title: Vertebral artery variations at the C1-2 level diagnosed by magnetic resonance angiography.
abstract: BACKGROUND
  The craniovertebral junction is clinically important. The vertebral artery (VA) in its several variations runs within this area. We report the prevalence of these VA variations on magnetic resonance angiography (MRA).
  
  
  METHODS
  We retrospectively reviewed MRA images, obtained using two 1.5-T imagers, of 2,739 patients, and paid special attention to the course and branching of the VA at the level of the C1-2 vertebral bodies.
  
  
  RESULTS
  There were three types of VA variation at the C1-2 level: (1) persistent first intersegmental artery (FIA), (2) VA fenestration, and (3) posterior inferior cerebellar artery (PICA) originating from the C1/2 level. The overall prevalence of these three variations was 5.0%. There was no laterality in frequency, but we found female predominance (P < 0.05). We most frequently observed the persistent FIA (3.2%), which was sometimes bilateral. We found VA fenestration (0.9%) and PICA of C1/2 origin (1.1%) with almost equal frequency. Two PICAs of C1/2 origin had no normal VA branch.
  
  
  CONCLUSIONS
  We frequently observed VA variations at the C1-2 level and with female predominance. The persistent FIA was most prevalent and sometimes seen bilaterally. Preoperative identification of these variations in VA is necessary to avoid complications during surgery at the craniovertebral junction.
authors.affiliation: Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan. auchino@saitama-med.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Uchino
authors.forename: Naoko
authors.initials: N
authors.lastname: Saito
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Watadani
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Okada
authors.forename: Eito
authors.initials: E
authors.lastname: Kozawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Nishi
authors.forename: Waka
authors.initials: W
authors.lastname: Mizukoshi
authors.forename: Kaiji
authors.initials: K
authors.lastname: Inoue
authors.forename: Reiko
authors.initials: R
authors.lastname: Nakajima
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takahashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000098:blood supply*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors; D014711:Vertebral Artery / Q000002:abnormalities*