Özet
Willis poligonu varyantları, anterior ve posterior dolaşım arasındaki damarların kalibresini veya sürekliliğini ve ACA dallanma örüntüsünü değiştirebilir. BT anjiyografi, Willis poligonu bağlantı varyantlarını ve ACA dallanma örüntülerini gösterebilir. Willis poligonu varyantları kollateral akımı ve beynin besleyici arterlere ait perfüzyon alanlarının yorumunu etkileyebilir. Willis poligonu varyantlarının oklüzyon veya hipoplaziyle karıştırılması damar anatomisinin ve inme mekanizmasının yanlış yorumlanmasına yol açabilir.
Faz ve pencere
- BTA tanısal
- Arteriyel BTA'da A1 segmentleri, AComA, PComA'lar, P1-P2 PCA geçişi ve distal ACA dalları opak lümen olarak izlenir. Fetal PCA'da ipsilateral PCA'nın PComA üzerinden ICA'dan beslendiği ve P1'in hipoplastik ya da izlenmediği; azygos ACA'da tek A2 gövdesinin iki medial hemisfere uzandığı görülür.
Önerilen pencereler: Anjiyo (G 600 / M 150).
BT bulguları
- Fetal tip PCA'da ipsilateral PComA belirgin bağlantıyı oluşturur ve PCA'nın P2 sonrası akımı internal karotid arterden gelir.
- Parsiyel fetal PCA’da PCA’nın beslenmesine ICA katkı sağlarken, tam fetal örüntüde PCA ağırlıklı ya da yalnızca ICA’dan beslenir.
- Fetal tip PCA'da ipsilateral PCA alanı, hipoplastik veya bulunmayan P1 ile birlikte, ağırlıklı olarak dominant PComA üzerinden ICA'dan beslenir.
- Azygos ACA'da A1 segmentleri tek orta hat A2 gövdesine katılır; distal perikallozal damar tek gövdeden iki medial hemisfer yönüne dallanır.
- ACA triplikasyonunda AComA distalinde üç ACA gövdesi izlenir; orta hatta seyreden ek dal median ACA örüntüsünü oluşturabilir. Her dalın distal gidişi takip edilir ve tek gövdeli azygos ACA ile karıştırılmaz.
- Bihemisferik ACA örüntüsünde bir taraftaki ACA ana gövdesi iki hemisferin medial yüzüne dallar verirken karşı A1 hipoplastik olabilir.
- Görüntülenemeyen A1, P1 veya PComA segmenti anatomik yoklukla eş tutulmamalı; Willis poligonu varyantı ve kollateral düzen bağlamında değerlendirilmelidir.
Normalde
Tipik erişkin bağlantı düzeninde AComA, sağ ve sol ACA sistemleri arasında anastomoz oluşturur; PCA’lar baziler arterin terminal dallarıdır ve PComA, ICA ile PCA arasındaki bağlantıyı sağlar. Willis poligonu damarlarının çap ve bağlantı varyantları kollateral akımı ve perfüzyon alanı yorumunu etkileyebileceğinden, şüpheli segmentin çapını ve ilgili alanın besleyici arterini görüntülerde birlikte değerlendirin.
Normal BT ile kıyasla
Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.
Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0849; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.
Ayırıcı tanı
- A1 segment oklüzyonu değerlendirilirken, azygos veya bihemisferik ACA varyantlarının distal ACA dallarının tek ya da baskın bir gövdeden beslenmesine yol açabileceği göz önünde tutulmalıdır.
- P1 segment oklüzyonunda P1 başlangıcında tıkanıklık görülebilir; fetal tip PCA’da distal PCA alanı ağırlıklı olarak dominant PComA üzerinden ICA’dan beslenir ve ipsilateral P1 hipoplastik ya da bulunmayabilir.
- Azygos ACA, tek bir A2 ana gövdesi bulunan bir anterior serebral arter varyantıdır.
- ACA triplikasyonu veya median ACA
- AComA distalinde üç ACA gövdesi izlenir; tek gövdeli azygos örüntüsünden farklıdır.
- Arter hipoplazisi, Willis poligonu damarlarında görülen bir kalibre varyantıdır; görüntüde seçilememe anatomik yoklukla aynı kabul edilmemelidir.
- Arteriyovenöz şant, arter ile ven arasında doğrudan bağlantı bulunmasıdır; yalnız arter kalibresindeki farklılık şantı tanımlamak için yeterli değildir.
Tuzaklar
- Fetal PCA'yı P1 oklüzyonu diye yorumlamadan önce PComA'nın ICA'dan PCA'ya kesintisiz devamını ve baziler kökenli P1'i ayrı ayrı izleyin.
- Hipoplastik P1'in ince lümeni kalın MIP slabında kaybolabilir; ince kaynak kesit veya oblik MPR'de baziler tepe bağlantısını arayın.
- Azygos ACA'da tek distal A2 gövdesi, karşı ACA'nın kayıp olduğu izlenimini verebilir; tek gövdenin iki tarafa verdiği distal dalları takip edin.
- PComA veya A1'in ince olması akım yönünü tek başına göstermez; tek fazlı BTA anatomik çapı gösterir, fizyolojik kollateral yönünü doğrudan ölçmez.
Kendini dene
PCA, ICA’dan dominant PComA üzerinden ağırlıklı olarak besleniyor ve ipsilateral P1 hipoplastik ancak açık. En uygun tanımlama hangisidir?
Cevabı göster
Parsiyel fetal PCA. PCA’nın ICA’dan ağırlıklı, ancak yalnızca ICA’dan beslenmediği örüntü parsiyel fetal PCA olarak tanımlanır; tam fetal PCA’da beslenme yalnızca ICA kaynaklıdır.
CTA’da tek bir A2 gövdesi izleniyor ve distalinde dallanıyor. En olası varyant?
Cevabı göster
Azygos ACA. Tek A2 gövdesi azygos ACA örüntüsüyle uyumludur. ACA triplikasyonunda üç ayrı A2 dalı bulunur; fetal PCA ise PCA’nın ICA’dan beslendiği posterior dolaşım varyantıdır.
İlgili konular
Kaynaklar
Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 24 cümle bu karşılaştırmada düzeltildi (2026-10-09).
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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.