Department of Neurology, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, 510630, Guangzhou, China.
Department of Medicine & Therapeutics, The Chinese University of Hong Kong Shatin, Hong Kong, SAR, China.
Clin Neuroradiol. 2021 Mar;31(1):51-59. doi: 10.1007/s00062-020-00927-w. Epub 2020 Jul 2.
Endovascular treatment in severe middle cerebral artery (MCA) stenosis is controversial owing to high rates of periprocedural complications, especially occlusion of the lenticulostriate arteries (LSA). The characteristics of LSAs and the spatial relationships between MCA plaques and LSAs using the fusion of three-dimensional (3D) digital subtraction angiography (DSA) and magnetic resonance imaging (3D DSA-MRI fusion) were investigated.
We retrospectively analyzed data from 32 ischemic stroke or transient ischemic attack patients with severe MCA stenosis, who underwent MRI and DSA within 2 weeks after symptom onset. The patients were divided into culprit and non-culprit MCA stenosis groups. The 3D DSA-MRI fusion was performed on dedicated workstations, which allowed automated overlays of the target vessels. The characteristics of LSAs, plaque distribution and lesion patterns, and their relationships were evaluated.
The 3D DSA-MRI fusion image was able to illustrate the spatial relationships between MCA plaques and LSA orifices. Of 42 LSA stems in 32 patients, 10 had MCA plaque over the LSA orifice and were all found in the culprit MCA stenosis group. Over half (51.9%) of the LSA stems in patients with culprit MCA stenosis originated from the stenotic MCA segment. The MCA plaque-LSA orifice spatial relationships were classified into four types, which were significantly different between the two groups (p = 0.016).
The 3D DSA-MRI fusion technique enables visualization of the LSA orifice and MCA plaque and their spatial relationships. This classification of the type of spatial relationships can provide insights into the pathogenesis of MCA stroke and useful guides for treatment strategies.
由于围手术期并发症发生率高，尤其是纹状体动脉（LSA）闭塞，因此对于严重大脑中动脉（MCA）狭窄的血管内治疗存在争议。本研究旨在通过三维（3D）数字减影血管造影（DSA）和磁共振成像（3D DSA-MRI 融合）融合，研究 LSA 的特征以及 MCA 斑块与 LSA 之间的空间关系。
我们回顾性分析了 32 例缺血性卒中和短暂性脑缺血发作伴严重 MCA 狭窄的患者资料，这些患者在症状发作后 2 周内行 MRI 和 DSA 检查。将患者分为责任 MCA 狭窄组和非责任 MCA 狭窄组。在专用工作站上进行 3D DSA-MRI 融合，允许对目标血管进行自动叠加。评估 LSA 的特征、斑块分布和病变模式及其关系。
3D DSA-MRI 融合图像能够说明 MCA 斑块与 LSA 口之间的空间关系。在 32 例患者的 42 个 LSA 干中，有 10 个 LSA 口有 MCA 斑块，均位于责任 MCA 狭窄组。责任 MCA 狭窄患者中超过一半（51.9%）的 LSA 干起源于狭窄 MCA 段。MCA 斑块-LSA 口的空间关系分为 4 型，两组间差异有统计学意义（p=0.016）。
3D DSA-MRI 融合技术可用于可视化 LSA 口和 MCA 斑块及其空间关系。这种空间关系类型的分类可以深入了解 MCA 卒中的发病机制，并为治疗策略提供有用的指导。
