Anatomical Variations in Circle of Willis in Patients Undergoing CT Cerebral Angiography in a Tertiary Hospital in Nepal: A Descriptive Cross-sectional Study.

Prajwal Dhakal,Ram Kumar Ghimire,Mohan Raj Sharma,Sharma Paudel,Sundar Suwal,Prakash Kayastha

doi:10.31729/jnma.5893

Abstract

Variation in Circle of Willis is a commonly encountered entity in patients undergoing computed tomography angiography, identification of which is crucial in the management of patients with vascular pathologies. The aim of the study was to find out the anatomical variations in the Circle of Willis in patients undergoing Computed Tomography cerebral angiography in a tertiary hospital in Nepal. This is a descriptive cross-sectional study involving 95 patients using convenient sampling techniques who were sent to the Department of Radiology and Imaging, Tribhuvan University Teaching hospital, for further evaluation of suspected vascular pathologies in the brain from April 2017 to September 2017. Ethical approval was taken from the Institutional Review Committee of the Institute of Medicine with reference number 326 (6-11-E). CT angiographic images of these patients were evaluated for the presence of variations in Circle of Willis, aneurysms, and other vascular pathologies. Data were analyzed using SPSS. Among 95 subjects included in the study, the anatomical variations in the arteries of Circle of Willis was seen in 52 (54.7%) patients, hypoplastic posterior communicating artery being the most common variation 33 (34.7%). The aneurysm was seen in 22 (23.2%) of cases. CT Angiography is a commonly performed imaging modality for suspected cases of cerebral aneurysms and various other vascular pathologies. Multidetector computed tomography can effectively detect variations in arteries of Circle of Willis, recognition of which is crucial in operative management of vascular pathologies.

Highlights

Variation in Circle of Willis is a commonly encountered entity in patients undergoing Computed Tomography angiography, identification of which is crucial in management of patients with vascular pathologies
Among 95 subjects included in the study, the anatomical variations in the Circle of Willis in patients undergoing CT cerebral angiography in a tertiary hospital was seen to be 52 (54.7%) while 43 (45.3%) did not show any variations
The patients who were referred to the Department of Radiology and Imaging of Tribhuvan University Teaching Hospital (TUTH) for obtaining CT cerebral angiography were the study population

Summary

Introduction

Variation in Circle of Willis is a commonly encountered entity in patients undergoing Computed Tomography angiography, identification of which is crucial in management of patients with vascular pathologies. The aim of the study was to find out the anatomical variations in Circle of Willis in patients undergoing Computed Tomography cerebral angiography in a tertiary hospital in Nepal. A classic arterial Circle of Willis (CoW) is bilaterally symmetrical and a complete ring of vessels but variations in this typical configuration is often seen.[1] Status of the circle is crucial in determining the adequacy of the brain circulation during management of cerebral aneurysms and other vascular diseases.[1]. Tomography (CT) cerebral angiography high sensitivity and specificity of 81% - 90% and 93%, respectively.[2] computed tomography angiography (CTA) is less invasive and is less time consuming compared to DSA.[3] radiation exposure in imaging.

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