AJDRAJNR - American Journal of Neuroradiology

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Satoh, T.
Right arrow Articles by Date, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Satoh, T.
Right arrow Articles by Date, I.

Differential Diagnosis of the Infundibular Dilation and Aneurysm of Internal Carotid Artery: Assessment with Fusion Imaging of 3D MR Cisternography/Angiography

T. Satoha, M. Omib, C. Ohsakob, K. Fujiwarac, K. Tsunoc, W. Sasaharaa,d, K. Onodad, K. Tokunagad, K. Sugiud and I. Dated

a Department of Neurological Surgery,Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan
b Department of Diagnostic Radiology, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan
c Department of Neurological Surgery, Kosei General Hospital, Mihara, Hiroshima, Japan
d Department of Neurological Surgery, Okayama University Postgraduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan


Figure 1
View larger version (143K):

[in a new window]
  		Fig 1. Case 1, Left infundibular dilation at the junction of the internal carotid artery–posterior communicating artery (adult type) in a 75-year-old woman.

A, Digital subtraction angiogram shows a round bulging (arrow) at the supraclinoid internal carotid artery.

B, 3D MR angiogram shows the trapezoid protrusion (arrow) at the supraclinoid internal carotid artery. A1, the first segment of the anterior cerebral artery; M1, the first segment of the middle cerebral artery; C2, the second segment of the internal carotid artery; C3, the third segment of the internal carotid artery; P1, the first segment of the posterior cerebral artery; P2, the second segment of the posterior cerebral artery; SCA, superior cerebellar artery.

C, 3D MR cisternogram, coordinated projection as to the 3D MR angiogram in B, shows an infundibular dilation (arrow) at the junction of the internal carotid artery-posterior communicating artery. A small posterior communicating artery arises at the apex. Intra- and juxtacisternal anatomic elements surrounding an infundibular dilation are visualized. ON, optic nerve; TS, tuberculum sellae; PS, pituitary stalk; PD, pituitary diaphragm; DS, dorsum sellae; PCP, posterior clinoid process; PComA, posterior communicating artery ({triangleright}); CN-III, oculomotor nerve (yellow arrow); PDF, petroclinoid dural fold.

D, Fusion image of the 3D MR angiography/cisternography shows the relationship of the bulging finding detected by the 3D MR angiography and its outer wall configuration depicted by the 3D MR cisternography.


Figure 2
View larger version (110K):

[in a new window]
  		Fig 2. Case 2, Right infundibular dilation at the junction of the internal carotid artery–posterior communicating artery (fetal-type), in a 36-year-old woman.

A, Maximum intensity projection image of MR angiogram shows a trapezoidal bulging (arrow) at the posterior portion of the supraclinoid internal carotid artery.

B, 3D MR angiogram shows an aneurysm-like protrusion (arrow).

C, 3D MR cisternogram, coordinated projection as to the 3D MR angiogram B, shows an infundibular widening (large arrow) with a large posterior communicating artery ({triangleright}), bended at the posterior clinoid process and run tortuously to the posterior cerebral artery. ON, optic nerve; AChorA, anterior choroidal artery (small arrow); PComA ({triangleright}).

D, Fusion image of the 3D MR angiography/cisternography shows not an aneurysm but an infundibular dilation.


Figure 3
Figure 3
View larger version (199K):

[in a new window]
  		Fig 3. Case 3, Left infundibular dilation at the junction of the internal carotid artery–anterior choroidal artery, in a 69-year-old-woman.

A, 3D MR angiogram shows an aneurysm-like trapezoid bulging (arrow). C1, the first segment of the internal carotid artery; BA, basilar artery.

B, 3D MR cisternogram, coordinated projection as to the 3D MR angiogram in A, shows an infundibular dilation (large arrow) at the junction of the anterior choroidal artery (small arrow). PComA ({triangleright}); CN-III ([GRAPHIC]); TL, temporal lobe.

C, Fusion image of the 3D MR angiography/cisternography shows an infundibular dilation at the junction of an anterior choroidal artery.


Figure 4
Figure 4
View larger version (218K):

[in a new window]
  		Fig 4. Case 4, Right infundibular dilation at the junction of the internal carotid artery–posterior communicating artery (fetal type), misdiagnosed as an aneurysm and treated surgically, in a 44-year-old woman.

A, 3D MR angiogram shows an aneurysm-like protrusion (large arrow) and a conical bleblike elongation (small arrow).

B, 3D MR cisternogram, coordinated projection as to the 3D MR angiogram in A, shows an infundibular dilation (arrow) with a large posterior communicating artery. PDF (small arrow); CN-III (large arrow); PComA ({triangleright}).

C, Fusion image of the 3D MR angiography/cisternography shows the anatomic relationship of an aneurysm-like complex to a large posterior communicating artery, and indicating not an aneurysm but an infundibular dilation.


Figure 5
Figure 5
View larger version (206K):

[in a new window]
  		Fig 5. Case 5, Left internal carotid artery–posterior communicating artery aneurysm, in a 66-year-old woman.

A, 3D MR angiogram shows an aneurysm with an irregular dome (arrow).

B, 3D MR cisternogram, coordinated projection as to the 3D MR angiogram in A, shows an aneurysm (arrow) and a large posterior communicating artery. AChorA, anterior choroidal artery; CN-III (arrow).

C, Fusion image of the 3D MR angiography/cisternography shows the aneurysm complex in relation to its perianeurysmal environment.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X