Visualization of the posterior communicating artery on magnetic resonance angiography
Abstract
Background: The posterior communicating artery (PComA) is crucial in the formation of the circle of Willis, displaying variations such as hypoplasia and aplasia. These impact collateral blood flow, with false diagnoses, posing risks in pre-surgical planning. Discrepancies between cadaveric and radiological studies highlight the imaging modality precision concerns.
Aim: To explore the sensitivity of 3D TOF (time-of-flight) angiograms in visualizing the PComA compared to maximum intensity projection (MIP) tomograms, and to assess whether CE-MRA (contrast-enhanced MRA) improves PComA visualization compared to native MRA.
Methods: In this retrospective study there were 137 subjects who underwent MRA between July 2008 and May 2013. Subjects with cerebrovascular disease, vascular malformations and brain tumors were excluded. The study focused on 274 PComA in 137 subjects, evaluating visualization on native and CE-MRA, as well analyzing axial 3D TOF angiograms and MIP images. The analysis categories were: not visualized, poorly visualized or well visualized.
Results: Among 211 arteries visualized on CE-MRA, only 2 (0.95%) were not seen on native MRA. CE-MRA, improved visualization in 5.22% of cases, with no significant difference (p=0.99) in PComA visualization between native and CE-MRA. Out of 209 PComA visualized on native MRA, 54 (25.84%) were visible on axial 3D TOF angiograms, but not on MIP reconstructions. Basic 3D TOF tomograms significantly outperformed MIP images (p=0.038) in visualizing PComA.
Conclusion: Contrast MRA does not significantly improve the visualization of PComA compared to native MRA, but basic 3D TOF tomograms are significantly better in visualizing PComA compared to MIP reconstructions.
Keywords
References
Gunnal SA, Farooqui MS, Wabale RN. Anatomical Variability of the Posterior Communicating Artery. Asian J Neurosurg 2018;13(2):363-9.
Mukherjee D, Jani ND, Narvid J, Shadden SC. The Role of Circle of Willis Anatomy Variations in Cardio-embolic Stroke: A Patient-Specific Simulation Based Study. Ann Biomed Eng 2018;46(8):1128-45.
Kapoor K, Singh B, Dewan LI. Variations in the configuration of the circle of Willis. Anat Sci Int 2008;83(2):96-106.
Eftekhar B, Dadmehr M, Ansari S, Ghodsi M, Nazparvar B, Ketabchi E. Are the distributions of variations of circle of Willis different in different populations? - Results of an anatomical study and review of literature. BMC Neurol 2006;24;6-22.
Zhou H, Sun J, Ji X, Lin J, Tang S, Zeng J, Fan YH. Correlation Between the Integrity of the Circle of Willis and the Severity of Initial Noncardiac Cerebral Infarction and Clinical Prognosis. Medicine (Baltimore) 2016;95(10):e2892.
Stock KW, Wetzel S, Kirsch E, Bongartz G, Steinbrich W, Radue EW. Anatomic evaluation of the circle of Willis: MR angiography versus intraarterial digital subtraction angiography. AJNR Am J Neuroradiol 1996;17(8):1495-9.
Ozsarlak O, Van Goethem JW, Maes M, Parizel PM. MR angiography of the intracranial vessels: technical aspects and clinical applications. Neuroradiology 2004;46(12):955-72.
Li J, Wang J, Wei XE, Zhao YW, Wang F, Li YH. Examination of Structural Variations of the Circle of Willis by 3D Time-of-Flight Magnetic Resonance Angiography. Front Neurosci 2020;11:14-71.
Alpers BJ, Berry RG, Paddison RM. Anatomical studies of the circle of Willis in normal brain. AMA Arch Neurol Psychiatry 1959;81(4):409-18.
Siddiqi H, Tahir M, Lone KP. Variations in cerebral arterial circle of Willis in adult Pakistani population. J Coll Physicians Surg Pak 2013;23(9):615-9.
Saikia B, Handique A, Phukan P, Lynser D, Jamil M. Study of anomalies in the circle of Willis using magnetic resonance angiography in north eastern India. Journal of the Anatomical Society of India 2014;63,67–73.
Maaly MA, Ismail AA. Three dimensional magnetic resonance angiography of the circle of Willis: Anatomical variations in general Egyptian population. The Egyptian Journal of Radiology and Nuclear Medicine 2011;42:405–12.
Jones JD, Castanho P, Bazira P, Sanders K. Anatomical variations of the circle of Willis and their prevalence, with a focus on the posterior communicating artery: A literature review and meta-analysis. Clin Anat 2021;34(7):978-90.
Krayenbuhl H and Yasargil MG. Intradural branches of the internal carotid artery. In Huber P, ed. Cerebral Angiography. Georg Thieme Verlag 1982.
DOI: 10.5457/ams.v54i1.776
