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Fenestration, early bifurcation, and duplication of the posterior cerebral artery (PCA) and the so-called hyperplastic anterior choroidal artery (AChA), considered a variation of the PCA, are rare. We evaluated the prevalence and characteristic features of these PCA variations on magnetic resonance (MR) angiography. We reviewed intracranial MR angiographic images of 2402 patients examined using a 3-tesla scanner. Images from the skull base to the intracranial region were obtained using the standard time-of-flight technique. We excluded images of 52 patients with insufficient image quality or occlusion of the PCA(s) and retrospectively evaluated the images of 2350 patients using a picture archiving and communication system. We observed PCA fenestration in eight (0.34 %) patients, most at the P1 segment and P1–P2 junction and all small in size, early bifurcation at the P1–P2 junction or proximal P2A segment in eight (0.34 %) patients, complete duplication in one patient, and hyperplastic AChA in 13 (0.55 %) patients. Eleven of the 13 hyperplastic AChAs supplied only the territory of the temporal branch of the PCA, and the remaining two supplied the entire territory of the PCA. We observed PCA variations in 30 (1.28 %) patients. We believe the name “hyperplastic AChA” inaccurately describes variations of the PCA in which the AChA supplies part of or all of the territory of the PCA and propose “accessory PCA” to describe an AChA that supplies part of the territory of the PCA or “replaced PCA” to describe that vessel that supplies the territory all branches of the PCA.

We present an extremely rare case of an aberrant course of the petrous internal carotid artery (ICA) associated with the ipsilateral occipital artery arising from the cervical ICA, a combination not previously reported by magnetic resonance (MR) angiography. The patient was a 53-year-old woman with no symptoms related to the anomalous ICA. Source images and partial maximum-intensity-projection images of MR angiography are useful in diagnosing these variations. Source images and curved multiplanar reconstruction images of computed tomography angiography are important for the accurate evaluation of reduced arterial diameter and the relationship between the anomalous artery and petrous bone.

Anastomosis of the carotid-anterior cerebral artery (ACA) is a rare anomalous vessel that arises from the internal carotid artery (ICA) at the level of the ophthalmic artery and takes an infraoptic and prechiasmatic path to anastomose with the ACA. It has known right-sided predominance. We report the case of an 83-year-old man with a left carotid-ACA anastomosis that was diagnosed by magnetic resonance (MR) angiography from the neck to the head during investigation of transient left hemiplegia. The right ICA was occluded at its origin. Our literature search revealed only six reported cases of left carotid-ACA anastomoses. We believe ours is the first case diagnosed by MR angiography.

Giant cell myocarditis (GCM) is rare and often fatal. Proper diagnosis is crucial, because immunosuppressive therapy has been reported to increase the median transplant-free survival time from 3.0 to 12.3 months.1 Although endomyocardial biopsy plays an essential role in early diagnosis, it may yield false-negative results. Imaging examinations including cardiac magnetic resonance (CMR) may facilitate the diagnosis, but the associations between specific CMR findings and the clinical features and pathological findings remain unclear. We present a patient with characteristic CMR findings, with intriguing associations with the clinical features and pathological findings of the biopsy and autopsy. A 73-year-old woman presented with acute chest pain and dyspnea that had continued for 7 hours. Her medical history was unremarkable, with the exception of uveitis and dyslipidemia. Initial examination showed resting blood pressure 132/83 mm Hg, heart rate 103 bpm, and respiratory rate 17 breaths/min. She required 5 L/min of oxygen via facemask to maintain Spo2>98%. Coarse crackles were heard over both lung fields. X-ray demonstrated mild cardiomegaly with bilateral pulmonary congestion (Figure 1). Electrocardiography, which had been within normal limits 2 years previously, showed changes resembling acute myocardial infarction (Figure I in the online-only Data Supplement). Echocardiography showed global hypokinesis in the left ventricular (LV) wall, and regional akinesis in the septum and inferoseptal wall. Coronary artery angiography revealed no significant stenosis or intracoronary plaque rupture. Her serum creatinine kinase level was high at 2558 IU/L. CMR was performed on day 7. Cine-CMR showed global hypokinesis in …

A persistent dorsal ophthalmic artery (OA) is a rare variation that originates from the cavernous segment of the internal carotid artery (ICA) and enters the orbit via the superior orbital fissure (SOF). Occasionally, the OA also arises from the middle meningeal artery (MMA) and enters the orbit via the SOF. These two major variations of the OA have not been well described by magnetic resonance (MR) angiography. We evaluated their prevalence on MR angiography at 3 T.We retrospectively reviewed our database of MR angiographic images obtained using a 3 T imager. Of images of 846 patients, we evaluated those of 826 patients (1,652 OAs) with special attention to OA origin and its course into the orbit. We excluded images of the 20 because quality was insufficient to assess.We found 7 (0.42%) persistent dorsal OAs among 1,652 OAs (right/left, 6/1; male/female, 3/4). Twenty-four (1.45%) OAs arose from the MMA (right/left/bilateral, 11/5/4; male/female, 10/10), three of which also demonstrated a small normally branching OA. In one patient, we observed both right persistent dorsal OA and left OA arising from the MMA.Per OA, the prevalence of persistent dorsal OA was 0.42% and of OA arising from the MMA, 1.45%, with a tendency toward right-side predominance. OA arising from the MMA can be seen bilaterally; preprocedural knowledge of this variation is important because of the danger associated with endovascular procedures of the external carotid system when the OA arises from the MMA.