High-Degree Middle Cerebral Artery Stenosis : Can Advanced 3D DSA-MRI Fusion Imaging Better Illustrate Plaques and
Min Guan1, Jia'xing Lin1, Sheng'ming Huang1
1Department of Neurology, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, 510630, Guangzhou, China.
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.
Insights
3D DSA-MRI fusion imaging visualizes the spatial relationship between middle cerebral artery plaques and lenticulostriate arteries. This technique aids in understanding stroke pathogenesis and guiding treatment strategies for MCA stenosis.
Area of Science:
- Neurology
- Radiology
- Interventional Neuroradiology
Background:
- Severe middle cerebral artery (MCA) stenosis poses treatment challenges due to high complication rates during endovascular procedures.
- Occlusion of lenticulostriate arteries (LSAs) is a significant periprocedural complication in MCA stenosis treatment.
Purpose of the Study:
- To investigate the characteristics of LSAs and their spatial relationship with MCA plaques.
- To evaluate the utility of 3D digital subtraction angiography (DSA)-magnetic resonance imaging (MRI) fusion in visualizing these relationships.
Main Methods:
- Retrospective analysis of 32 patients with severe MCA stenosis undergoing MRI and DSA within two weeks of symptom onset.
- Division of patients into culprit and non-culprit MCA stenosis groups.
- Utilized 3D DSA-MRI fusion for automated overlay and evaluation of MCA plaque-LSA spatial relationships.
Main Results:
- 3D DSA-MRI fusion successfully illustrated spatial relationships between MCA plaques and LSA orifices.
- MCA plaque was found over the LSA orifice in 10 out of 42 LSA stems, exclusively in the culprit stenosis group.
- Over half of LSA stems in culprit stenosis originated from the stenotic MCA segment; MCA plaque-LSA orifice relationships differed significantly between groups (p=0.016).
Conclusions:
- 3D DSA-MRI fusion provides clear visualization of LSA orifices and MCA plaques, detailing their spatial interactions.
- Classification of MCA plaque-LSA orifice spatial relationships offers insights into MCA stroke pathogenesis.
- This technique can guide the development of improved treatment strategies for MCA stenosis.
