum (R),
genu (G), body (B), and splenium (S) of the corpus cal-
losum are well seen with the third ventricle (3rd Vent)
inferior to the body. The fornix (F) is seen arching pos-
teriorly toward the splenium. Inferior to the fornix,
the thalamus (Th) is seen just lateral to the third
ventricle. The fornix originates in the subiculum and
terminates in the mammillary bodies (mb). The pitui-
tary gland (P) is located in the sella (s). Superior to
the sella is the optic chiasm (c). The superior colliculus
(sc), along with the inferior colliculus (ic), form the
quadrigeminal plate in the tectum of the midbrain
(MB), posterior to the cerebral aqueduct. A flow
void within the basilar artery (basilar a.) is present
anterior to the belly of the pons (pons). The triangular
fourth ventricle (4) is seen anterior to the cerebellum
(CB). The cerebellar tonsils (T) are present in the
foramen magnum (FM). The subcallosal area (subC)
of the cingulate gyrus (CG) continues around the
corpus callosum where it becomes the isthmus of
the corpus callosum inferior to the splenium and
continues as the parahippocampal gyrus (not shown).
Demarcating the parietal and occipital lobes, the pari-
etooccipital sulcus (black arrow) sits posterior to the
precuneus (P). The calcarine sulcus (white arrow)
divides the medial occipital lobe into the cuneus and
lingual gyrus. Notice the bright signal within the cli-
vus (CL) and C2, indicating fatty marrow.
structures are better seen on the midline sagittal
views, discussed next.
Midline Structures
The easiest structure to identify on the midline
sagittal image is the corpus callosum, consisting
of the rostrum, genu, body, and splenium (see
Fig. 6). The cingulate gyrus parallels the corpus cal-
losum anteriorly until its marginal branch courses to
the superior brain surface. The sulcus anterior to
the marginal sulcus is named the central sulcus.

Posteriorly, the isthmus of the cingulate gyrus
is located between the splenium of the corpus
callosum and the anterior calcarine sulcus9 and
continues laterally as the parahippocampal gyrus
where its superior border is demarcated by the
hippocampal fissure. The hippocampal fissure
continues above the body of the corpus callosum
as the callosal sulcus (see Fig. 3).10 Anteriorly, the
cingulate gyrus dives under the rostrum of the
corpus callosum and becomes the subcallosal
area.10 The posterior medial parietal lobe, or precu-
neus, is seen anterior to the parietooccipital sulcus.
The calcarine sulcus divides the medial occipital
lobe into the cuneus and lingual gyrus (see Fig. 6).
The lamina terminalis demarcates the anterior
wall of the third ventricle and plays a role in cardio-
vascular and body fluid homeostasis.11
The hippocampal formation, found in the medial
temporal lobe, is composed of the subiculum, the
dentate gyrus, the hippocampus, and their contin-
uations around the corpus callosum10 and is best
seen on coronal images. The parahippocampal
gyrus forms the inferomedial border of the temporal
lobe (Fig. 7). The subiculum forms the medial and
superior curvature of the parahippocampal gyrus
and arcs into the hippocampal fissure.10 The
hippocampal fissure is bordered superiorly by the
dentate gyrus and inferiorly by the subiculum.10
The hippocampus forms a cap on the hippo-
campal fissure and bulges into the medial wall and
floor of the temporal horn.10
The fornix, a white matter tract that connects
the subiculum and the mammillary bodies, origi-
nates in the subiculum where its axons travel
laterally to form a thin layer of white matter along
the inferomedial temporal horn.10 The fornix
continues posterior to the undersurface of the
splenium, and most fibers arch upward, anterior,
and inferior to the splenium to form the crura of
the fornices,10 ending in the mammillary bodies
(see Fig. 2).
The amygdala is a gray matter structure located
just lateral to the uncus and anterior to the
temporal horn and remains attached to the puta-
men superiorly.10 The tail of the caudate nucleus
terminates in the amygdala. The anterior commis-
sure is a white matter tract located in the anterior
wall of the third ventricle at the junction of the
lamina terminalis and the rostrum of the corpus
callosum that connects the 2 temporal lobes and
is easily seen on MR images.12
Deep Structures
The deep central cerebral structures located
between the insula and the sagittal midline are
referred to as the central core (Fig. 8).13 This core
Normal Brain MRI 433
Fig. 7. Coronal T2-weighted image (repetition time,
6360 ms; echo time, 89 ms) demonstrating the inferior
and medial border of the temporal lobe, the parahip-
pocampal gyrus (PHG). The subiculum (S) and body of
the hippocampus (H) are also demarcated. The hippo-
campal sulcus is seen on the left (black arrow), as are
the collateral sulcus (cs) and the occipitotemporal
sulcus (ots). Note the flow voids in the ambient cistern
(white arrow) and sylvian fissure (SF). The superior,
middle, and inferior temporal gyri (STG, MTG, ITG,
respectively) are also seen. At this level, the bodies
of the fornices (F) are present inferior to the corpus
callosum (CC) and within the lateral ventricles (LAT).
The cingulate gyrus (C) and interhemispheric fissure
(IHF) are present in the midline.
contains, among others structures, the extreme,
external, and internal capsules, the claustrum,
the putamen, the globus pallidus, the caudate
nucleus, the amygdala, the diencephalon, and
thalamic structures. It is related to motor and
sensory functions, emotion, endocrine integration,
and cognition.14 All the information passing be-
tween the brainstem and cortex passes through
fibers in the central core.15 Anteriorly, the central
core gray matter consists of the caudate nucleus
and, to a lesser extent, the lentiform nucleus (puta-
men and globus pallidus), whereas the white matter
consists primarily of the anterior limb of the internal
capsule.15 More posteriorly, at the level of the
foramen of Monro, the internal capsule contributes
most of the white matter, whereas the lentiform
nucleus contributes most of the gray matter, with
a lesser contribution from the caudate nucleus.15
At the posterior insular level, most of the gray
matter contribution arises from the thalamus and
the white matter from the posterior limb of the
internal capsule.15
434 Pukenas
Fig. 8. Axial T2-weighted image (repetition time,
6900 ms; echo time, 96 ms) through the basal ganglia
demonstrating the head of the caudate (C), anterior
limb of the internal capsule (white arrow), putamen
(P), globus pallidus (GP), thalamus (THAL), and corpus
callosum (CC).
Cerebellum
The cerebellum can be divided into 4 lobes: the
anterior and posterior lobes, separated by the
primary fissure (see Fig. 3), the vermis, and
the flocculonodular lobe. The inferior vermis
and flocculonodular lobes help regulate balance
and eye movements via interactions with the
vestibular system. It is generally assumed that
these regions, along with other parts of the vermis,
are involved in control of the proximal trunk
muscles, whereas the more lateral regions help
control the distal appendicular muscles. The most
lateral cerebellar hemispheres are involved in
motor planning.16 The cerebellar tonsils are located
inferolaterally and herniate through the foramen
magnum in patients with Chiari malformations.17
The dentate nucleus may be seen on T1-weighted
images and is located lateral to the white matter
of the cerebellum.18 There are 3 main white matter
tracts connecting the cerebellum to the brainstem:
the superior cerebellar peduncle (cerebellum to
midbrain), middle cerebellar peduncle (pons to
cerebellum), and inferior cerebellar peduncle
(medulla to cerebellum).19
Brainstem
The brainstem, consisting of the diencephalon,
mesencephalon, pons, and medulla oblongata,
serves as the connection between the cerebral
hemispheres, the cerebellum, and the medulla,
and is responsible for the basic life functions
such as breathing, heartbeat, blood pressure,
consciousness, and sleep.20 There are 3 main
longitudinal divisions of the brainstem: the basis,
the tectum, and the tegmentum. The motor
pathway runs in the most anterior segment, the
basis; the cranial nerve nuclei and somatosensory
tracts are present in the tegmentum, located ante-
rior to the fourth ventricle; and the quadrigeminal
plate and superior (pons) and inferior (medulla
oblongata) medullary velum form the tectum.20,21
The pineal gland can be seen inferior to the corpus
callosum on sagittal midline images.
The diencephalon contains the third ventricle
and its bounding structures and is divided into 4
parts: the epithalamus, hypothalamus, subthala-
mus, and thalamus.20 The epithalamus contains
the trigonum habenulae, the pineal gland, and
the posterior commissure.20 The hypothalamus
consists of the mammillary bodies, the tuber ciner-
eum, the infundibulum, the hypophysis, and the
optic chiasm (see Fig. 6).20 The thalamus is the
largest part of the diencephalon and is situated
on both sides of the third ventricle (see Figs. 6, 8
and 9).20 The anterior end of the thalamus forms
the posterior boundary of the interventricular
foramen, whereas the posterior aspect expands
and overlaps the superior colliculus.20 Medially,
the posterior portion of the thalamus, the pulvinar,
blends into the lateral geniculate body, which is
involved in the visual pathway.20 Beneath the pul-
vinar is the medial geniculate body, forming part of
the auditory pathway.20
The midbrain connects the diencephalon to the
pons and has a characteristic midline cleft, the in-
terpeduncular cistern, which is bounded on each
Fig. 9. Axial T2-weighted image (repetition time,
6900 ms; echo time, 96 ms) through the basal ganglia
demonstrating the anterior commissure (AC), pineal
gland (P), thalamus (THAL), and flow voids within
the anterior cerebral arteries located in the interhemi-
spheric fissure (white arrow).

side by the crus cerebri (see Fig. 5).20 The tectum
contains the quadrigeminal plate and lies posterior
to the cerebral aqueduct. The superior colliculi
contain centers for visual reflexes and connect to
the superior brachium via the lateral geniculate
body and the optic tract.20 The inferior colliculi
contain auditory centers and connect to the medial
geniculate via the inferior brachium.20 The fourth
cranial nerves arise in the midline, below the infe-
rior colliculi. The red nucleus is seen as areas of
decreased signal intensity on T2-weighted images
as a result of their high iron content (Fig. 10).20 The
third cranial nerve also arises from the midbrain.
The pons, named for its appearance as a bridge
between the cerebellar hemispheres, has a large
convex anterior surface (see Fig. 6) containing
transverse fibers that converge to form the middle
cerebellar peduncles.20 The sixth, seventh, and
eighth cranial nerves emerge from a groove at
the pontomedullary junction; the trigeminal nerve
also emerges from the pons.20 The posterior
pons forms the roof of the fourth ventricle and is
covered by the cerebellum.20
The medulla oblongata connects the spinal cord
and pons (Fig. 11). Running along both sides of the
median fissure, the pyramids are composed of
axons from the precentral gyrus that innervate
the spinal cord gray matter (corticospinal or pyra-
midal tracts).20 Lateral and posterior to the pyra-
mids, separated by the preolivary groove, are
elongated elevations formed by the olivary nuclei,
the medullary olives. The ninth, tenth, eleventh,
and twelfth cranial nerves are located in the
Fig. 10. Axial T2-weighted image (repetition time,
6900 ms; echo time, 96 ms) through the inferior
midbrain demonstrating areas of decreased T2 signal
(indicating iron deposition) within the red nucleus
(R) and substantia nigra (SN). The superior colliculus
is also seen at this level. Flow voids within the internal
carotid artery terminus (i), middle cerebral artery
(mca), anterior cerebral artery (white arrow), and
anterior communicating artery (black arrow) are
noted.
Normal Brain MRI 435
Fig. 11. Axial T2-weighted image (repetition time,
6900 ms; echo time, 96 ms) through the medulla
demonstrating the medullary pyramid (P), olive (O),
cerebellar tonsil (T), and cerebellar vermis (V). The
seventh nerve (arrow, 7) is seen coursing toward the
internal auditory canal (IAC).
medulla, and the rootlets of the hypoglossal nerve
arise from the preolivary groove.20
The pituitary stalk projects inferiorly from the
infundibular recess of the third ventricle, leading
into the bilobed pituitary gland. The anterior lobe
appears isointense to the brain on T1-weighted
and T2-weighted images, although hyperintensity
on T1-weighted images has been reported in preg-
nancy. For as yet unknown reasons, the posterior
pituitary gland is hyperintense on T1-wieghted
images and shows lower intensity on T2-weighted
images. Injection of gadolinium results in prompt
enhancement of the anterior pituitary gland and
infundibulum. The normal pituitary gland has a max-
imal height of 8 mm in men and 9 mm in women.
Immediately posterior to the pituitary, the cortical
bone of the dorsum sella can be seen as a rim of
hypointense signal. Posterior to this hypointensity,
the fatty marrow of the clivus appears hyperintense
on T1-weighted images.1
IMAGING NOOKS AND CRANNIES
This section provides a few anatomic insights
about overlooked areas on specific sequences,
namely, sagittal T1-weighted and axial T2-
weighted images.
Sagittal T1
Although several anatomic features of the brain
are well delineated on standard sagittal T1 images,
these images also allow evaluation of the orbits
and cranial marrow signal. T1-weighted images
436 Pukenas
provide some insight into cerebrovascular struc-
tures, and normal flow voids can be visualized in
the deep venous structures and dural venous
sinuses.
The orbit is bounded medially by the thin-walled
lamina papyracea, separating the orbit from the
ethmoid air cells. The inferior boundary of the orbit,
the orbital floor, also serves as the roof of the maxil-
lary sinus,22 whereas the orbital roof is formed by
the frontal bone. The extraocular muscles, seen
well on axial and sagittal T1-weighted images,
show slight increase in signal intensity relative to
the temporalis muscle on T1-weighted images
and greater enhancement relative to the temporalis
muscle after gadolinium adminstration.23 Thus, the
extraocular muscles should be evaluated on more
than 1 imaging sequence when evaluating for path-
ologic abnormalities. The normal orbital fat demon-
strates increased signal intensity on T1-weighted
images and decreased signal intensity on T1-
weighted fat-saturated images. When evaluating
the orbital fat with frequency-selective fat suppres-
sion techniques, field inhomogeneity can con-
tribute to incomplete fat suppression in the orbital
fat. Inversion recovery techniques can be particu-
larly useful because these sequences yield more
uniform fat suppression.24
Conversion of red (active) marrow to yellow (inac-
tive) marrow is a normal process usually completed
by 25 years of age. Red marrow usually demon-
strates a relative isointense signal compared with
skeletal muscle, and yellow marrow appears
hyperintense to muscle and relatively isointense
to subcutaneous fat. Loevner and colleagues25
described alterations of the normal marrow signal
intensity on T1-weighted images, which may be
the first indicator of a systemic disorder.
Enclosed in dural leaves, the dural venous
sinuses are the major drainage pathways of the
cerebral veins, and their flow voids are often seen
on the sagittal T1-weighted images. However, eval-
uation of the dural sinuses must be performed
using multiple pulse sequences. T1-weighted
images are not diagnostic for sinus thrombosis
because 24% to 31% of normal patients may
have hypoplasia of a sinus.26,27
Axial T2
Although T2-weighted images provide substantial
anatomic detail about the brain, these sequences
also provide important detail about the intracranial
vascular structures. Flow voids appear as areas of
signal dropout on T2-weighted images and are
normally expected for intracranial arteries. Loss
of an expected flow void should key the interpret-
ing physician to the possibility of vascular
occlusion. In addition to vessel patency, flow voids
on T2-weighted images may also suggest abnor-
malities in vascular caliber. It is not uncommon
to detect middle cerebral artery aneurysms in the
sylvian fissure or internal carotid artery aneurysms
near the clinoids. One pitfall may occur in the case
of a pneumatized clinoid process that can mimic
an internal carotid artery aneurysm.
DW Imaging
As discussed earlier, DW images are exquisitely
sensitive to the detection of acute infarction. In
addition, these images are fat-saturated, so evalu-
ation of calvarial lesions is aided by this sequence,
particularly if there is concern for a scalp or calva-
rial lipoma.
SUMMARY
The exquisite detail provided by brain MR imaging
scans can make interpretation simultaneously
straightforward and complicated, particularly to
the novice. For this reason, it is essential to
become familiar with normal structures before
describing the pathologic condition. This article
serves as a practical reference point to further
enhance knowledge of the intracranial anatomy.
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