Yalcin Bozkurt

Normal Anatomical Features and Variations of the Vertebrobasilar Circulation and Its Branches: An Analysis with 64-Detector Row CT and 3T MR Angiographies

Purpose. To determine the normal anatomical features and variations of the vertebrobasilar circulation and its branches in patients who underwent multidetector computed tomography (CT) or magnetic resonance (MR) angiographies of the brain. Methods. 135 patients (male, 83 and female, 52; mean age, 50.1 years) who underwent CT (n = 71) or MR (n = 64) angiographies of the vertebrobasilar vasculature for various reasons were analyzed retrospectively. The right and left distal vertebral arteries (VAs), posterior inferior cerebellar arteries (PICAs), anterior inferior cerebellar arteries (AICAs), superior cerebellar arteries (SCAs), posterior cerebral arteries (PCAs), and posterior communicating arteries (PCoAs) were analyzed individually. Results. In 24.4% of the cases (33/135) right PICA, in 19.3% of the cases (26/135) left PICA, in 17.8% of the cases (24/135) right AICA, and in 18.5% of the cases (25/135) left AICA were absent. In cases without PICA or AICA, there was a statistically significant, moderately or well-developed AICA or PICA on the same side, respectively (P < 0.001). The most common variation was isolated absence of right PICA and was seen in 17.8% of the cases. Conclusions. The anatomic features of the branches of the vertebrobasilar circulation may be different from well-known normal anatomy. CT and MR angiographies allow a precise and detailed evaluation of vertebrobasilar circulation.

The anatomic evaluation of the internal mammary artery using multidetector CT angiography.

PURPOSE To determine the normal anatomic features and variations of the internal mammary arteries (IMAs) and to describe the relationship between the diameter and distance to the sternal edge of the IMAs, gender, and location (right-left) of the IMAs in patients who underwent multidetector computed tomography (MDCT) angiography of the thorax for various reasons. MATERIALS AND METHODS A total of 164 patients who underwent MDCT angiography of the thoracic vascular structures for various reasons were analyzed retrospectively. The right and left IMAs were analyzed individually, and normal anatomic features and variations were recorded. The relationships between gender, side and diameter of the IMAs, and distance to the sternal edge of the IMAs were evaluated. RESULTS There were 328 (164 right, 164 left) IMAs in 164 patients (110 males, 54 females; mean age, 43.96 years). A total number of five arteries (1.5%) had anatomic variation. Whereas 325 IMAs had an origin separate from the subclavian artery, three LIMA of the 328 arteries (0.91%) had a common origin with the thyrocervical trunk or costocervical trunk. Two (0.6%) IMAs (one LIMA and one RIMA) in the same patient were duplicated at the level of the first and second costal cartilage. There were no statistically significant correlations between age and diameter or between gender and diameter of the RIMA and LIMA at the origin and level of tracheal bifurcation (P > 0.05). Mean distance between the lateral margin of the sternum and midpoint of LIMA and RIMA were 12.42 mm and 13.00 mm, respectively. CONCLUSION The normal anatomic features and variations of the IMAs have an important role in cardiovascular bypass surgery, breast reconstruction, and percutaneous transthoracic procedures. MDCT angiography allows a precise and detailed evaluation of IMAs.

Popliteal artery entrapment syndrome with thrombosed popliteal aneurysm: multidetector computed tomography angiography findings of a case.

Popliteal artery entrapment syndrome (PAES) is a rare congenital vascular pathology caused by the compression of the popliteal artery by adjacent muscle and tendinous structures. Popliteal artery aneurysm associated with this syndrome is extremely rare. A 45-year-old male suffering from pain at the right lower extremity during exercise was admitted to our hospital. Physical examination and Doppler imaging revealed a weak pulse at the posterior tibial artery and no pulse at dorsalis pedis and anterior tibial arteries. The patient was further evaluated with multidetector computed tomography angiography (MDCTA). MDCTA revealed PAES due to compression of the accessory fibers of the gastrocnemius muscle and related thrombosed popliteal aneurysm.

Complete Currarino Syndrome Recognized in Adulthood

Currarino syndrome is a hereditary pathology that is characterized by sacrococcygeal bone defect, presacral mass, and anorectal malformation. Sacrococcygeal bone defect is almost always a part of the syndrome. The complete form of this entity displays all three abnormalities and is very uncommon. In this report, we present the magnetic resonance imaging findings of a case with complete form of Currarino syndrome recognized in adulthood.

Is there a correlation between bronchial artery hypertrophy and coronary artery disease

We read the recent article titled ‘‘Bronchial artery hypertrophy is correlated with coronary artery disease’’ by Tresoldi et al. (1) with great interest. The authors evaluated a possible association between bronchial artery hypertrophy and coronary artery disease in patients without known pulmonary diseases undergoing coronary computed tomography angiography. They concluded that there is an association between coronary artery disease and bronchial artery hypertrophy, and bronchial artery hypertrophy could be caused by undiagnosed underlying coronary artery disease. When we read the article, some questions were raised in our minds. We need clarification from the authors on a few topics. In addition, we would like to make a contribution regarding normal anatomical features of bronchial arteries. First, the authors stated that the scanning volume was from the carina to the diaphragm in 75% (75/100) of the patients without coronary artery bypass graft (1). This information leads to two important questions:

Congenital superior–inferior mesenteric arterial variation or arc of Riolan due to occlusion of proximal superior mesenteric artery

doomed to die without surgical intervention. the authors did not mention about any midgut atresia or malformation in the patient’s radiologic and endoscopic examinations. We are curious: Was there any midgut malformation caused from congenital absence of the SMA? If not, how can the authors extrapolate the diagnosis of congenital absence of the SMA? Second, the authors stated that contrast enhanced Ct was performed to exclude other intra-abdominal pathology [6]. Why did the authors perform an arterial phase Ct angiography with thin slice section? Because we know that usual abdominal Ct examination is performed at the portal venous phase (70 s after the contrast administration) with 5 mm slice thickness for better evaluation of abdominal solid organs, arterial and venous structures, and reasonable radiation dose. We are curious: Was there a suspicion for abdominal vascular event (stenosis or occlusion) according to the patient’s history and symptoms? third, did the authors consider loop shaped vascular structure, which originates from the inferior mesenteric artery (IMA) and provides blood supply to SMA might be consistent with arc of Riolan (AOR)? the AOR is also known as the meandering mesenteric artery. It is an inconstant artery that connects the proximal SMA or one of its primary branches (usually middle colic branch) to the proximal IMA or one of its primary branches (usually left colic branch). the AOR forms a short loop that runs close to the root of the mesentery. When present, the AOR is an important connection between the SMA and IMA in the setting of arterial occlusion or significant stenosis. In proximal SMA occlusion, the AOR provides collateral flow from the IMA to the SMA territory [4]. We think that if the axial source and sagittal multi-planar reformatted (MPR) Ct images showed a proximal occlusion of SMA, the possible AOR could have been considered in the differential to the editor,

Variations of the vertebrobasilar circulation and its impact on the neurosurgical interventions

We read the recent article titled “Importance of the perforating rteries in the proximal part of the PICA for surgical approaches o the brain stem and fourth ventricle – an anatomical study” by ayaci et al. [1] with great interest. The authors evaluated the erforating arteries in the proximal part of the posterior inferior erebellar artery (PICA) for surgical approaches to the brain stem nd fourth ventricle in 26 adult cadavers. We would like to make a ontribution regarding the impact on the neurosurgical intervenions and radiologic evaluation of vertebrobasilar variations. Kayaci et al. [1] suggested that in the absent PICA cases, surgial approach from agenesic side of the PICA should be preferred o avoid the ischaemic complications due to iatrogenic damage of erforating arteries. A recent and comprehensive study based on he normal anatomical features and variations of the vertebrobasiar circulation and its branches in computed tomography (CT) and T magnetic resonance (MR) angiography performed by Akgun t al. [2] showed that only 34.8% (47/135) of the cases had wellnown normal vertebrobasilar system anatomy. In the rest of the ases (65.2%), there was at least one anatomic variation. The most ommon variations were isolated agenesis of right PICA (17.8%) nd isolated agenesis of left PICA (11.1%). Akgun et al. [2] also eported that there was no PICA bilaterally in 4 cases (3%). In all of ilaterally absent PICA cases there were bilaterally well-developed nterior inferior cerebellar arteries (AICAs). Moreover majority of he cases without right PICA or without left PICA, there were modertely or well-developed contralateral PICAs and/or ipsilateral AICAs 2]. Although Kayaci et al. [1] suggested that in the absent PICA ases agenesic side may be safe, we think that unexpected termial branches originating from well-developed contralateral PICA or psilateral AICA and its perforating arteries may be encountered in urgical approach at the agenesic PICA side. As also reported by Kayaci et al. [1], the preoperative identication of normal anatomy and variations of the vertebrobasilar irculation and its branches are important in planning surgical trategy and in preventing complications when approaching the rain stem and fourth ventricle pathologies. CT angiography perits an accurate and detailed analysis of normal vascular anatomy nd variations of the intracranial arteries. However, after the introuction of high magnetic field MR systems, normal anatomical