Cadaver vs. CTA: Which Should Be the Core of Modern Anatomy Teaching?

The traditional answer to the question "what is the core of anatomy teaching?" has been simple: cadaver dissection. The last two decades have disrupted that consensus as high-quality CT, CT angiography (CTA), MR and 3D reconstructions have become routine in both clinical practice and anatomy laboratories.⁸ At the same time, curriculum compression, cost, ethical and logistical pressures on dissection rooms have encouraged some schools to reduce or abandon cadaver-based teaching in favour of prosections and digital resources.⁹

Parallel advances in CTA have transformed our understanding of renal vascular variants, paranasal sinus anatomy and vertebral artery pathways, providing rich, population-level data on anatomical diversity that were difficult to achieve with cadaveric work alone.^{2, 4} Modern students also encounter anatomy first in radiology, endoscopy and navigation systems rather than in the dissecting room. The central question is therefore not whether cadavers or imaging are "better", but which modality should anchor a modern curriculum and how they should be integrated.

This narrative, data-informed review contrasts cadaveric and imaging-based anatomy along three exemplar systems: renal arterial anatomy, paranasal sinus variants and vertebral artery entry patterns. For renal arteries, cadaveric series reporting additional or accessory renal arteries were compared with CTA and multidetector CT angiography studies that quantified renal vascular variants in potential kidney donors and general cohorts.^{1, 2} For paranasal sinuses, CT-based prevalence studies of key variants such as concha bullosa, agger nasi and Haller cells were used as imaging comparators.^{4, 5}

Vertebral artery analysis focused on the V2 segment, where cadaveric and MR / CT angiography data quantify the frequency of non-C6 transverse foramen entry, a critical risk factor in anterior cervical surgery.⁶ To frame educational implications, we drew on comparative and review articles examining exam performance and learner perceptions with cadaver dissection, imaging-based teaching and multimodal or technology-rich approaches.^{7, 9}

Direct anatomical work by Saldarriaga and colleagues on Colombian cadavers found additional renal arteries in roughly one quarter of kidneys, with accessory vessels more often unilateral than bilateral, and a predominance of single extra arteries rather than multiple branches.¹ Such series define fine-grained morphology, including polar versus hilar entry and pre-hilar branching patterns, but are limited in size and regional diversity.

CTA-based cohorts now routinely examine hundreds of patients in a single series. Çınar and Türkvatan reported renal vascular variations in approximately one quarter of MDCT angiography studies, while more recent CTA donor series from Sudan and other regions have described congenital vascular variants, including accessory renal arteries, in around 20–25% of donors.^{2, 3} Review articles on living donor evaluation emphasise that CTA reliably detects accessory renal arteries, early branching and venous variants that are essential for surgical planning and graft selection.³

From a teaching standpoint, cadaveric kidneys allow stepwise dissection of the renal pedicle, tactile appreciation of vessel calibre and direct correlation with didactic schematics of the renal arterial tree, such as those illustrated in abdominal aorta branches and renal arterial tree. CTA datasets, in contrast, permit rapid exposure to dozens of real variants across a few teaching sessions and align directly with preoperative imaging that trainees will interpret in vascular and transplant practice.

Cadaveric sinonasal studies remain important for demonstrating mucosal relationships and surgical landmarks, but high-resolution CT has become the practical reference for enumerating anatomic variants relevant to functional endoscopic sinus surgery. Classic and contemporary CT series document frequent variants such as concha bullosa, agger nasi cells, Haller cells and complex ethmoid pneumatization patterns with sample sizes in the hundreds.^{4, 5}

Nautiyal and co-workers, for example, reported middle turbinate concha bullosa in roughly 31% of subjects, agger nasi cells in about 22%, Haller cells in 23% and nasal septal deviation in just under 22% in a CT cohort without paranasal sinus symptoms.⁵ Similar ranges appear in multi-centre and ethnic-comparison studies of sinonasal anatomy.⁴ These imaging datasets map directly onto preoperative planning: learners can scroll through axial and coronal CT scans to appreciate how variations displace ostia, narrow drainage pathways or alter proximity to the orbit and skull base.

By contrast, cadaver heads—especially when dissected under endoscopic vision—offer unparalleled appreciation of tissue planes, bleeding surfaces and the tactile feedback of instrument manipulation in narrow corridors, which CT cannot convey. For teaching, this argues against viewing CT as a replacement for cadaveric sinonasal dissection; instead, CT should be used to prime and then consolidate lab sessions, with students identifying variants on imaging and immediately correlating them with dissected specimens.

The V2 segment of the vertebral artery is an instructive example of how imaging and cadaver work answer different questions. Bruneau et al. analysed 500 vertebral arteries on MR and CT and found that the vessel entered the C6 transverse foramen in about 93% of courses, with entrance at C5, C4, C7 or more cranial levels making up the remaining 7%.⁶ Such variants substantially alter the risk profile of anterior cervical surgery; they are best identified on preoperative imaging rather than inferred from generic cadaver-derived descriptions.

Cadaveric studies remain critical, however, for defining the safe working corridors once the artery has been exposed, clarifying the relationship between V2 loops, uncovertebral joints, nerve roots and the longus colli muscle. Imaging cannot replicate the hands-on judgement required when resecting osteophytes close to a laterally displaced vertebral artery, but it does ensure that residents appreciate how often textbook "normal" anatomy is modified by developmental variants.

Biasutto's classic comparative study of medical students exposed to cadaver dissection, computer-based learning or both concluded that the best exam performance and practical understanding occurred in the combined group, with cadaver-only students performing better than those taught by computers alone.⁷ Estai and Bunt's critical review of anatomy education similarly argues that no single modality is sufficient; instead, cadaver work, imaging, living anatomy and multimedia each contribute distinct advantages that should be intentionally combined rather than positioned as mutually exclusive alternatives.⁹

Subsequent literature, including McMenamin's multi-author debate on whether cadavers are still needed, reinforces three themes: dissection strongly supports long-term spatial understanding and professional identity formation; high-quality imaging and digital tools improve transfer to clinical and radiological contexts; and purely virtual courses risk superficial, short-lived knowledge gains.^{8, 10} Across diverse curricula, the most effective programmes appear to be those that keep cadaver laboratories at the centre but redesign them to work in tandem with structured imaging sessions and thoughtfully curated digital resources.

Across the vascular, sinonasal and vertebral artery examples, a consistent pattern emerges: CTA and related imaging methods excel at quantifying anatomical variation and presenting anatomy in the same planes and projections used for clinical decision-making, whereas cadavers remain unrivalled for developing deep three-dimensional understanding, tissue-handling skills and professional attitudes towards the human body.^{1, 8} Imaging can show, in a single laboratory session, more accessory renal arteries, paranasal variants or unusual vertebral artery courses than most students would encounter in an entire year of dissection. However, images are inherently filtered representations whose interpretation depends on mental models often built in the dissection room.

Education-focused reviews emphasise that attempts to replace cadavers entirely with imaging, plastic models or virtual systems have not produced clear, sustained gains in anatomical competence or clinical performance.^{9, 10} Instead, multimodal curricula—where cadaver dissection anchors core regional teaching and is tightly integrated with radiology, surface anatomy and technology-enhanced resources—are associated with better knowledge retention and student satisfaction. From a logistical perspective, such integration also makes more efficient use of limited cadaveric material by focusing lab time on high-yield regions and complementing them with imaging-based exploration of rarer variants.

For anatomists and surgeons involved in curriculum design, the practical implication is that CTA should not be treated as a rival to cadaveric teaching but as an indispensable partner. Vascular, sinonasal and vertebral examples can be used to construct vertically integrated learning threads that start with dissection in early years, continue with image-based case discussions in clinical blocks and culminate in procedure-focused simulation and navigation training.

Cadaver dissection and CTA occupy different, complementary niches in anatomy education. Cadavers uniquely support hands-on exploration of three-dimensional relationships, appreciation of tissue planes and professional formation around death and donation. CTA and other modern imaging techniques, meanwhile, reveal the real-world spectrum of anatomical variation and align closely with how anatomy is encountered in radiology, endoscopy and the operating theatre.^{2, 8}

The core of a modern anatomy curriculum should therefore be neither cadavers nor CTA alone, but a deliberately multimodal programme in which cadaveric teaching remains central and is systematically linked to imaging and digital resources. Such an approach respects the enduring educational and ethical value of dissection while harnessing the strengths of contemporary imaging to prepare students for practice in image-rich surgical and interventional environments.