Aneurysm CTA of intracranial circulation:60 cc of Omnipaque 350 was administered for this study.Axial 0.9 contiguous CT images of head after administration of contrast were obtained. 3-D reformatted images were acquired utilizing an independent workstation.Axial, coronal and sagittal 2-D MIP images are also rendered.Examination demonstrates an aneurysm of anterior communicating artery which involves the entire length of the anterior communicating artery. The aneurysm extends from the junction of the right A1 with anterior communicating artery to the junction of the left A1 with the anterior communicating artery. It also appears to incorporate the origins of the A2 segments of anterior cerebral arteries. The aneurysm measures 8.2 mm in transverse axis, 7.2-mm in AP axis and 7.7-mm in cranial -- cephalad axis. The aneurysm is smooth and rounded and with no evidence of any intraluminal defect.The bilateral A1 segments of anterior anterior cerebral arteries are symmetrical in size. There is also normal visualization of bilateral A2 segments and distal branches of the anterior cerebral arteries with no additional abnormality.There is normal visualization of bilateral middle cerebral arteries without evidence of aneurysm.Normal appearing bilateral supraclinoid internal carotid arteries and a single dominant right posterior communicating artery without aneurysm.Intracondylar components of vertebral arteries are normal bilaterally and the normal visualization of bilateral pica branches.Vaso-artery, superior cerebellar arteries and posterior cerebral arteries are also well visualized and without evidence of pathology.In comparison with MRA of intracranial circulation from Ingalls open MRI study dated 8 -- 3 -- 11 there is no appreciable interval change.Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.New patchy subcortical and periventricular foci of increased signal intensity in bilateral cerebral hemispheres as was noted on prior MRI are brief to represent small vessel ischemic disease of indeterminate age.The cortical sulci and ventricular systems as well as CSF cisterns remain within normal for patient's stated age of 73.Calvarium is intact. Visualized mastoid air cells and paranasal sinuses are unremarkable.Incidental note is made of bilateral soft tissue density within the external auditory canals with no evidence of any bony changes. Findings are believed to represent debris within the external auditory canals. Recommend And further evaluation by direct inspection.
1.Single locule anterior communicating artery aneurysm which appears to incorporate the entire length of anterior communicating artery. The aneurysm has a smooth round configuration and measures 8.2 x 7.2 X 7.7 mm in three dimensional measurements. There is no evidence of hemorrhage, vasospasm or mass effect.2.Negative CTA of intracranial circulation otherwise.3.Nonenhanced head CT demonstrates moderate findings of small vessel ischemic disease of indeterminate age.