Macey Mathew, Albalooshy Basimah, Schmidli Alexandra, Chang Jessica, Small Juan E
Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, United States.
Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, United States.
Eur J Radiol. 2024 Dec;181:111765. doi: 10.1016/j.ejrad.2024.111765. Epub 2024 Sep 26.
Arterial fenestrations are a benign entity arising from a failure of fetal fusion. However, fenestrations in the head and neck may be misinterpreted as carotid webs or dissections. Given differences in clinical management, the differentiation of these entities is imperative. We aim to document the prevalence of these entities on CTA imaging and highlight imaging features for confident differentiation.
We retrospectively reviewed head and neck CTA studies performed at our institution over an 18-month period. The extradural common carotid, internal carotid, external carotid, and vertebral arteries were inspected for intraluminal abnormalities. These abnormalities were classified as fenestration, web, or dissection. Location and associated non-atherosclerotic calcification, pseudoaneurysm, or thrombosis were also documented.
A total of 1800 head and neck CTAs were examined. Normal extradural arteries were seen in 1731 patients (1731/1800; 96.2 %). An intraluminal abnormality was evident in the remaining 69 patients (69/1800; 3.8 %). There were 16 carotid webs (16/1800; 0.9 %), 46 dissections (46/1800; 2.6 %), and 7 fenestrations (7/1800; 0.4 %). An associated non-atherosclerotic pattern of calcification was only identified in a single fenestration case (1/7; 14.3 %). Thrombosis was not identified in any fenestration case.
Arterial fenestrations of the extradural head and neck arterial vasculature are evident on 0.4 % of CTAs. It is important to differentiate these benign entities from carotid webs and arterial dissections. With the appropriate knowledge and interpretive tools, characteristic imaging findings on CTA can be used for reliable differentiation.
动脉窗是由于胎儿融合失败而产生的一种良性病变。然而，头颈部的动脉窗可能会被误诊为颈动脉网或夹层。鉴于临床处理方式存在差异，区分这些病变至关重要。我们旨在记录这些病变在CTA成像上的发生率，并强调有助于可靠鉴别的影像学特征。
我们回顾性分析了在本机构18个月期间进行的头颈部CTA研究。检查硬膜外颈总动脉、颈内动脉、颈外动脉和椎动脉的管腔内异常情况。这些异常被分类为动脉窗、网或夹层。还记录了病变位置以及相关的非动脉粥样硬化性钙化、假性动脉瘤或血栓形成情况。
共检查了1800例头颈部CTA。1731例患者（1731/1800；96.2%）的硬膜外动脉正常。其余69例患者（69/1800；3.8%）存在管腔内异常。其中有16例颈动脉网（16/1800；0.9%），46例夹层（46/1800；2.6%），7例动脉窗（7/1800；0.4%）。仅在1例动脉窗病例中发现了相关的非动脉粥样硬化性钙化模式（1/7；14.3%）。在任何动脉窗病例中均未发现血栓形成。
硬膜外头颈部动脉血管的动脉窗在0.4%的CTA中可见。将这些良性病变与颈动脉网和动脉夹层区分开来很重要。凭借适当的知识和解读工具，CTA上的特征性影像学表现可用于可靠鉴别。
