Anatomy and Frequency of Large Pontomesencephalic Veins on 3D CT Angiograms of the Circle of Willis

Abstract

BACKGROUND AND PURPOSE: The pontomesencephalic veins (PMVs), especially the anterior PMV, are sometimes large enough that they could potentially affect the interpretation of CT angiograms of the circle of Willis. We investigated the frequency and anatomy of visible PMVs on 3D CT angiograms.

METHODS: CT angiograms of 211 consecutive patients who underwent CT angiography for a variety of clinical indications were evaluated retrospectively. Images evaluated by consensus between two neuroradiologists were maximum intensity projection and volume-rendered 3D CT angaiograms.

RESULTS: Visible PMVs were present on 3D CT angiograms in 11 (5.2%) of 211 patients. Eight of 11 patients had a visible anterior PMV behind the basilar artery. In four patients, the venous caliber of the anterior PMV was sufficiently large enough to be potentially confused with arterial structures. In one patient, 3D CT angiography revealed a large anterior PMV (∼2.6 mm in diameter) in the interpeduncular cistern, which had been mistaken for subarachnoid hemorrhage on a nonenhanced CT scan. Two patients had interpeduncular veins of the anterior PMV draping over the dome of a basilar tip aneurysm. In only one patient was the anterior PMV visible possibly owing to arteriovenous malformation. One patient had visible lateral mesencephalic veins, and four patients had visible transverse pontine veins. In one case, on certain views, the transverse pontine veins appeared to arise from the basilar artery.

CONCLUSION: Because of their small size, PMVs were seen only infrequently on 3D CT angiograms, but neuroradiologists should be familiar with the normal variants of large PMVs to avoid diagnostic and anatomic confusion.