Kammerer S, Mueller-Eschner M, Berkefeld J, Tritt S
Institute of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
Clin Neuroradiol. 2017 Dec;27(4):451-457. doi: 10.1007/s00062-017-0578-8. Epub 2017 Mar 28.
The lenticulostriate arteries (LSA) and other perforators may play a role for collateral supply in cases with ischemia due to stenosis or occlusions of the middle cerebral artery (MCA). Purpose of this case series was to evaluate the potential of time-resolved 3D rotational angiography data sets (4D DSA) for detailed visualization of anatomic variants of LSA feeders and for display of local collaterals involving the LSA in cases with chronic MCA obstruction.
Multiplanar and volume rendering reconstructions of 4D DSA data were computed in addition to standard postprocessing in 24 patients who had indications for 3D rotational angiography (3DRA) of the internal carotid artery (ICA) without pathologies of the ICA, middle cerebral artery (MCA) and anterior cerebral artery (ACA) main stems (n = 18) or with stenosis or chronic occlusion of the MCA (n = 6). For acquisition of 3DRA, we used a modified digital subtraction angiography (DSA) image acquisition protocol with an extended rotation angle of 260° and a prolonged scan time of 12 s on a Siemens Axiom Artis Zee biplane neuroangiography equipment. The 4D reconstructions of existing 3DRA data were computed on a dedicated workstation. Origin and course of LSA and other perforators were analyzed according to coronal multiplanar reconstructions (MPRs) with slice thicknesses between 6 and 28 mm.
In all cases 4D reconstructions of the LSA were technically feasible and evaluable. As expected, origin and course of LSA showed a wide range of variations: The most common pattern was a common trunk dividing into multiple ascending branches originating from the proximal M1 (n = 5) or the proximal A1 segment (n = 4). Alternatively, 8 patients showed several individual branches that directly originated from the proximal M1 segment of the MCA and occasionally from the A1 segment of the ACA. In patients with M1 stenosis or occlusion, 4 out of 6 cases had local collaterals with involvement of proximal LSA trunks and a network parallel to the obstructed vessel segment. The 4D reconstructions were found to be equivalent (n = 16) or superior to 3D reconstructions (n = 8).
The 4D DSA reconstructions provide a reliable display of normal LSA variants and connections to local collateral networks in cases with chronic MCA obstruction. The possibility to select a correct angiographic phase is advantageous compared to 3D DSA.
豆纹动脉（LSA）和其他穿支动脉可能在大脑中动脉（MCA）狭窄或闭塞导致缺血的情况下发挥侧支供血作用。本病例系列的目的是评估时间分辨三维旋转血管造影数据集（4D DSA）详细显示LSA供血支解剖变异以及在慢性MCA梗阻病例中显示涉及LSA的局部侧支循环的潜力。
除了对24例有颈内动脉（ICA）三维旋转血管造影（3DRA）指征且ICA、大脑中动脉（MCA）和大脑前动脉（ACA）主干无病变（n = 18）或有MCA狭窄或慢性闭塞（n = 6）的患者进行标准后处理外，还对4D DSA数据进行了多平面和容积再现重建。为了进行3DRA采集，我们在西门子Axiom Artis Zee双平面神经血管造影设备上使用了改良的数字减影血管造影（DSA）图像采集协议，旋转角度扩展到260°，扫描时间延长至12秒。在专用工作站上对现有的3DRA数据进行4D重建。根据层厚为6至28毫米的冠状多平面重建（MPR）分析LSA和其他穿支动脉的起源和走行。
在所有病例中，LSA的4D重建在技术上都是可行且可评估的。正如预期的那样，LSA的起源和走行表现出广泛的变异：最常见的模式是一个共同的主干分成多个起源于近端M1（n = 5）或近端A1段（n = 4）的上升分支。另外，8例患者显示有几个单独的分支直接起源于MCA的近端M1段，偶尔也起源于ACA的A1段。在M1狭窄或闭塞的患者中，6例中有4例有涉及近端LSA主干的局部侧支循环以及与阻塞血管段平行的网络。发现4D重建与3D重建相当（n = 16）或优于3D重建（n = 8）。
4D DSA重建能够可靠地显示慢性MCA梗阻病例中正常的LSA变异以及与局部侧支循环网络的连接。与3D DSA相比，能够选择正确的血管造影相位是有利的。
