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      Common and uncommon intracranial arterial anatomic variations in multi-detector computed tomography angiography (MDCTA). What radiologists should be aware of

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          Abstract

          Objectives

          The aim of this retrospective study was twofold: (1) to show the role of multi-detector computed tomography angiography (MDCTA) in the evaluation of intracranial arterial anatomic variations; (2) to highlight their clinical importance with illustrated example cases.

          Materials and methods

          One thousand seven hundred thirty-nine patients who underwent carotid and/or cerebral CTA using a 16-row multi-detector CT over the last 9 years were retrospectively analysed with attention to the presence of persistent carotid-basilar anastomosis and other intracranial arterial variations.

          Results

          All kinds of persistent carotid-basilar anastomosis were present in our series. The most common was the presence of fetal pCom (23 %). From the other studied anatomic variants, the most common was the presence of a hypoplastic A1 segment. In all cases CTA was an excellent diagnostic tool, providing not only high-resolution angiographic images, but also details of the surrounding structures.

          Conclusions

          The knowledge of intracranial anatomic variations could be very important for the treatment planning of patients who need neurointervention or to explain uncommon and unexpected clinical findings. CTA can reliably provide this kind of information by depicting intracranial anatomic variations.

          Teaching Points

          Knowledge of intracranial anatomic variations is important.

          Radiologist should be aware of the intracranial anatomic variations.

          Computed tomography angiography can reliably depict intracranial anatomic variations.

          Related collections

          Most cited references18

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          Normal variants of the cerebral circulation at multidetector CT angiography.

          Multidetector computed tomographic (CT) angiography is used in many institutions for initial evaluation of the cerebral circulation for acute stroke and subarachnoid hemorrhage as well as in various preoperative settings. A comprehensive CT examination that includes a review of three-dimensional and maximum intensity projection images of the intra- and extracranial arteries and axial images of the skull base (obtained with bone window settings) allows identification of most abnormalities and normal variants. Knowledge of the presence and clinical relevance of normal variants such as fenestrations, duplications, and persistent fetal arteries plays a crucial role in the diagnosis and management of acute stroke and subarachnoid hemorrhage and may aid in surgical planning. For example, the preoperative detection of a medial or intrasellar persistent trigeminal artery may help surgeons avoid a potentially life-threatening hemorrhage in a patient undergoing transsphenoidal surgery for pituitary adenoma. However, the significance of normal variants diverges widely: A clinically important association has been observed between fenestration and intracranial aneurysm formation, whereas early branching of the middle cerebral artery is not associated with an increased risk of aneurysm formation and has little clinical significance. Supplemental material available at http://radiographics.rsnajnls.org/cgi/content/full/29/4/1027/DC1. Copyright RSNA, 2009
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            • Article: not found

            Patent primitive trigeminal artery studied by cerebral angiography.

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              • Article: not found

              Anatomic variations of the cerebral arteries and their embryology: a pictorial review.

              In the embryonic period, several developmental anomalies of the cerebral arteries occur. The knowledge of these anatomic variations of the cerebral artery is important to avoid the unnecessary surgery and to undergo surgery or interventional radiology with safety. We reviewed 3000 MR angiographies and 700 cerebral angiographies of the previous 5 years to assess cerebral arterial system, and to illustrate the embryological development, imaging findings, occurrence, and clinical significance of the anatomic variation of the cerebral arteries. The normal development and variations of the cerebral arteries are depicted. Knowledge of the anatomic variations is important since it can influence surgical and interventional procedure.
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                Author and article information

                Contributors
                pzampakis@gmail.com
                panagiotopoulos2000@yahoo.com
                petsas@upatras.gr
                0030 2610 999812 , ckrat@upatras.gr
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1869-4101
                14 February 2015
                14 February 2015
                February 2015
                : 6
                : 1
                : 33-42
                Affiliations
                [ ]Department of Radiology, University Hospital of Patras, Rion, Greece PC 26500
                [ ]Department of Neurosurgery, University Hospital of Patras, Rion, Greece PC 26500
                Article
                381
                10.1007/s13244-014-0381-x
                4330235
                25680324
                f766ba88-1e97-4e30-b903-77694670ebe5
                © The Author(s) 2015

                Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                : 11 November 2014
                : 18 December 2014
                : 19 December 2014
                Categories
                Pictorial Review
                Custom metadata
                © The Author(s) 2015

                Radiology & Imaging
                embryology,anatomic variation,multi-detector computed tomography,cerebral angiography,cerebral arteries

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