Ecr2010 C-2710

Key signs for sulcal and gyral localisation on MRI scans
revisited
Poster No.: C-2710

Congress: ECR 2010
Type: Educational Exhibit
Topic: Neuro - Miscellaneous
Authors: 1 1
R. M. S. V. Vadapalli , R. Reshma Reddy , A. Roychowdhury ;
2
1 2
Hyderabad/IN, Sturbridge, MA/US
Keywords: precentral gyrus, post central gyrus, Broca's area
Keywords: Neuroradiology brain, Neuroradiology peripheral nerve,
Neuroradiology spine
DOI: 10.1594/ecr2010/C-2710
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Page 1 of 70
Learning objectives
Learning Objectives: 1. To evaluate and compare the new and previously described signs
for localizing the central sulcus and related gyri in axial and Sagittal MRI Scans. 2. To
familiarize the cortical anatomy on Axial MRI studies 3. To impart skills for interpreting
Signs useful for localization of Major sulci and gyri. 4. To translate this knowledge in doing
fiber tracking studies.
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Background
Fig.: key signs:theme diagram

References: Department of Radiology and Imaging, Vijaya Diagnostics research -
Hyderabad/IN
Signs
:SFS -PRECS SIGN •PARS BRACKET SIGN •BIFID POST CS SIGN •SIGMOID
CURVE OF POSTERIOR SURFACE OF PRECENTRAL GYRUS AND CENTRAL
SULCUS(Omega or Sigmoid Hook or Lambdoid hook Sign) •THIN POST CG SIGN
•IPS POST CS SIGN
•WHITE MATTER DIGITATIONS:MEDULLAR SPIKE SIGN •MID LINE SULCUS SIGN

•HOLISTIC USE OF ALL SIGNS ON 3D SURFACE RECONS
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These signs will be described with clinical examples
Fig.: key rules:1

Hyderabad/IN
Page 4 of 70
Fig.: key rules
Hyderabad/IN
Page 5 of 70
Fig.: Precentral gyral infarcts and SFG infarction
Hyderabad/IN
Sigmoid hook sign : a FLAIR T2 axial Image showing infarcts in right SFG,Precentral
gyrus and Right Intra Parietal sulcus region
Note the sigmoid hook sign or Mega sign on left side for reference which represents the
Central sulcus and hence identifies the precentral gyrus.
Right side Sigmoid Hook shows gyral FLAIR hyper intensity and anteriorly the SFG
Hyperintensity due to infarctions
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Images for this section:
Fig. 0: SFS
© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN
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Fig. 0: sigmoid hook
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Fig. 0: bifid post CS
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Fig. 0: Thin Post CG
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Fig. 0: Pars bracket
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Fig. 0: IPS
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Fig. 0: medullary spike sign
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Fig. 0: Midline sulcus sign
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Imaging findings OR Procedure details
Fig.: STORY STARTS FROM sUPERIOR FRONTAL SULCUS

Hyderabad/IN
High resolution T1 ,3D isotropic Images with T2 and FLAIR axials ,with 3D
reocnstructions were used as base line reference data
Following signs were Evaluated:
SFS -PRECS SIGN nPARS BRACKET SIGN BIFID POST CS SIGN nSIGMOID
CURVE OF POSTERIOR SURFACE OF PRECENTRAL GYRUS AND CENTRAL
SULCUS ,THIN POST CG SIGN ,IPS POST CS SIGN.
Page 15 of 70
Fig.: key signs:theme diagram
Hyderabad/IN
Page 16 of 70
Fig.: key rules:1
Hyderabad/IN
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Fig.: signs:listings
Hyderabad/IN
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Fig.: Precentral gyral infarcts and SFG infarction
Hyderabad/IN
Page 19 of 70
Fig.: RIGHT SFG GLIOMA:iLLUSTRATES THE SFS PRE CS SIGN AND SIGMOID
HOOK SIGN
Hyderabad/IN
Page 20 of 70
Fig.: Right SFG and Precentral Gyrus infarcts: SFS Pre CS and Sigmoid Hook/Omega
signs
Hyderabad/IN
Page 21 of 70
Fig.: surface convexity signs
Hyderabad/IN
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Fig.: key rules:2
Hyderabad/IN
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Fig. 0: key signs for sulcal gyral localization
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Fig. 0: key signs:theme diagram
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Fig. 0: signs:listings
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Fig. 0: signs:listings
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Fig. 0: key rules
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Fig. 0: Bifid post CS sign
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Fig. 0: sFS sign: superior frontal gyral granuloma
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Fig. 0: Sigmoid hook or Omega sign
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Fig. 0: SFS PRE CS SIGN
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Fig. 0: Banana: indicates Intraparietal sulcus and post central sulcus intersection
Moustache: Inidcates pars bracket sign which demarcates the posterior margin of
paracentral lobule
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Fig. 0: #D Volme rendered Image showing key signs
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Fig. 0: sigmoid hook sign
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Fig. 0: sigmoid hook sign for central sulcus
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Page 37 of 70
Fig. 0: SFS Pre CS sign: effaced due to edema and post surgical changes with a recurrent
Glioma on left. Compare to the normal contra lateral superior frontal sulcus the flip L
Page 38 of 70
Fig. 0: key signs illustrated
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Fig. 0: Metastatic lesions involving left precentral gyrus .Look at the contralateral sigmoid
hook or omega sign
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Fig. 0: Enclosure of Pars Marginalis by bifid post central sulcus
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Fig. 0: bifid post CS sign
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Fig. 0: SFS Pre CS sign
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Fig. 0: ring like enhancing abscess with perifocal edema effacing the central sulcus: the
absent sigmoid hook sign on right compare it to normal contralateral reference side
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Fig. 0: key rules:1
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Fig. 0: Macdonald M sign for broca's area
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Fig. 0: Alligator sign of Middle frontal sulcius for IFG
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Fig. 0: pars bracket sign left superior parietal convexity metastatic lung carcinoma with
perifocal edema
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Fig. 0: Midline sulcus sign
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Fig. 0: Right precentral gyrus atypical infective granuloma
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Fig. 0: Pars bracket sign
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Fig. 0: Banana appearance of IPS
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Fig. 0: IPS-POST CS sign
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Fig. 0: Pars Bracket sign
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Fig. 0: Pars Bracket sign
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Fig. 0: Pre CG and post CG dimensions
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Fig. 0: surface convexity signs
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Page 61 of 70
Fig. 0: TRIO of signs to be remembererd
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Fig. 0: key rules:2
Page 63 of 70
Conclusion
Conclusion: This exhibit highlights the Use of these important signs of Localization of
sulci and Gyri in Clinical Practice.
Page 64 of 70
Page 65 of 70
Personal Information
Dr.Rammohan Vadapalli
MD
Consultant Radiologist
Vijaya Diagnostics and Research
Hyderabad AP India
Page 66 of 70
References
• Naidich TP, Brightbill TC. The intraparietal sulcus: a landmark for

localization of pathology on axial CT scans. Int J Neuroadiol 1995;1:3-16
• Naidich TP, Brightbill TC. The pars marginalis, II: a "bracket" sign for the
central sulcus in axial plane CT and MRI. Int J Neuroradiol 1996;2:3-19
• Naidich TP, Brightbill TC. The pars marginalis, II: the pars deflection
sign, a white matter pattern for identifying the pars marginalis in axial
plane CT and MRI. Int J Neuroradiol 1996;2:20-24
• Naidich TP, Brightbill TC. Systems for localizing fronto-parietal gyri and
sulci on axial CT and MRI. Int J Neuroradiol 1996;2:313-338
• Valente M, Naidich TP, Abrams KJ, Blum JT. Differentiating the pars
marginalis from the parieto-occipital sulcus in axial computed
tomography sections. Int J Neuroadiol 1998;4:105-111
• Naidich TP, Valavanis AG, Kubik S. Anatomic relationships along the

low-middle convexity, I: normal specimens and magnetic resonance
imaging. Neurosurgery 1995;36:517-532[Medline]
• Naidich TP, Valavanis AG, Kubik S, Taber KH, Yasargil M. Anatomic

relationships along the low-middle convexity, II: lesion localization. Int
J Neuroradiol 1997;3:393-409
• Ono H, Kubik S, Abernathy C. Atlas of Cerebral Sulci.. Stuttgart: Thieme

1990;
• Duvernoy H. The Human Brain: Surface, Three Dimensional Sectional

Anatomy and MRI.. New York: Springer 1991;
• Yousry TA, Schmid UD, Alkadhi H, et al. Localization of the motor

hand area to a knob on the precentral gyrus: a new landmark. Brain
1997;120:141-157[Abstract/Free Full Text]
Page 67 of 70
• Yousry TA, Schmid UD, Jassoy AJ, et al. Topography of the cortical
motor hand area: prospective study with functional MR imaging and
direct motor mapping at surgery. Radiology 1995;195:23-29[Abstract/
Free Full Text]
• Yousry TA, Fesl G, Buttner A, Noachtar S, Schmid UD. Heschl's gyrus:

anatomic description and methods of identification on magnetic
resonance imaging. Int J Neuroradiol 1997;3:2-12
• Meyer J, Roychowdhury S, Russell E, Callahan C, Gitelman D, Mesulam

MM. Location of the central sulcus via cortical thickness of the
precentral and postcentral gyri on MR. AJNR Am J Neuroradiol
1996;17:1699-1706[Abstract]
• Ebeling U, Steinmetz H, Huang Y, Kahn T. Topography and identification

of the inferior precentral sulcus in MR imaging. AJNR Am J Neuroradiol
1989;10:937-942[Abstract]
• LeMay M. Asymmetries of the skull and handedness: phrenology

revisited. J Neurol Sci 1977;32:243-253[Medline]
• Le Gros Clark WE, Medawar PB, eds. Essays on Growth and Form
Presented to Darcy Wentworth Thompson.. London: Oxford University
Press 1945;1-22
• Richman DP, Stewart M, Hutchinson JW, Caviness VS Jr. Mechanical

model of brain convolutional development: pathologic and
experimental data suggest a model based on differential growth within
the cerebral cortex. Science 1975;189:18-21[Free Full Text]
• Prothero JW, Sundsten JW. Folding of the cerebral cortex in mammals: a

scaling model. Brain Behav Evol 1984;24:152-167[Medline]
• Zilles K, Armstrong E, Schleicher A, Kretschmann H-J. The human

pattern of gyrification in the cerebral cortex. Anat Embryol
1988;179:173-179[Medline]
• Biondi A, Nogueira H, Dormont D, et al. Are the brains of monozygotic

twins similar? A three-dimensional MR study. AJNR Am J Neuroradiol
1998;19:1361-1367[Abstract]
Page 68 of 70
• Barron DH. An experimental analysis of some factors involved in the
development of the fissure pattern of the cerebral cortex. J Exp Zool
1950;113:553-581
• Paus T. Location and function of the human frontal eye field: a

selective review. Neuropsychologia 1996;34:475-483[Medline]
• Luna B, Thulborn KR, Strojwas MH, et al. Dorsal cortical regions

subserving visually guided saccades in humans: an fMRI study. Cereb
Cortex 1998;8:40-47[Abstract/Free Full Text]
• Rumeau C, Tzourio N, Murayama P, et al. Location of hand function.

AJNR Am J Neuroradiol 1994;15:567-572[Abstract]
• Kawashima R, Naitoh E, Michikazu M, et al. Topographic representation

in human intraparietal sulcus of reaching and saccade. Neuroreport
1996;7:1253-1256[Medline]
• Naidich TP, Grant JL, Altman N, et al. The developing cerebral surface:
preliminary report on the patterns of sulcal and gyral maturation:
anatomy, ultrasound, and magnetic resonance imaging. Neuroimaging
Clin North Am 1994;4:201-240
• Van der Zwan A, Hillen B, Tulleken CAF, Dujovny M, Dragovic L.

Variability of the territories of the major cerebral arteries. J Neurosurg
1992;77:927-940[Medline]
• Greitz T, Bohm C, Holte S, Eriksson L. A computerized brain atlas:

construction, anatomical content and some applications. J Comput
Assist Tomogr 1991;15:26-38[Medline]
• Vanier M, Roch Lecours A, Ethier R, et al. Proportional localization

system for anatomical interpretation of cerebral computer tomograms.
J Comput Assist Tomogr 1985;9:715-724[Medline]
• Talairach J, Tournoux P. Co-planar Stereotaxic Atlas of the Human

Brain: 3-Dimensional Proportional System, an Approach to Cerebral
Imaging.. Stuttgart: Thieme Medical 1998;
Page 69 of 70
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Key signs for sulcal and gyral localisation on MRI scans

Poster No.: C-2710

Fig.: key signs:theme diagram

•WHITE MATTER DIGITATIONS:MEDULLAR SPIKE SIGN •MID LINE SULCUS SIGN

Fig.: key rules:1

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

Fig.: STORY STARTS FROM sUPERIOR FRONTAL SULCUS

Following signs were Evaluated:

Fig. 0: key signs for sulcal gyral localization

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

Fig. 0: surface convexity signs

© Department of Radiology and Imaging, Vijaya Diagnostics research - Hyderabad/IN

Vijaya Diagnostics and Research

• Naidich TP, Brightbill TC. The intraparietal sulcus: a landmark for

• Naidich TP, Valavanis AG, Kubik S. Anatomic relationships along the

• Naidich TP, Valavanis AG, Kubik S, Taber KH, Yasargil M. Anatomic

• Ono H, Kubik S, Abernathy C. Atlas of Cerebral Sulci.. Stuttgart: Thieme