Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

中文翻译：

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大脑中动脉高度狭窄：先进的 3D DSA-MRI 融合成像能否更好地说明斑块和穿孔？

目的

由于围手术期并发症发生率高，尤其是豆纹动脉（LSA）闭塞，严重大脑中动脉（MCA）狭窄的血管内治疗存在争议。使用三维 (3D) 数字减影血管造影 (DSA) 和磁共振成像 (3D DSA-MRI 融合) 的融合研究 LSA 的特征以及 MCA 斑块和 LSA 之间的空间关系。

方法

我们回顾性分析了 32 名患有严重 MCA 狭窄的缺血性卒中或短暂性脑缺血发作患者的数据，这些患者在症状出现后 2 周内接受了 MRI 和 DSA。将患者分为罪犯和非罪犯 MCA 狭窄组。3D DSA-MRI 融合是在专用工作站上进行的，可以自动叠加目标血管。评估了 LSA 的特征、斑块分布和病变模式，以及它们之间的关系。

结果

3D DSA-MRI 融合图像能够说明 MCA 斑块和 LSA 孔口之间的空间关系。在 32 名患者的 42 根 LSA 茎中，10 根在 LSA 口上有 MCA 斑块，并且都在罪魁祸首 MCA 狭窄组中发现。超过一半 (51.9%) 的 LSA 源于 MCA 狭窄段的罪魁祸首 MCA 狭窄患者。MCA斑块-LSA孔口空间关系分为四种类型，两组之间存在显着差异（p  = 0.016）。

结论

3D DSA-MRI 融合技术能够可视化 LSA 孔口和 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 中风的发病机制，并为治疗策略提供有用的指导。