Differentiating extradural head and neck arterial fenestrations from other intraluminal abnormalities

Area of Science:

• Vascular imaging
• Head and neck radiology
• Cerebrovascular anatomy

Background:

• Arterial fenestrations are benign developmental variations.
• Head and neck fenestrations can be misdiagnosed as carotid webs or dissections.
• Accurate differentiation is vital for appropriate clinical management.

Purpose of the Study:

• To determine the prevalence of arterial fenestrations, webs, and dissections in the head and neck using CTA.
• To identify key imaging features for differentiating these vascular abnormalities.

Main Methods:

• Retrospective review of 1800 head and neck CTAs over 18 months.
• Inspection of extradural carotid and vertebral arteries for intraluminal abnormalities.
• Classification of abnormalities as fenestration, web, or dissection, noting associated findings.

Main Results:

• Intraluminal abnormalities were found in 3.8% of patients.
• Prevalence: 2.6% dissections, 0.9% webs, and 0.4% fenestrations.
• Fenestrations showed minimal associated calcification or thrombosis.

Conclusions:

• Arterial fenestrations occur in 0.4% of head and neck CTAs.
• Differentiating fenestrations from webs and dissections is clinically important.
• CTA imaging findings allow for reliable differentiation with appropriate knowledge.