Clinical question: 60 years old female with probable meningioma. Need to evaluate carotid anatomy in relation to tumor. Signs and symptoms: Headaches CTA of intracranial circulation:65 cc of Omnipaque 350 is administered for this exam.Previous reformatted images of the intracranial vasculature were obtained utilizing an independent workstation.Right internal carotid:There is a normal appearing right internal carotid artery across the skull base. There is also normal-appearing right internal carotid artery across the cavernous sinus and to its supraclinoid component. There is no evidence of any encasement of the right internal carotid artery from patient's known right-sided subfrontal meningioma. The right middle cerebral artery appears to traverse direct D. posterior to the tumor and the no evidence of direct contact with the tumor or any evidence of encasement. On reformatted images there is suggestion of slight bowing of the right M1 posteriorly due to tumor immediately anterior to the right MCA. There is normal appearing bifurcation of right middle cerebral artery. The right MCA branches distal to M1 are unremarkable. The right and right ophthalmic artery is also well visualized and unremarkable. A small right posterior communicating artery is also identified.Left internal carotid.There is normal appearing left internal carotid artery across the skull base, cavernous sinus and in its supraclinoid component. There is no posterior communicating artery present. There is normal bifurcation the left internal carotid artery and normal visualization of both anterior and middle cerebral arteries and their branches. Anterior communicating artery is unremarkable. No evidence of vascular abnormality in particular no aneurysm or stenosis is detected. Incidental note is made of a large empty sella. There is inferior herniation of the suprasellar visual complex partially into the sella. This finding was also noted on prior MRI examination.Vertebral -- basilar system:Patent bilateral intracranial vertebral arteries. Normal basilar artery, posterior cerebral is and superior cerebellar arteries. There is a normal-appearing right pico however no visualization of left pico. There is a prominent left aica branch which is believed to supply the left pituitary. This is in normal anatomical variation.Nonenhanced head CT:There is a poorly visualized patient's known right anterior clinoid/subfrontal meningioma. There is no evidence of intracranial edema, hemorrhage, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray to white matter differentiation remains within normal
1.Unremarkable CTA of intracranial circulation and in particular no evidence of encasement of right internal carotid artery, right ophthalmic artery, right middle or anterior cerebral artery with patient's known right anterior clinoid/subfrontal meningioma.2.Unremarkable nonenhanced CT of brain. Very poorly visualized patient's known right sided meningioma.