Preliminary study of dual energy bone removal CT angiography for the diagnosis of intra and extracranial arterial fenestration

Objective Arterial fenestration of the head and neck is uncommon,and there are few imaging reports on it.This study was to investigate the value of dual-energy computed tomography angiography(DE-CTA) in the diagnosis of intra-and extra-cranial arterial fenestration.Methods We introspectively studied the imaging and clinical manifestations of 23 cases of arterial fenestration of the head and neck.All the cases underwent craniocervical angiography(CTA),8 of them followed by cranial magnetic resonance angiograms(MRA) and 6 by digital subtraction angiography(DSA),and another 2 examined by CTA,MRA and DSA at the same time.Results A single artery was fenestrated in each of the 23 cases: 15 in the proximal portion of the basilar artery(1 complicated by intracranial aneurysm with subarachnoid hemorrhage),6 in vertebral artery(3 in the extracranial and 3 in the intracranial portion),and the other 2 in the intracranial artery(1 in the proximal portion of the anterior cerebral artery and 1 in the beginning of the middle cerebral artery).All the cases exhibited localized vascular duplication.Conclusion DE-CTA,capable of effectively removing the bone structure and displaying the exact location,shape and adjacent structure of fenestration,is a useful tool for the diagnosis of fenestration in intra-and extra-cranial arteries.