Relationship between Variations in the Circle of Willis and Flow Rates in Internal Carotid and Basilar Arteries Determined by Means of Magnetic Resonance Imaging with Semiautomated Lumen Segmentation: Reference Data from 125 Healthy Volunteers

H. Tanaka; N. Fujita; T. Enoki; K. Matsumoto; Y. Watanabe; K. Murase; H. Nakamura

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Fig 1.
MR examination and flow measurement procedures for a representative case (23-year-old woman).
A, Lateral view of 3D time-of-flight MR angiography. The white line indicates the section used for the phase-contrast MR imaging.
B, Axial view of 3D time-of-flight MR angiography. The variation in the circle of Willis in this case was assessed as hypoplasia of the precommunicating segment of the right anterior cerebral artery (right A1 hypoplasia) based on diameter measurements obtained from the original MR angiography images.
C, As the first step of flow measurement, an operator selected 3 pixels from each artery. These pixels are shown as red dots in this phase-contrast image. The inset in the bottom right corner shows a magnified image of the basilar artery for instance.
D, From these selected pixels, vessel lumens (clusters of red dots) were automatically identified by pulsatility-based segmentation.¹⁷ To compensate for eddy current-induced error, 3 static regions of interest (clusters of blue dots) were also determined automatically. This compensation was based on the assumption that the error induced by the eddy current was a linear function of space.¹⁴ Eventually volume flow rate of each arterywas automatically obtained.
Download figure
Open in new tab
Download powerpoint
Fig 2.
Classification of the anatomic variations in the circle of Willis. In the “textbook” type, both the precommunicating segment of the anterior cerebral artery (A1) and that of the posterior cerebral artery (P1) were normal in size. The next group included both right and left A1 hypoplasia. Because no significant difference between cerebral arteries on the right and left sides has been established,^5,18 we combined right and left A1 hypoplasia into A1 hypoplasia. The next group included right and left P1 hypoplasia, which again were treated as a single category, P1 hypoplasia. “Other” type included a combination of A1 hypoplasia and P1 hypoplasia, bilateral P1 hypoplasia, as well as other unclassified variations. ACA indicates anterior cerebral artery; ACo, anterior communicating artery; MCA, middle cerebral artery; ICA, internal cerebral artery; PCo, posterior communicating artery; PCA, posterior cerebral artery; BA, basilar artery
Download figure
Open in new tab
Download powerpoint
Fig 3.
Relative contribution of proximal arteries to total volume flow in variations in the circle of Willis. Values signify mean percentage ± SD. The upper left value corresponds to the relative contribution of the right internal carotid artery in the “textbook” type or of the internal carotid artery ipsilateral to hypoplastic A1 or P1 in the other variations. The upper right value corresponds to the relative contribution of the left internal carotid artery in the “textbook” type, or of the internal carotid artery contralateral to hypoplastic A1 or P1 in the other variations. The value at the bottom corresponds to the relative contribution of the basilar artery.
* The value for A1 hypoplasia variation was significantly smaller than those for “textbook” type and P1 hypoplasia variation. The value for P1 hypoplasia variation was significantly larger than that for “textbook” type.
** The value for A1 hypoplasia variation was significantly larger than that for “textbook” type.
*** The value for P1 hypoplasia variation was significantly smaller than that for “textbook” type.
Download figure
Open in new tab
Download powerpoint
Fig 4.
Estimated volume flow ratio of the anterior, middle, and posterior cerebral artery. These values were estimated from Fig 3 and approximated to multiples of 10%.

Tables

Figures

View popup

Table 1:

Diameters of A1 and P1 and volume flow rates of 6 subjects with A1 hypolasia (nos. 1–6) and 6 with P1 hypoplasia (nos. 7–12)

Subject No.	Diameter (mm)				Volume Flow Rates (mL/min) (Relative Percentage Contribution (%))
	Ipsilateral to Hypolastic A1 or P1		Contralateral to Hypoplastic A1 or P1		ICA Ipsilateral to Hypoplastic A1 or P1	ICA Contralateral to Hypoplastic A1 or P1	Basilar Artery
	A1	P1	A1	P1	ICA Ipsilateral to Hypoplastic A1 or P1	ICA Contralateral to Hypoplastic A1 or P1	Basilar Artery
1	0.0^*	2.3	1.4 + 1.3^†	2.4	267 (29)	468 (51)	188 (20)
2	0.7	1.0	2.0	1.7	305 (38)	405 (51)	88 (11)
3	0.9	2.0	2.7	2.4	257 (32)	380 (47)	166 (21)
4	0.8	1.4	1.5	2.1	212 (35)	274 (45)	119 (20)
5	0.0^*	1.8	2.3	2.0	179 (26)	348 (50)	169 (24)
6	0.0^*	1.9	2.7	2.0	199 (31)	325 (51)	116 (18)
7	1.5	0.8	2.2	2.1	438 (48)	349 (38)	120 (13)
8	1.8	0.9	2.2	1.4	298 (44)	303 (45)	76 (11)
9	1.3	0.9	1.7	2.0	379 (52)	254 (35)	91 (13)
10	2.1	0.8	2.0	1.1	296 (48)	266 (43)	52 (8)
11	1.4	0.0^*	2.0	1.8	300 (42)	312 (43)	108 (15)
12	1.5	0.9	2.5	1.9	422 (45)	418 (45)	95 (10)

Note:— A1 indicates precommunicating segment of the anterior cerebral artery; P1, precommunicating segment of the posterior cerebral artery; ICA, internal carotid artery. An artery with a diameter ≤0.9 mm was considered to be hypoplastic.
* The relevant artery was not depicted.
^† Duplicate A1s were observed.

View popup

Table 2:

Variations in the circle of Willis and volume flow rates

Variations in the Circle of Willis	“Textbook” Type (n = 105)	A1 Hypoplasia (n = 6)	P1 Hypoplasia (n = 6)
Total volume flow (mL/min) (mean ± SD)	781 ± 151	744 ± 119	763 ± 129
Right internal carotid artery or internal carotid artery ipsilateral to hypoplastic A1 or P1	311 ± 73	236 ± 48	355 ± 66
Left internal carotid artery or internal carotid artery contralateral to hypoplastic A1 to P1	304 ± 74	367 ± 67	317 ± 60
Basilar artery	165 ± 43	141 ± 39	90 ± 24