Department of Neurology, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Korea.
JAMA Neurol. 2019 Jan 1;76(1):72-80. doi: 10.1001/jamaneurol.2018.2808.
Cerebral vascular territories are of key clinical importance in patients with stroke, but available maps are highly variable and based on prior studies with small sample sizes.
To update and improve the state of knowledge on the supratentorial vascular supply to the brain by using the natural experiment of large artery infarcts and to map out the variable anatomy of the anterior, middle, and posterior cerebral artery (ACA, MCA, and PCA) territories.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, digital maps of supratentorial infarcts were generated using diffusion-weighted magnetic resonance imaging (MRI) of 1160 patients with acute (<1-week) stroke recruited (May 2011 to February 2013) consecutively from 11 Korean stroke centers. All had supratentorial infarction associated with significant stenosis or occlusion of 1 of 3 large supratentorial cerebral arteries but with patent intracranial or extracranial carotid arteries. Data were analyzed between February 2016 and August 2017.
The 3 vascular territories were mapped individually by affected vessel, generating 3 data sets for which infarct frequency is defined for each voxel in the data set. By mapping these 3 vascular territories collectively, we generated data sets showing the Certainty Index (CI) to reflect the likelihood of a voxel being a member of a specific vascular territory, calculated as either ACA, MCA, or PCA infarct frequency divided by total infarct frequency in that voxel.
Of the 1160 patients (mean [SD] age, 67.0 [13.3] years old), 623 were men (53.7%). When the cutoff CI was set as 90%, the volume of the MCA territory (approximately 54% of the supratentorial parenchymal brain volume) was about 4-fold bigger than the volumes of the ACA and PCA territories (each approximately 13%). Quantitative studies showed that the medial frontal gyrus, superior frontal gyrus, and anterior cingulate were involved mostly in ACA infarcts, whereas the middle frontal gyrus and caudate were involved mostly by MCA infarcts. The PCA infarct territory was smaller and narrower than traditionally shown. Border-zone maps could be defined by using either relative infarct frequencies or CI differences.
We have generated statistically rigorous maps to delineate territorial border zones and lines. The new topographic brain atlas can be used in clinical care and in research to objectively define the supratentorial arterial territories and their borders.
在脑卒中患者中，脑血管区域具有关键的临床重要性，但现有的图谱差异很大，且基于样本量较小的先前研究。
利用大动脉梗死这一自然实验，更新和改进对大脑幕上血管供应的认识，并绘制出前循环、中循环和后循环（ACA、MCA 和 PCA）区域的可变解剖结构。
设计、设置和参与者：在这项横断面研究中，通过对 1160 例急性（<1 周）脑卒中患者的弥散加权磁共振成像（MRI）进行数字图谱绘制，这些患者连续从 11 个韩国脑卒中中心招募（2011 年 5 月至 2013 年 2 月）。所有患者均存在幕上梗死，与 3 条大的幕上脑血管中的 1 条显著狭窄或闭塞相关，但颅内或颅外颈动脉通畅。数据在 2016 年 2 月至 2017 年 8 月间进行分析。
通过受累血管分别对 3 个血管区域进行映射，为每个数据集中的每个体素生成 3 个定义梗死频率的数据组。通过对这 3 个血管区域进行集体映射，我们生成了数据组，反映了特定血管区域成员的可能性，该指数为特定体素的 ACA、MCA 或 PCA 梗死频率除以该体素的总梗死频率。
在 1160 例患者（平均[标准差]年龄为 67.0[13.3]岁）中，有 623 例男性（53.7%）。当截断置信指数设定为 90%时，MCA 区域的体积（约占幕上脑实质脑容量的 54%）约为 ACA 和 PCA 区域的 4 倍（每个区域约为 13%）。定量研究表明，内侧额回、额上回和前扣带回主要与 ACA 梗死相关，而中额回和尾状核主要与 MCA 梗死相关。PCA 梗死区域比传统显示的更小更窄。通过使用相对梗死频率或 CI 差异，可以定义边界区域图谱。
我们生成了具有统计学严格性的图谱，以描绘区域边界区域和线。新的拓扑大脑图谱可用于临床护理和研究中，以客观地定义幕上动脉区域及其边界。
