Background and Purpose: The diagnosis of external borderzone infarction is made when the stroke is located at the border between the arterial territories. Recent studies have raised questions regarding the location of this borderzone given the variability in the arterial territories. We examined the location of this region using a digital approach and its correspondence with the ‘traditional’ template. Methods: Infarcts resulting from occlusion of the middle cerebral artery (MCA) or posterior cerebral artery (PCA) trunk or branches were segmented from T2-weighted MR images and linearly registered into a common stereotaxic coordinate space. For MCA infarcts and PCA infarcts, maps of voxels in a rim surrounding the infarct were created. The maps of individual rims were averaged to create images of the probability of each voxel lying in the MCA and PCA rims. The MCA and PCA rims were used to create a digital atlas of the probability of each voxel lying concurrently in both rims. Results: The MCA group consisted of 36 patients (16 males) with a median age of 73 (range 25–87) years. The PCA territory group consisted of 30 patients (24 males) with a median age of 61 (range 22–86) years. The probability of involvement in the digital atlas was higher in the posterior putamen (probability 0.12–0.29) and optic tract (probability 0.13–0.0.20) than in the angular gyrus (probability 0.01). Conclusion: We have created a digital model of the border region between the MCA and PCA territories. This approach may be useful for evaluating the likelihood of a stroke mechanism from topography.
Background and Purpose-Knowledge of the extent and distribution of infarcts of the posterior cerebral artery (PCA) may give insight into the limits of the arterial territory and infarct mechanism. We describe the creation of a digital atlas of PCA infarcts associated with PCA branch and trunk occlusion by magnetic resonance imaging techniques. Methods-Infarcts were manually segmented on T 2 -weighted magnetic resonance images obtained Ͼ24 hours after stroke onset. The images were linearly registered into a common stereotaxic coordinate space. The segmented images were averaged to yield the probability of involvement by infarction at each voxel. Comparisons were made with existing maps of the PCA territory. Results-Thirty patients with a median age of 61 years (range, 22 to 86 years) were studied. In the digital atlas of the PCA, the highest frequency of infarction was within the medial temporal lobe and lingual gyrus (probabilityϭ0.60 to 0.70). The mean and maximal PCA infarct volumes were 55.1 and 128.9 cm 3 , respectively. Comparison with published maps showed greater agreement in the anterior and medial boundaries of the PCA territory compared with its posterior and lateral boundaries. Conclusions-We have created a probabilistic digital atlas of the PCA based on subacute magnetic resonance scans. This approach is useful for establishing the spatial distribution of strokes in a given cerebral arterial territory and determining the regions within the arterial territory that are at greatest risk of infarction.
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