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American Journal of Neuroradiology 25:222-232, February 2004
© 2004 American Society of Neuroradiology

BRAIN

The Insula: Anatomic Study and MR Imaging Display at 1.5 T

Thomas P. Naidicha, Eugene Kanga, Girish M. Fatterpekara, Bradley N. Delmana, S. Humayun Gultekinb, David Wolfeb, Orlando Ortizc, Indra Yousryd, Martin Weismannd,e and Tarek A. Yousryf

a Department of Radiology, Section of Neuropathology, Mount Sinai Medical Center, New York, NY
b Department of Pathology, Section of Neuropathology, Mount Sinai Medical Center, New York, NY
c Department of Radiology, Winthrop University Hospital, Mineola, NY
d Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians University of Munich Medical School, Munich, Germany
e Department of Radiology, Medical University, Luebeck, Germany
f the Lysholm Radiologic Department, the National Hospital for Nervous Diseases, Queen Square, London, UK

Address reprint requests to Thomas P. Naidich, MD, Department of Radiology, Box 1234, Mount Sinai Medical Center, One Gustave Levy Pl, New York, NY 10029

BACKGROUND AND PURPOSE: The insula is important for gustatory sensation, motor speech control, vestibular function, and sympathetic control of cardiovascular tone. The purpose of this study was to test two hypotheses: 1) gross anatomic study of the insula will disclose reproducible patterns of insular structure, and 2) analysis of MR appearance will enable physicians to recognize these patterns on imaging studies.

METHODS: Gross insular anatomy was determined in 16 normal human cadaveric hemispheres. The 1.5-T MR images of 300 insulae were analyzed to determine the gyral and sulcal patterns displayed; their relationship to the Heschl gyrus, to the overlying opercula, and to the vertical planes perpendicular to the Talairach-Tournoux baseline at the anterior commissure (VAC) and posterior commissure (VPC); their continuity into the orbitofrontal cortex; and appropriate landmarks for the anterior border, apex, and posterior border of the insula.

RESULTS: MR images displayed the central sulcus of the insula (97%); the anterior (99%), middle (78%), and posterior (98%) short insular gyri that converge to the apex (100%) anteriorly; and the anterior (99%) and posterior (58%) long insular gyri posteriorly. The middle short gyrus was often hypoplastic (33%). The anterior intersections of the internal and external capsules typically delimit the anterior insular border (87%). VAC intersects the anterior insula (99%), usually at the precentral sulcus. The Heschl gyrus circumscribes the posteroinferior insula (100%). VPC demarcates the posterior insular border (94%).

CONCLUSION: The two hypotheses were proved correct. The insula shows reproducible patterns of gross anatomy that are demonstrable on routine clinical MR images obtained at 1.5 T.






Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X