Rogge Annette, Doepp Florian, Schreiber Stephan, Valdueza José Manuel
Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany (A.R., J.M.V.); Neurological Department, Charité Campus Virchow, Berlin, Germany (F.D.); and Neurological Department, Charité Campus Mitte, Berlin, Germany (S.S.).
J Ultrasound Med. 2015 Feb;34(2):267-73. doi: 10.7863/ultra.34.2.267.
Routine sonography of the middle cerebral artery in acute ischemic stroke usually focuses on the main stem (M1 segment). However, stenoses and occlusions affect not only proximal but also more distal vessel branches, such as the M2 segments. Transcranial color-coded duplex sonography allows visualization of these segments; however, a formal analysis and description of normal blood flow values are missing. The purpose of this study was to analyze middle cerebral artery branching patterns with transcranial color-coded duplex sonography and to establish reference flow velocity values in the detectable M2 branches as well as the early temporal M1 branch.
Transcranial color-coded duplex sonography in the axial and coronal planes was performed in 50 participants without vascular disease and with a good temporal bone window (ie, fully visible M1 middle cerebral artery segment and A1 anterior cerebral artery segment). We analyzed the course and branching pattern of the M1 segment, including anatomic variants such as an early temporal M1 branch, and measured the length and flow parameters of the detectable M2 branches.
Assessment of 100 hemispheres allowed classification into 3 anatomic patterns: M1 bifurcation (63%), M1 trifurcation (32%), and medial M1 branching into 2 major segments (2%). A clear distinction was not possible in 3 cases (3%). An early temporal M1 branch was detected in the coronal plane in 26%.
Transcranial color-coded duplex sonography is a useful tool for analyzing anatomic variants and branching patterns of the middle cerebral artery as well as flow characteristics of M2 segments. Therefore, it also has potential to increase the diagnostic yield for the detection of middle cerebral artery disease in these vessel segments.
急性缺血性卒中时，大脑中动脉的常规超声检查通常聚焦于主干（M1段）。然而，狭窄和闭塞不仅会影响近端血管，还会影响更远端的血管分支，如M2段。经颅彩色编码双功超声可显示这些节段；然而，目前尚缺乏对正常血流值的正式分析和描述。本研究的目的是利用经颅彩色编码双功超声分析大脑中动脉的分支模式，并确定可检测到的M2分支以及大脑中动脉M1段颞叶早期分支的参考流速值。
对50名无血管疾病且颞骨窗良好（即大脑中动脉M1段和大脑前动脉A1段完全可见）的参与者进行轴向和冠状面的经颅彩色编码双功超声检查。我们分析了M1段的走行和分支模式，包括解剖变异，如颞叶早期M1分支，并测量了可检测到的M2分支的长度和血流参数。
对100个半球的评估可分为3种解剖模式：M1分叉（63%）、M1三叉（32%）和M1内侧分支为2个主要节段（2%）。3例（3%）无法明确区分。在26%的冠状面中检测到颞叶早期M1分支。
经颅彩色编码双功超声是分析大脑中动脉解剖变异和分支模式以及M2段血流特征的有用工具。因此，它也有可能提高这些血管节段大脑中动脉疾病检测的诊断率。
