Jantre Mansi, Howlett David C
East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK.
Neuroradiology. 2025 Apr;67(4):785-798. doi: 10.1007/s00234-025-03585-2. Epub 2025 Mar 10.
The Artery of Percheron (AoP) supplying bilateral paramedian thalami and rostral midbrain is a rare anatomical variant. In the event of occlusion of AoP, a characteristic pattern of ischaemia is seen, presenting as bithalamic signal abnormality on magnetic resonance imaging (MRI). However, this particular imaging finding has significant radiological and clinical overlap with other conditions, necessitating a comprehensive understanding of the imaging characteristics and potential differential diagnosis. The aim of this pictorial essay is to provide a visual documentation of varying appearances of AoP infarction on imaging and highlighting other important pathologies that may cause similar appearance.
Retrospective collection and review of imaging from patients with confirmed AoP infarction and other pathologies causing bithalamic signal abnormalities and identify crucial imaging caveats for differentiation.
We present a comprehensive visual spectrum of AoP infarction patterns, including bithalamic involvement (paramedian thalamic lesions) with or without midbrain involvement. Additionally, the "V" sign, observed on FLAIR and DWI sequences, is fairly characteristic of AoP infarction. Other important vascular causes seen include top of basilar artery syndrome, internal cerebral vein thrombosis as well as neoplastic lesions including diffuse midline glioma (DMG) H3 K27-altered. Additionally various inflammatory, metabolic and infective etiologies including viral encephalitis like Japanese encephalitis can cause a similar appearance.
This pictorial essay demonstrates the diverse patterns of AoP infarction and emphasizes the significance of recognizing important mimics of this condition, highlighting the need for a meticulous evaluation. Improved awareness and understanding of these imaging characteristics will contribute to more effective management of patients with thalamic strokes.
供应双侧丘脑旁正中区域和中脑嘴侧的Percheron动脉（AoP）是一种罕见的解剖变异。在AoP闭塞的情况下，会出现特征性的缺血模式，在磁共振成像（MRI）上表现为双侧丘脑信号异常。然而，这一特殊的影像学表现与其他疾病在放射学和临床上有显著重叠，因此有必要全面了解其影像学特征及潜在的鉴别诊断。本图谱文章的目的是直观呈现AoP梗死在影像学上的不同表现，并突出其他可能导致类似表现的重要病变。
回顾性收集并分析确诊为AoP梗死及其他导致双侧丘脑信号异常的病变患者的影像学资料，确定鉴别诊断的关键影像学注意事项。
我们展示了AoP梗死模式的全面直观图谱，包括伴有或不伴有中脑受累的双侧丘脑受累（丘脑旁正中病变）。此外，在液体衰减反转恢复序列（FLAIR）和扩散加权成像（DWI）序列上观察到的“V”征是AoP梗死相当典型的表现。其他可见的重要血管性病因包括基底动脉尖综合征、大脑内静脉血栓形成以及肿瘤性病变，包括H3 K27改变的弥漫性中线胶质瘤（DMG）。此外，各种炎症、代谢和感染性病因，包括如日本脑炎等病毒性脑炎，也可导致类似表现。
本图谱文章展示了AoP梗死的多样模式，并强调了识别该病症重要模仿者的意义，突出了细致评估的必要性。提高对这些影像学特征的认识和理解将有助于更有效地管理丘脑卒中患者。
