Koge Junpei, Ogura Shiori, Tanaka Kanta, Egashira Shuhei, Yoshimoto Takeshi, Shiozawa Masayuki, Ohta Yasutoshi, Fukuda Tetsuya, Ihara Masafumi, Toyoda Kazunori, Koga Masatoshi
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shimmachi, 564-8565, Suita, Osaka, Japan.
Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
Clin Neuroradiol. 2025 May 9. doi: 10.1007/s00062-025-01520-9.
Visualizing the culprit perforating artery in subcortical infarction using in vivo imaging is challenging. We aimed to identify the culprit perforating arteries in subcortical infarctions and assess their morphology using an image fusion technique.
We retrospectively reviewed consecutive patients who had an ischemic stroke in the anterior circulation perforating area (caudate nucleus, lentiform nucleus, internal capsule, corona radiata, or centrum semiovale) and underwent three-dimensional rotational-angiography (3D-RA) and 3D fluid-attenuated inversion recovery MRI. Images were registered using an original fusion software. The spatial relationship between the infarction and culprit perforating artery and its morphological characteristics were analyzed in the fusion images. Stenosis was defined as > 50% luminal narrowing or a focal intraluminal defect in the perforating artery.
Of 118 patients, the culprit perforating artery was identified in 52 patients (44%); They tended to have younger age and had a higher baseline NIHSS score and higher prevalence of infarcts in the lentiform nucleus than did those without identified culprit perforating artery. Among the 44 patients with assessable morphology of the culprit perforating artery, 27 (61%) exhibited stenosis in the proximal segment. Atrial fibrillation was more frequent in patients without stenosis in the proximal segment of the culprit perforating artery than in those with stenosis (29% vs. 4%, P = 0.03).
The 3D-RA and MRI fusion technique enables identification of the culprit perforating arteries in subcortical infarctions, especially in the lentiform nucleus. Morphological features of the culprit perforating artery may be associated with the etiological mechanism of stroke.
利用活体成像技术可视化皮质下梗死中的责任穿支动脉具有挑战性。我们旨在识别皮质下梗死中的责任穿支动脉，并使用图像融合技术评估其形态。
我们回顾性分析了在前循环穿支区域（尾状核、豆状核、内囊、放射冠或半卵圆中心）发生缺血性卒中并接受三维旋转血管造影（3D-RA）和三维液体衰减反转恢复磁共振成像（3D FLAIR MRI）的连续患者。使用原始融合软件对图像进行配准。在融合图像中分析梗死灶与责任穿支动脉之间的空间关系及其形态特征。狭窄定义为穿支动脉管腔狭窄>50%或存在局灶性腔内缺损。
118例患者中，52例（44%）识别出责任穿支动脉；与未识别出责任穿支动脉的患者相比，他们往往年龄较小，基线美国国立卫生研究院卒中量表（NIHSS）评分较高，豆状核梗死的患病率也较高。在44例可评估责任穿支动脉形态的患者中，27例（61%）近端节段出现狭窄。责任穿支动脉近端节段无狭窄的患者心房颤动比有狭窄的患者更常见（29%对4%，P=0.03）。
3D-RA和MRI融合技术能够识别皮质下梗死中的责任穿支动脉，尤其是在豆状核。责任穿支动脉的形态特征可能与卒中的病因机制有关。
