Surg Radiol Anat DOI 10.1007/s00276-011-0926-3 123 ORIGINAL ARTICLE Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches Salvatore Cappabianca · Assunta Scuotto · Francesco Iaselli · Nicoletta Pignatelli di Spinazzola · Fabrizio Urraro · Giuseppe Sarti · Marcella Montemarano · Roberto Grassi · Antonio Rotondo Received: 15 September 2011 / Accepted: 18 December 2011  Springer-Verlag 2011 Abstract Aim of our study was to evaluate the preva- lence of aberrant origin of the branches of the external carotid artery (ECA) in 97 patients by computed tomogra- phy (CTA) and magnetic resonance angiography (MRA) and to compare the accuracy of these two techniques in the visualization of the ECA system. All patients underwent CTA and MRA examination of the head and neck. Multi- planar and volumetric reformations were obtained in all cases. For each set of images, the presence of aberrant ori- gin of the branches of the external carotid artery was inves- tigated. MRA and CTA images of each patient were compared to deWne their information content. Anatomical anomalies were found in 88 heminecks, with a prevalence of 53.3%. In the 61 patients in whom the CTA was per- formed before the MRA, the latter method showed only 92% of abnormalities detected at the Wrst examination; in the 36 patients in whom MRA was performed Wrst, CTA identiWed all of the anomalies highlighted by the former, adding 12 new. Knowledge of the anomalies of origin of the ECA branches is essential for the head and neck sur- geon; the high prevalence of anomalies found in our series as in the previous studies indicates the opportunity to per- form a CTA or a MRA of the head and neck before any sur- gical or interventional procedure. CTA is the method of choice in the evaluation of anomalies of origin of the branches of the ECA and in the deWnition of their course. Keywords External carotid artery · Computed tomography angiography · Magnetic resonance angiography · Anatomical variants · Neck Introduction In the literature, there are numerous reports of anomalous origin, course and branching of the internal carotid artery (ICA) and its branches because of the importance of the districts which they provide blood supply. A less-treated topic are the anatomical variants of the external carotid artery (ECA) tree, in most cases not associated with symp- toms and incidentally diagnosed during imaging studies or even detected only at autopsy. In a signiWcant number of subjects, however, the ana- tomical variants of the ECA system, especially if the aber- rant vessel is aVected by pathological changes (severe atherosclerosis, aneurismal disease, etc.), may be associ- ated with speciWc signs and symptoms; moreover, due to the large and heterogeneous area sprayed by this arterial tree, diseases may be of interest of several medical branches (e.g., Otorhinolaryngology, Ophthalmology, Neu- rosurgery, General Surgery, Plastic Surgery, Odontostoma- tology). Undetected vascular anomalies in the head and S. Cappabianca · F. Iaselli · N. Pignatelli di Spinazzola · F. Urraro · G. Sarti · M. Montemarano · R. Grassi · A. Rotondo Science Section of Radiology, Department of Experimental and Clinical Internistic “F. Magrassi, A. Lanzara”, Primo Policlinico di Napoli, Second University of Naples, Piazza Miraglia 5, 80100 Naples, Italy e-mail: salvatore.cappabianca@unina2.it A. Scuotto Science Section of Neuroradiology, Department of Experimental and Clinical Internistic “F. Magrassi, A. Lanzara”, Azienda Ospedaliera CTO, Second University of Naples, Viale Colli Aminei 5–7, 80100 Naples, Italy e-mail: assunta.scuotto@unina2.it F. Iaselli (&) 273, Corso Trieste, 81100 Caserta, Italy e-mail: francescoiaselli@hotmail.it