Hosoda Kohkichi, Ishii Kazunari, Minoshima Satoshi, Kohmura Eiji
Department of Neurosurgery, Hyogo Emergency Medical Center/Kobe Red Cross Hospital, Kobe, Japan.
J Neurosurg. 2007 Jan;106(1):119-27. doi: 10.3171/jns.2007.106.1.119.
The middle cerebral artery (MCA) is the intracranial vessel most frequently affected by cerebrovascular diseases. A more accurate knowledge of the topography of this vessel may have an impact on treatment strategies for ischemic cerebrovascular diseases. The aim of this study was to construct a topographic map of the MCA territory for single-photon emission computed tomography (SPECT) using statistical brain mapping.
The margin of the perfusion deficit associated with infarction due to arterial occlusion, as seen on SPECT imaging, is presumed to approximate the borders of the territory of the artery. Basing the study on this hypothesis, SPECT images obtained in 12 patients with large MCA infarctions due to angiographically confirmed MCA trunk occlusion were selected, anatomically standardized, and compared with SPECT images obtained in healthy volunteers to construct probabilistic cortical surface maps of the MCA territory. Crossed cerebellar diaschisis was used as a primary cutoff marker for creation of the map. This MCA map (Method C) was compared with the conventional region of interest (ROI) method (Method A) and previously reported predefined cortical templates (Method B) for preliminary clinical application. The probabilistic cortical surface map of the MCA territory showed that regions with the highest ratio of MCA territory included the transverse temporal gyrus (100%), supramarginal gyrus (100%), and inferior parietal lobule (91-92%). For preliminarily clinical application, this map (Method C) was compared with the conventional ROI method (Method A) in predicting hyperperfusion after carotid endarterectomy by performing a receiver operating characteristic (ROC) analysis, which demonstrated the statistically significant superiority of the MCA map (area under the ROC curve [Az] = 0.91) to the ROI method (Az = 0.75; p = 0.025). The ROC analysis also demonstrated a diagnostic value of the MCA map (Az = 0.95) that equaled predefined cortical templates (Method B) (Az = 0.93).
The probabilistic cortical surface map of the MCA territory used for SPECT, which was created using statistical brain mapping techniques, would be useful for an objective assessment of the cerebral perfusion status of patients with cerebrovascular diseases.
大脑中动脉（MCA）是最常受脑血管疾病影响的颅内血管。对该血管地形的更准确了解可能会影响缺血性脑血管疾病的治疗策略。本研究的目的是使用统计脑图谱构建单光子发射计算机断层扫描（SPECT）的MCA区域地形图。
在SPECT成像中，与动脉闭塞所致梗死相关的灌注缺损边缘被推测接近该动脉区域的边界。基于这一假设开展本研究，选取12例经血管造影证实为MCA主干闭塞导致大面积MCA梗死患者的SPECT图像，进行解剖学标准化处理，并与健康志愿者的SPECT图像进行比较，以构建MCA区域的概率性皮质表面图谱。交叉性小脑失联络被用作创建图谱的主要截断标记。将该MCA图谱（方法C）与传统的感兴趣区域（ROI）方法（方法A）以及先前报道的预定义皮质模板（方法B）进行比较，用于初步临床应用。MCA区域的概率性皮质表面图谱显示，MCA区域比例最高的区域包括颞横回（100%）、缘上回（100%）和顶下小叶（91 - 92%）。为进行初步临床应用，通过进行受试者操作特征（ROC）分析，将该图谱（方法C）与传统ROI方法（方法A）在预测颈动脉内膜切除术后的高灌注情况方面进行比较，结果表明MCA图谱（ROC曲线下面积[Az]=0.91）在统计学上显著优于ROI方法（Az = 0.75；p = 0.025）。ROC分析还显示MCA图谱（Az = 0.95）的诊断价值与预定义皮质模板（方法B）（Az = 0.93）相当。
使用统计脑图谱技术创建的用于SPECT的MCA区域概率性皮质表面图谱，将有助于客观评估脑血管疾病患者的脑灌注状态。
