In vivo flow territory mapping of major brain feeding arteries

The ability to visualize the perfusion territories of major feeding arteries to the brain is important for many clinical applications. Since the work of Duret in 1874 on vascularization of the brain, many textbooks and atlases have shown schematic drawings of the supply areas of the major cerebral arteries. Recent postmortem studies demonstrated that the variability of the cerebral vascular territories is significantly greater than previously assumed. The aim of the present study was to investigate in vivo, the variability of flow territories of major brain feeding arteries. Flow territory mapping of the anterior (internal carotid arteries) and posterior (basilar artery) circulation was performed in 115 (58 +/- 9 years of age) subjects with selective arterial spin labeling MRI. Flow territory maps for the entire population indicated significant variation in flow territories. However, when the subjects are further categorized into groups with a complete circle of Willis, with a missing A1 segment and with a unilateral or bilateral fetal-type posterior cerebral artery, the results showed considerably lower variation within groups. It is therefore concluded that, the variation observed from the entire population is mainly caused by anatomical variants of the circle of Willis. To relate focal brain lesions to underlying flow territories in individual cases, knowledge of the anatomy of the circle of Willis is essential.