Anat Cell Biol.  2023 Dec;56(4):469-473. 10.5115/acb.23.162.

Magnetic resonance angiography in assessment of anomalies of anterior cerebral artery in adults

• Ahmed Madkour NA

• KMID: 2548901
• DOI: http://doi.org/10.5115/acb.23.162

Abstract

Anomalies of anterior cerebral artery (ACA) include aplasia, hypoplasia and variations in number. Magnetic resonance angiography (MRA) is a non-invasive diagnostic technique for assessment of anomalies of cerebral arteries. The aim of the study was to determine the role of MRA in detection of variants of ACA in adults. This study is an observational retrospective study. This study included forty-nine adult cases (28 males and 21 females), mean age 48±12.9 SD with anomalies of ACA in MRA. Magnetic resonance imaging of the brain and MRA were done to all patients. Cerebral MRA and magnetic resonance images were evaluated for frequency and distribution of variants of anterior cerebral arteries, associated aneurysms and infarctions. Odds ratios (ORs) and relative risk were calculated to determine risk of occurrence of cerebral infarctions in patients with anomalies of ACA. Hypoplasia of ACA was the commonest anomaly of ACA (51% of cases). Risk of occurrence of cerebral infarctions was higher in cases with azygos variant (OR, 3.3; P=0.35) than in those with hypoplastic ACA (OR, 2; P=0.58). MRA was highly reliable in identification of different variants of ACA and concomitant vascular changes.

Keyword

Anomalies; Anterior cerebral artery; Magnetic resonance angiography; Adults

Figure

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  Fig. 1 Magnetic resonance angiography of both ICA and cerebral branches in a 64-year-old male patient. Hypoplastic A1 segment of right ACA (arrow). ICA, internal carotid artery; ACA, anterior cerebral artery.

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  Fig. 2 Magnetic resonance angiography (MRA) of both intracranial ICA in a 63-year-old male patient with bihemispheric ACA. Antro-posterior (A) and right oblique (B) views of MRA revealed hypoplastic right ACA (blue arrow) and dominant left ACA arising from a common A2 trunk (yellow arrow). ICA, internal carotid artery; ACA, anterior cerebral artery.

Reference

References

1. Lasjaunias PL, Berenstein A, Brugge KG. 2001. Surgical neuroangiography. 1, clinical vascular anatomy and variations. 2nd ed. Springer;p. 479–631. DOI: 10.1007/978-3-662-10172-8_6.

2. Stefani MA, Schneider FL, Marrone AC, Severino AG, Jackowski AP, Wallace MC. 2000; Anatomic variations of anterior cerebral artery cortical branches. Clin Anat. 13:231–6. DOI: 10.1002/1098-2353(2000)13:4<231::AID-CA1>3.0.CO;2-T. PMID: 10873213.

3. Stock KW, Wetzel S, Kirsch E, Bongartz G, Steinbrich W, Radue EW. 1996; Anatomic evaluation of the circle of Willis: MR angiography versus intraarterial digital subtraction angiography. AJNR Am J Neuroradiol. 17:1495–9. PMID: 8883648. PMCID: PMC8338732.

4. Barboriak DP, Provenzale JM. 1997; Pictorial review: magnetic resonance angiography of arterial variants at the Circle of Willis. Clin Radiol. 52:429–36. DOI: 10.1016/S0009-9260(97)80003-7. PMID: 9202585.

5. Patrux B, Laissy JP, Jouini S, Kawiecki W, Coty P, Thiébot J. 1994; Magnetic resonance angiography (MRA) of the circle of Willis: a prospective comparison with conventional angiography in 54 subjects. Neuroradiology. 36:193–7. DOI: 10.1007/BF00588129. PMID: 8041438.

6. Baptista AG. 1963; Studies on the arteries of the brain. II. The anterior cerebral artery: some anatomic features and their clinical implications. Neurology. 13:825–35. DOI: 10.1212/WNL.13.10.825. PMID: 14066997.

7. Ravikanth R, Philip B. 2019; Magnetic resonance angiography determined variations in the circle of Willis: analysis of a large series from a single center. Tzu Chi Med J. 31:52–9. DOI: 10.4103/tcmj.tcmj_167_17. PMID: 30692833. PMCID: PMC6334567. PMID: a8a2144ff23d4811a6a7c902a749bffe.

8. Alpers BJ, Berry RG, Paddison RM. 1959; Anatomical studies of the circle of Willis in normal brain. AMA Arch Neurol Psychiatry. 81:409–18. DOI: 10.1001/archneurpsyc.1959.02340160007002. PMID: 13636509.

9. Krabbe-Hartkamp MJ, van der Grond J, de Leeuw FE, de Groot JC, Algra A, Hillen B, Breteler MM, Mali WP. 1998; Circle of Willis: morphologic variation on three-dimensional time-of-flight MR angiograms. Radiology. 207:103–11. DOI: 10.1148/radiology.207.1.9530305. PMID: 9530305.

10. Taşar M, Yetişer S, Taşar A, Uğurel S, Gönül E, Sağlam M. 2004; Congenital absence or hypoplasia of the carotid artery: radioclinical issues. Am J Otolaryngol. 25:339–49. DOI: 10.1016/j.amjoto.2004.04.008. PMID: 15334399.

11. Perlmutter D, Rhoton AL Jr. 1976; Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg. 45:259–72. DOI: 10.3171/jns.1976.45.3.0259. PMID: 948013.

12. Shatri J, Cerkezi S, Ademi V, Reci V, Bexheti S. 2019; Anatomical variations and dimensions of arteries in the anterior part of the circle of Willis. Folia Morphol (Warsz). 78:259–66. DOI: 10.5603/FM.a2018.0095. PMID: 30311936.

13. Stehbens WE. 1963; Aneurysms and anatomical variation of cerebral arteries. Arch Pathol. 75:45–64. PMID: 14087271.

14. Huber P, Braun J, Hirschmann D, Agyeman JF. 1980; Incidence of berry aneurysms of the unpaired pericallosal artery: angiographic study. Neuroradiology. 19:143–7. DOI: 10.1007/BF00342389. PMID: 7383334.

15. Kayembe KN, Sasahara M, Hazama F. 1984; Cerebral aneurysms and variations in the circle of Willis. Stroke. 15:846–50. DOI: 10.1161/01.STR.15.5.846. PMID: 6474536.

16. Ghazali RM, Shuaib IL. 2003; Comparison between 3D TOF magnetic resonance angiography and intraarterial digital subtraction angiography in imaging the circle of Willis. Malays J Med Sci. 10:37–42. PMID: 23365498. PMCID: PMC3557107.

17. Grandin CB, Mathurin P, Duprez T, Stroobandt G, Hammer F, Goffette P, Cosnard G. 1998; Diagnosis of intracranial aneurysms: accuracy of MR angiography at 0.5 T. AJNR Am J Neuroradiol. 19:245–52.

18. Huston J 3rd, Nichols DA, Luetmer PH, Goodwin JT, Meyer FB, Wiebers DO, Weaver AL. 1994; Blinded prospective evaluation of sensitivity of MR angiography to known intracranial aneurysms: importance of aneurysm size. AJNR Am J Neuroradiol. 15:1607–14. PMID: 7857409. PMCID: PMC8333739.

19. Uchino A, Nomiyama K, Takase Y, Kudo S. 2006; Anterior cerebral artery variations detected by MR angiography. Neuroradiology. 48:647–52. DOI: 10.1007/s00234-006-0110-3. PMID: 16786350.

20. Pentyala S, Sankar KD, Bhanu PS, Kumar NSS. 2019; Magnetic resonance angiography of hypoplastic A1 segment of anterior cerebral artery at 3.0-Tesla in Andhra Pradesh population of India. Anat Cell Biol. 52:43–7. DOI: 10.5115/acb.2019.52.1.43. PMID: 30984451. PMCID: PMC6449583.

21. Qiu C, Zhang Y, Xue C, Jiang S, Zhang W. 2015; MRA study on variation of the circle of willis in healthy Chinese male adults. Biomed Res Int. 2015:976340. DOI: 10.1155/2015/976340. PMID: 25629057. PMCID: PMC4299360.

22. Zampakis P, Panagiotopoulos V, Petsas T, Kalogeropoulou C. 2015; Common and uncommon intracranial arterial anatomic variations in multi-detector computed tomography angiography (MDCTA). What radiologists should be aware of. Insights Imaging. 6:33–42. DOI: 10.1007/s13244-014-0381-x. PMID: 25680324. PMCID: PMC4330235.

23. Singh R, Kannabathula AB, Sunam H, Deka D. 2017; Anatomical variations of circle of Willis - a cadaveric study. Int Surg J. 4:1249–58. DOI: 10.18203/2349-2902.isj20171016.

24. Truwit CL. 1994; Embryology of the cerebral vasculature. Neuroimaging Clin N Am. 4:663–89. PMID: 7858915.

25. Huh JS, Park SK, Shin JJ, Kim TH. 2007; Saccular aneurysm of the azygos anterior cerebral artery: three case reports. J Korean Neurosurg Soc. 42:342–5. DOI: 10.3340/jkns.2007.42.4.342. PMID: 19096567. PMCID: PMC2588199.

26. Nutik S, Dilenge D. 1976; Carotid-anterior cerebral artery anastomosis. Case report. J Neurosurg. 44:378–82. DOI: 10.3171/jns.1976.44.3.0378. PMID: 1249618.

27. Okahara M, Kiyosue H, Mori H, Tanoue S, Sainou M, Nagatomi H. 2002; Anatomic variations of the cerebral arteries and their embryology: a pictorial review. Eur Radiol. 12:2548–61. DOI: 10.1007/s00330-001-1286-x. PMID: 12271398.

28. Yamaguchi K, Uchino A, Sawada A, Takase Y, Kuroda Y, Kudo S. 2004; Bilateral anterior cerebral artery territory infarction associated with unilateral hypoplasia of the A1 segment: report of two cases. Radiat Med. 22:422–5. PMID: 15648459.

29. Waaijer A, van Leeuwen MS, van der Worp HB, Verhagen HJ, Mali WP, Velthuis BK. 2007; Anatomic variations in the circle of Willis in patients with symptomatic carotid artery stenosis assessed with multidetector row CT angiography. Cerebrovasc Dis. 23:267–74. DOI: 10.1159/000098326. PMID: 17199084.

30. Kwak HS, Hwang SB, Chung GH, Lee SY. 2015; Pattern of circle of Willis between normal subject and patients with carotid atherosclerotic plaque. Neurol Asia. 20:7–14.

31. Hindenes LB, Håberg AK, Johnsen LH, Mathiesen EB, Robben D, Vangberg TR. 2020; Variations in the Circle of Willis in a large population sample using 3D TOF angiography: the Tromsø study. PLoS One. 15:e0241373. DOI: 10.1371/journal.pone.0241373. PMID: 33141840. PMCID: PMC7608873. PMID: f7037f08eaef4666aacaf161d4481e5e.