Evaluation of Circle of Willis variants using magnetic resonance angiography

Abstract

The Circle of Willis (COW) is an important collateral pathway to protect the persistence of cerebral blood perfusion. This study aims to investigate the morphological variants of this significant vascular structure with a large study population. 867 patients who had undergone MR angiography (MRA) evaluation were enrolled in this study. The MRA images of these patients obtained by the three-dimensional time-of-flight technique were re-interpreted to measure the vessel diameters of all components of the COW and classify the COW variations. In addition, correlations of the vessel calibers and the integrity of the COW with gender and age groups were presented. There was female dominance in the study population, and the mean age was 48. Type A was the most common variation in anterior (75.78%) and posterior (53.98%) circulation. Types G and H were the other common variation in the anterior circulation, and types E and D were the second and third common variations in the posterior COW, respectively. Smaller calibration for both ICAs, both P1s and BA were observed in females compared with the male group. Diameters of the BA, and both P1 segments were lower, and the left PCom diameter was significantly higher in the patients with a complete circle. There was a significant sex and age difference regarding the distribution of the complete, partially complete, and incomplete circle groups. The significant differences in the vessel calibers of specific components of the COW for complete, partial, and incomplete circulations revealed by this study should be explained with further research. In addition, meta-analyses with other studies in the literature might be a guide to understanding the morphological alterations of the COW and their relationships with a complete and non-complete circle.