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Pictorial Essay
The Hippocampus: Normal Anatomy and Pathology
L AnneHayman1,
GregoryN.Fuller2,Jos
E.Cavazos3,
MarkJ. Pfleger4,
ChristinaA.Meyers5,EdwardF.Jackson6
T
@J).
frur@;)-
Paraterminal
gyros
.@-.
Parahippocampal
gyrue
@.
..
Vesti@
-.
gyms
:. ,@
supracallosal
(induseum
griseum)
Tail
Vestigialparaterminalgyros
Body
Head(foot,pes)
Fig.1.Limbic
lobeanatomy.
Drawings
showsubdivisions
ofouterandinner
limbiclobegyri.
ReceivedJanuary22,1998;acceptedafterrevisionMarch10,1998.
1Department
2 Department
of Neuropathology,
to L A. Hayman.
of Neuro-oncology,
AJR:171,October1998
1139
Hayman et al.
I
e
m
Temporal Horn
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e
r
n
A
m
b
. .
;. ...
J@.. @.
e
n
t
..
/1'
I
COLLATERAL
.. .
@.
@:
(Fusiform
. \gyrus
SULCUS
Dentate
gyrus
(molecular
cell
layer)
CAl
CA2
CA4
(end
folium)
@
A
Fig.2.Hippocampal
anatomy.
A,Drawing
ofaxialsection
oflefthippocampus
seenfrombelowshowsrotation
ofhippocampus
anditsrelationship
withdentate
gyrus.
(Modified
withpermission
from11])
B,Drawingofcoronalsectionatmidbodyoflefthippocampus
showscross-sectional
relationship
betweenhippocampus
andsurrounding
structures.
(Modifiedwithpermis
sionfrom [41)
(Fig. 2) 115].
At this level, it consistsof two in
terlocking laminae of gray matter: the cornu
ammonis (Ammon's horn) and the dentategy
flis. The comu ammonis can be divided into
four microscopic zones of granular cells:
k: :i
Ch@
Fig.3.Normal
coronalhippocampus
in24-year-old
man.
A,Fastspin-echo
12-weighted
MRimagethrough
bellyofponsshowschoroidal
fissure
(Ch),fimbriodentate
fissure
(FD),andhippocampal
sulci(H)(fissures)
onleft(also
seeFig.8A).Notethatsmallcysticresidualoffetalhippocampal
sulcus(fissure)isseenonbothsides.
B,Fastspin-echo12-weightedMRimagethroughmiddlecerebellarpeduncleshowscontinuation
ofthreemajorhippocampal
sulci(fissures).Ch=choroidalfissure,
FD=fimbriodentate
fissure,H =hippocampa)
sulcus.Notesmallcysticresidualoffetalhippocampal
sulcus(fissure)(solitaryarrowonrighthippocampus).
1140
AJR:171,October1998
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@,-#
.
Mama
@arybodyd
Uncaf
:@
notch
(tertora@
r@press@on)
@
@
,.
Collateraf
Choroidaf fia
r
.2
S Uncal guiCuS
@UncaI
notch
tentoraf
Imoress;orr)
Collateral
fissure
E
Dsntategynhs
@
CA -
(Ammon's horn)
Comu Ammonia
@en.r
sictor)
:@:@.i.islatIt
zen.)
CM
entorhinal
area
body
of
parahippocampal
gyrus
tail
of
parahippocampal
gyms
vestigial
supracallosal
gyms
(connects parahippocampus with CAl)
amygdala
gyms amblins
!.@::unaris
lanterlorparahlppocampalgyrus)
Fig.4.Normal
anatomy
ofamygdala
andhippocampal
headonpairedserial,myelin-stained
coronalbrainsections
andcompanion
12-weighted
MRimages.
Bothmyelin-stained
sec
tionsandMRimages
areasymmetric,
causing
slightlydifferent
appearance
between
right-andleft-sided
structures,
whichproduces
sixuniquesections.
Colorkeyisguidetoimportant
structuresandlandmarks.
A,Myelin-stained
brainsectionimmediately
rostraltoheadofbothhippocampi.
B,Companion
MRimagerostraltohippocampi
showsdiverging
optictract(Ot),sylvian
fissure(Sf),anduniquebranching
patternofwhitematterinrostraltemporal
lobeonrightRostral
amygdala(A)is seenonleft
C,Myelin-stained
brainsectionofanteriormost
lefthippocampal
headorpes(foot)showscornuammonis
zone1(CAl)belowtemporal
horn.Amygdala
(blue)persists
onrightbuthas
almostdisappearedonleftside.Uncus(pink)is seenaboveandmedialto bothamygdalae.Uncalnotchis postmortemartifact.
D,Companion
MRimageshowsmamilothalamic
tractsconverging
tositeofmamillary
bodies
(Mb),sylvian
fissure(Sf),androstralrightamygdala
(A)asitfadesintouncus.Uncalrecess
(Ur)oftemporal
hornisseenonright(joinedarrows).
UralsoisseeninE.
E,Myelin-stained
brainsectionofleftmidportionofhippocampal
headorpes(foot)showsrelationship
ofuncus(pink)toCAlcells(red).Notethatuncalextension
oftemporal
horn
seenonrightshouldnotbemistaken
forpathology
(Fig.10).Uncalsulcusisshownonleft CAlcellsseparate
uncalsulcusfromuncalrecess.Righthippocampal
headshowscompli
catedalternatingcellularrelationshipsof CAl (red),CA2(turquoise),andCA3(brightyellow)cellsto centrallylocatedamygdala(blue).CA4appearsin Figure5A.
1@
Companion
MRimageshowsinterpeduncularfossa
(If)between
cerebral
peduncles
andvessels
inambient
cistern(Ac)asitmerges
withchoroidalfissure
(Ch)andtemporal
horn(Th).
.-
Al F
\4
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A4
@
@
4'
@----@- Choroidal
fissure
fissure
Collateral fissure
Dentate
gyrus
CA =
Comu Ammonia
@imer
sector)
amygdala
(Ammon's horn)
@@iaI
rsslstant zone)
gy@u@ambiens
(End
folium)
CA3
entorhina)
area
body
of
parah(ppocampai
gyms
tao
of
parahippocampa)
gyms
vestigial
supracaliosa)
gyrus
anterior parahlppocampat gyrus)
becomescingulategyrus[notshown])
@:@7unaris
)induslum griseum)
Fig.5.Normal
anatomy
ofhippocampal
bodyonpairedserial,myelin-stained
coronalbrainsections
andcompanion
12-weighted
MRimages.
Bothmyelin-stained
sections
andMR
imagesareasymmetric,causingslightlydifferentappearancebetweenright-andleft-sidedstructures,which producessixuniquesections.Colorkeyis guideto importantstructures
andlandmarks.
A,Myelin-stained
brainsectionofbothanteriorhippocampal
bodieshasclassiccellularconfiguration
ofcornuammonis
zone1(CAl,red),zone2(CA2,
turquoise),
zone3(CA3,bright
yellow),andthesmallest
zone4(CA4,
magenta)
showninFigure
2.Largeportionofuncus(pink)continues
tobepresent
onrightbuthasalmostdisappeared
onleftside.
B,Companion
MRimageshowshypointense
whitematterofalveus(Al)andfimbria(F),whichseparate
hippocampal
cortexbelowfromsuperior
brightsignalintensity
ofpartialvolume
ofCSFandchoroidal
plexusinthintemporal
horn.Hypocellular
molecular
layerofdentate
gyrus(arrowheads)
hashypointense
signalintensity
thatissameasthatseeninwhitematter
elsewhere
inbrain.Imageisconfusing
because
intervening
cellsofcornuammonis
zone2(CA2,
turquoise)
anddentate
fibers(darkgreen)that
separate
hypointense
alveusabovefrom
hypointense
molecular
layerbelow(A)arenotresolved
and,therefore,
hypointensity
appears
ascontinuous
band.
C,Myelin-stained
brainsectionofhippocampal
bodyissmallerversionofclassiccellularconfiguration
showninA andinFigure2.UncalsulcusseeninA hasbecome
hippocampal
sulcus(fissure),
andfimbriodentate
fissurehasappeared.
Atthislevel,cellsofentorhinal
area(lightgreen2)havebeenreplaced
bymainbodyofparahippocampal
gyrus(lightgreen2a).
D,Companion
MRimageshowspulvinar
(Pul)ofthalamus,
choroidal
fissure(Ch),collateral
fissure(CoIl),
andtemporal
horn(Th)entering
atriumoflateralventricle.
E,Myelin-stained
brainsectionoflastportionofhippocampal
bodyatantenormost
splenium
ofcorpuscallosum.
Bodyofparahippocampal
gyrus(lightgreen2a),whichispresentin
previous
sections,
islastseenonthislevel.Itisreplaced
inFigure
6Abytailofparahippocampal
gyrus(lightgreen3).
F,Companion
MRimage
shows
splenium
ISpI),caudate
nucleus
)Cn),
andcrusoffornix
)Cfx).
MR Imaging
of the Hippocampus
@,if
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Sp:
@B
I
,@(tk,@@.
Dentate
gynis
@
CA
ComuAmmonia
@sn.r
sector)
(Ammon'.
@@r@aI
nshetuit son.)
horn)
entorhinal
area
body
of
parahlppocampai
gyms
tail
of
parahippocampal
gyms
vestigial
supracaiiosai
gyms
(connects parahlppocampus with CAl)
amygdaia
gyi'tzs amblens
CA3
@::i@unai1s
(indusiumgriseum)
Fig.6.Normal
anatomyofhippocampal
tailonpairedserial,myelin-stained
coronalbrainsectionsandcompanion
12-weighted
MRimages.Bothmyelin-stained
sections
and MR imagesare asymmetric,causing slightly different appearancebetween right- and left-sided structures, which producesfour uniquesections. Colorkey is guide
to important structures and landmarks.
A,Myelin-stained
brainsectionofjunctionofbodyandhippocampal
tailbelowposteriorspleniumofcorpuscallosum.Cornuammonis
zone1(CAl)cells(red)predominate
and surround dentate gyrus (dark green).Gyrusfasciolaris is composedof CA3cells (yellow). Gyruscinerea is formed by CA4cells (magenta).Body of parahippocampal
gyrus (light green 2a in Figure5E)hasterminated, andtail of parahippocampalgyrus appears(light green 3). Collateralsulcus terminates at this level.
B,Companion
MRimageshowsatriumof lateralventricle,anteriorcalcarinefissure(AC),andsplenium)Spl)of corpuscallosum.Alveus(Al)oftencanbeidentifiedbe
tweenbrightsignalintensityof CSFandcortexofcornuammonis
zone1(CAl)hippocampal
cells.
C,Myelin-stained
brainsectionofhippocampal
tailcontainslastsmallremnantofcorpuscallosumbelowsupracallosal
gyrusonright.Anteriorcalcarinefissureseparates
cornu ammoniszones1 (CAl, red) and 3 (CA3,brightyellow) cellular layers of hippocampusfrom subiculum(light green 1).
D,Companion
MRimageshowsanteriorcalcarinefissure(AC).
MR lmagingTechniques
Clinical1-lippocompalImaging
Volumetric
Analysis
Over the last few years, more than 90 arti-
Spectroscopy
1143
Hayman et al.
PC
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Cr
Cr
-,@.
I,,.,
ppm
A
Fig.7.'HMRspectra.
A,Eightcubiccentimeters
ofnormal
frontoparietal
region.
Short-TE
(30msec)MRspectroscopy
showsgoodwatersuppression
andspectral
resolution
ofvarious
bio
chemicals.NAA= N-acetyl-L-aspartate,GABA=y-aminobutyric
acid, glu = glutamate,gIn= glutamine,asp= aspartate,PCr= phosphocreatine,Cr creatine, Cho= choline,
Ins= myo-inositol.
B,Fivecubiccentimetersof normalhippocampus.
Short-TE
(30msec)MRspectroscopy
showsbroaderspectralpeaksandpoorlydefinedbaselineresultingfromlocal
field inhomogeneitiesin region.Useof longerTE(>100msec)would significantly improvebaselineby increasingwater-suppressionefficiency. However,resulting spectral
information
wouldincludeonlyNAA,Cr,PCr,andChobecauseotherbiochemicals
haveshort12relaxationtimes.
CAt2@
.,,
..
.,
.,@
..
.p
:@
i@/P:,,:1@i1@::
A
Fig.8.Hippocampal
sclerosis.
CAl=cornuammonis
zone1.CA2= cornuammonis
zone2.
A,Coronal
section
ofbrainshowsnormal
leftCA2andsevereatrophy
ofleftCAlwithflattening
ofnormal
hippocampal
bulgeintotemporal
horn(curved
arrow)(seenormal
coronalprofileinFig.2).Normalfissures(choroidal,Ch;fimbriodentate,
FD;andhippocampal,
H)aremarkedfororientation.
B,Microscopiccoronalsectionofbodyofhippocampus
showsclassiclossofcellsinCAlofhippocampus
compared
withnormaldarktriangularpyramidalcells(arrows)
in CA2region.(HandE,xlOO)
tient and has been performed in an effort to
detect early onset of Alzheimer's disease and to
study normal age-associated memory impair
ment. MR spectroscopy may be of particular
Refractory Epilepsy
Epilepsy affects 0.51%of the population in
the United States.Of theseindividuals, 1530%
importance
1144
may expand
the clinical
applications
of MR
are refractory
to medical treatment
and are po
AJR:171,October1998
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,@
,1
.1
I
Fig.9.Hippocampal
sclerosis.
A,Coronal
fastspin-echo
12-weighted
scanshowsabnormal
increased
signalintensity
inbodyoflefthippocampus
(arrow)compared
withnormal
rightside.
B,Coronalfastspin-echo12-weighted
scancaudalto A showsthatatrophyof hippocampus
onleftresultsin subtleincreasedsizeof leftchoroidalfissure(Ch)(arrow).
Normalthinner choroidal fissure on right side also is markedwith arrow for comparison.
Fig.10.Fibrillary
astrocytoma.
A,Coronal
fastspin-echo
12-weighted
scanshowsabnormal
focusofincreased
signalintensity
atjunction
ofrightamygdala
andhippocampal
head(arrow)(seeFig.4C,
left hippocampalsection).This finding should not be mistakenfor uncal recess of temporal horn (see Figs.4D and 4E).
B,Companion
11-weighted
imagesbefore(notshown)andaftergadolinium
administration
donotshowabnormality.
@@#@fT 7:
tu
AJR:171,October1998
localize
Fig. 11.Temporal
lobe ganglioglioma.Fastspin-echo 12-weighted image shows left inferior temporal lobe le
sion(arrow)thatwasnotseenonunenhanced
11-weightedscans.Scalpelectroencephalograph
erroneously
indicated focus in oppositetemporal lobe. Subduralelectrodes correctly localized lesion.
1145
Hayman et al.
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Summary
The hippocampus is a complex and fasci
nating region of the brain that has enormous
clinical significance. Specifically, small imag
ing abnormalities may cause major symp
toms. We believe that the detection of these
lesions will be improved if imaging clinicians
have an organized
1146
4. FullerGN,BurgerPC.Centralnervoussystem.In:
Sternberg
SS,ed.Histologyfor pathologists,
2nd
ed.NewYork:LippinconRaven,
1997:243282
5. Tien RD. FelsbergGJ. Cram B. Normal anatomy
lag,1988:145
6. Jack CR, Rydberg CH, Krecke KN, et al. Mesial
2. BronenRA, Cheung0. Relationshipof hippo
temporalsclerosis:diagnosiswith fluid-attenu
campusandamygdala
tocoronalMRI landmarks.
ated inversion-recoveryversusspin-echoMR im
Magn Reson Imaging 1991:9:449457
3. Naidich TP, Daniels DL, Haughton VM, Williams
lepsy.MayoClinPmc 1996;7l:695711
AJR:171,October1998