The diagnostic value of three-dimensional reconstruction CT angiography for vertebral artery variations at the C1-2 level

English Keywords:Three-dimensional CT angiography  Vertebral artery variation  C1-2 internal fixation  High-riding vertebral artery  Vertebral artery injury

English Abstract:

  【Abstract】 Objectives: To investigate the diagnostic value of three-dimensional reconstruction CT angiography (CTA) for vertebral artery variations at the C1-2 level. Methods: Imaging data of 171 patients with head and neck examination were retrospective analyzed, most of whom were due to diseases, such as cerebral hemorrhage and brain tumor unrelated to variation of vertebral artery(VA). The subjects of this study included 108 males and 63 females. The average age was 59.5±14.7 years old(from 20 to 88 years old). The three-dimensional reconstruction of the original image was performed to confirm whether there existed high-riding VA(HRVA), a persistent first intersegmental artery(FIA), fenestration of the VA above and below C1(FEN), posterior inferior cerebellar artery(PICA), and ponticulus posticus(PP). Results: There were 78 patients(45.6%) having variations at the C1-2 level, and there were two or more variations in some patients. HRVA was observed in 58 patients(33.9%), of which 19 cases were on the left side, 15 cases were on the right side, and 24 cases were bilateral. There were 2 cases(1.2%) of FIA, which located on the left side. There were 4 cases(2.3%) of FEN, 2 cases on the left side, and 2 cases on the right side. PICA did not originate at C1-2 in any of these cases, but PICA was observed in 16 patients(9.4%) who originated between the atlas and the foramen magnum, 13 of them were located on the left side, and 3 cases on the right side. In addition, there were 32 cases(18.7%) of PP, of which 11 were located on the left side, 5 on the right and 16 on both sides. Conclusions: The most common variation of the vertebral artery at the C1-2 is the HRVA of C2, and its incidence is higher in women than in men. The three-dimensional reconstruction CTA can show clearly the variation of each type of vertebral artery in the level of C1-2, which is of great significance for the diagnosis of vertebral artery variation.