T2 MRI Axial 1

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UMass Medical School

ANTERIOR

CSF in the
subarachoid space
appears bright in T2weighted images.
QUESTION: What
does the blue
question mark
indicate. Is that a
gyrus or a sulcus of
cerebral cortex?

MRI (magnetic resonance imaging)

The goal of MRI imaging is to display differences in tissue
contrast in order to achieve high resolution, high contrast
views of the brain and spinal cord. Unlike convention X-rays,
structures can be made to look different in MRI depending on
the technique used. Just as an example, CSF appears dark in
T1-weighted images but bright (hyperintense) in T2 images.
There are many different techniques that can be used to
accentuate particular components of nervous tissue, and
clinicians select a combination of techniques depending on
the particular patient and the goal of the study.
This axial atlas is made from T2-weighted images. Note that
the CSF, which fills the subarachnoid space, is bright (white).
A word to the wise - the pulse sequence used in this scan
makes fat look bright, which is different from classic T2
images.
If you'd like to learn a little more about the basis of the MRI,
read the note below.

T2 MRI Axial 2

Mind Brain and Behavior 1

UMass Medical School

Appearance of air, CSF, bone, and

fat in this T2 MRI Atlas
Use blue arrows in this image to
review the appearance of each of
these components.

Is the corpus callosum

present in this section?

Which lobe of the brain?

Which lobe of the brain?

T2 MRI Axial 3

Mind Brain and Behavior 1

UMass Medical School

CLINICAL TERMINOLOGY:
Intra-axial vs. Extra-axial Lesions

Which lobe of the brain?

The term intra-axial refers to the pia

and brain itself (recall that the pia
tightly hugs the surface of the
brain).
The term extra-axial refers to the
subarachnoid space and all the
structures and real/potential spaces
that lie OUTSIDE the pia. So for
instance a subdural hemorrhage is
an extra-axial problem.
This is really information for the
future, so if you hear a clinician use
these terms you'll know what
they're talking about.

Which lobe of the brain?

T2 MRI Axial 4

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UMass Medical School

In a T2-weighted MRI:
White matter is dark gray.
Gray matter is lighter gray.

What major cerebral

artery supplies this
region of cortex?

T2 MRI Axial 5

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UMass Medical School

What is present in this

hyperintense (bright)
region?

T2 MRI Axial 6
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What major cerebral vessel

supplies this region of
cortex? You can see some
its branches in this image.

T2 MRI Axial 7

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UMass Medical School

What major cerebral

arteries supply this
white matter?

C
P

What major cerebral

arteries supply this
white matter?
This is the occipital
lobe. What major
artery supplies its
medial cortex?

T2 MRI Axial 8

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UMass Medical School

What is the name of

the white matter
sandwiched between
the caudate and
thalamus (medially)
and the putamen
(laterally). In general,
what kinds of
connections do these
axons make?

Hippo

The blue arrows

indicate the course of
the visual radiations
on their way to the
primary visual cortex
in the medial occipital
lobe.

T2 MRI Axial 9

Mind Brain and Behavior 1

UMass Medical School

The internal geography of

this section is really
confusing, so we've labeled
some big structures to help
you get oriented.
C = caudate
P = putamen
GP = globus pallidus
SC = superior colliculus
(yes that's midbrain!)

GP
Thalamus

SC
Hippo

Which lobe of the brain?

Cerebellum

Predict the neurologic

deficit that will be
produced if this cortex
is damaged in a way
that spares its more
posterior parts.

T2 MRI Axial 10

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UMass Medical School

The red-shaded region

is the hypothalamus.
What specific part does
the arrow point to?

What structure is
indicated by the
black asterisk?

A1

*
CP

amygdala

hippo

In cerebellar cortex, the fissures run left-right across

the midline. That's not true of cerebral cortex.

T2 MRI Axial 11

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UMass Medical School

Eyeball

Use this image to review what can happen if

intracranial pressure is increased because of a
space-filling mas such as tumor or hemorrhage or
cerebral edema and the uncus (or another part
of the medial temporal lobe) is pushed inferior
through the tentorial notch.
The uncus is outlined in red on the image.
List 3 important clinical signs that are produced
uncal herniation. What anatomic structures are
involved? See if you can identify those structures
in this image or image 10.

Sometimes the posterior cerebral artery is

compressed by uncal herniation, infarcting
posterior cerebral artery territory. (Remember that
PCA has to pass upward through the tentorial
notch.)
Identify PCA in this image.
Name at last 3 major structures that are supplied
by PCA.

T2 MRI Axial 12

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Which muscle? Which

cranial nerve innervates it?

If this structure is
damaged, what will the
patient experience?

This is the lateral rectus

muscle. Which cranial
nerve innervates it?

This is the internal carotid artery in

the cavernous sinus. What are
some of the signs/symptoms that
you might expect after a complete
lesion involving the cavernous
sinus (e.g. thrombosis)? What
neuroanatomic structures would
each involve?

T2 MRI Axial 13

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Ethmoid Bone
and Air Cells

Sphenoid
Sinus (air)

The asterisk is in the

internal auditory canal.
Which two cranial
nerves travel here?

T2 MRI Axial 14
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T2 MRI Axial 15
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Is damage here more

likely to produce
incoordination (ataxia) of
distal movements or of
truncal movements (gait).
On which side would the
ataxia be present?

15

T2 MRI Axial 16

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UMass Medical School

The green dots circle

circle one of the
famous cerebellar
tonsils. In situations
where a mass lesion or
enormously elevated
intracranial pressure
pushes the brainstem
downward, the tonsils
may herniate caudally
through the foramen
magnum (section 18).
This compresses the
medulla, causing death
because cardiac and
respiratory centers in
the reticular formation
malfunction.

T2 MRI Axial 17
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T2 MRI Axial 18
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UMass Medical School

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