MRA-based evaluation of anatomical variation of circle of Willis in adult Pakistanis

Objective: To determine the frequency and patterns of normal anatomical variation of Circle of Willis on magnetic resonance angiogram in adults without cerebrovascular disease. Methods: This descriptive cross-sectional study was conducted at the Radiology Department of Dow University of Health Sciences / Civil Hospital, Karachi, from January to December 2016, and comprised patients referred for magnetic resonance imaging of the brain and magnetic resonance angiogram without any clinical or radiological manifestation of cerebrovascular disease, primarily including those with suspected demyelination, infection, epilepsy or metastases. Three-dimensional time-of-flight magnetic resonance angiography was performed. The Circle of Willis was assessed for its completeness along with anatomical variations of anterior and posterior components of the circle. Results: Of the 135 subjects, 70(51.8%) were males and 65(48.2%) were females with an overall mean age of 49.26 +/- 9.2 years. Among all the subjects, 30(22.2%) showed a complete circle, while 82 (60.7%) and 23(17.1%) had partially complete and incomplete circles respectively. The anterior part of the circle was completed in 108 (80%) subjects, showing type 'a' as the most common variant in 93(68.9%). The posterior part of the circle was completed in 30 (22.2%) subjects with type 'e' variant in 52(38.5%). Conclusion: There was a wide variability in the anatomy of the Circle of Willis in Pakistani adults asymptomatic for cerebrovascular disease.