A Digital Map of Middle Cerebral Artery Infarcts Associated With Middle Cerebral Artery Trunk and Branch Occlusion

Phan, Thanh G.; Donnan, Geoffrey A.; Wright, Peter M.; Reutens, David C.

doi:10.1161/01.str.0000163087.66828.e9

Cited by 116 publications

(162 citation statements)

References 30 publications

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“…In our initial study on MCA occlusion, we included cases of combined ICA and MCA occlusion, 10 raising the possibility that the MCA-occlusion group in this study was different with respect to infarct pattern. However, despite removing these combined cases from the MCAocclusion group, the regional risk of infarction in the MCA-occlusion group remained the same.…”

Section: Methodological Limitationsmentioning

confidence: 99%

“…Infarcts were segmented and registered to a standard brain template (details can be found in a previous publication 10 ). Similar to our previous development of cerebral infarct digital atlases, 10,11 infarcts arising from ICA and MCA trunk or branch occlusion were manually segmented on T2-weighted images.…”

Section: Segmentationmentioning

confidence: 99%

“…Similar to our previous development of cerebral infarct digital atlases, 10,11 infarcts arising from ICA and MCA trunk or branch occlusion were manually segmented on T2-weighted images. The images from subjects with infarcts in the right hemisphere were turned along the y-axis so that all infarcts lay on the left side of the image according to the radiological convention.…”

Section: Segmentationmentioning

confidence: 99%

“…Details on the time of magnetic resonance imaging, stroke mechanisms, and sites of arterial occlusion for MCA infarcts have been published previously. 10 …”

Section: Infarct Patternsmentioning

confidence: 99%

See 3 more Smart Citations

Heterogeneity in Infarct Patterns and Clinical Outcomes Following Internal Carotid Artery Occlusion

Phan¹,

Donnan²,

Srikanth³

et al. 2009

Arch Neurol

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Section: Methodological Limitationsmentioning

confidence: 99%

Section: Segmentationmentioning

confidence: 99%

Section: Segmentationmentioning

confidence: 99%

“…Details on the time of magnetic resonance imaging, stroke mechanisms, and sites of arterial occlusion for MCA infarcts have been published previously. 10 …”

Section: Infarct Patternsmentioning

confidence: 99%

See 2 more Smart Citations

Heterogeneity in Infarct Patterns and Clinical Outcomes Following Internal Carotid Artery Occlusion

Phan¹,

Donnan²,

Srikanth³

et al. 2009

Arch Neurol

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“…The cutoff of 100ml was chosen because this translates roughly into an involvement of one-third of the MCA territory, a commonly used criterion in CT-based studies for assessment of extensive EICs. 2,19,20 The lower cutoff (Յ10ml) was arbitrarily chosen to distinguish between patients with small and moderate DWI lesions. Because DWI lesions were not normally distributed (predominance of small and moderate DWI lesions) and sample size was not balanced within the 3 prespecified groups, we additionally performed a separate analysis using quintiles (n ϭ 128 -130 patients in each group; median DWI lesion [minimum to maximum range]): group 1, 3ml (0 -6); group 2, 9ml (6 -13); group 3, 18ml (13-26); group 4, 37ml (26 -55); and group 5, 95ml (55-382).…”

Section: Magnetic Resonance Imaging Data Acquisition and Analysismentioning

confidence: 99%

Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion‐weighted magnetic resonance imaging

Singer

Humpich²,

Fiehler

et al. 2007

Annals of Neurology

172

112

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Objective:The risk for symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic treatment has not been evaluated in large studies using diffusion-weighted imaging (DWI). Here, we investigated the relation between pretreatment DWI lesion size and the risk for sICH after thrombolysis. Methods: In this retrospective multicenter study, prospectively collected data from 645 patients with anterior circulation stroke treated with intravenous or intraarterial thrombolysis within 6 hours (Ͻ3 hours: n ϭ 320) after symptom onset were pooled. Patients were categorized according to the pretreatment DWI lesion size into three prespecified groups: small (Յ10ml; n ϭ 218), moderate (10 -100ml; n ϭ 371), and large (Ͼ100ml; n ϭ 56) DWI lesions. Results: In total, 44 (6.8%) patients experienced development of sICH. The sICH rate was significantly different between subgroups: 2.8, 7.8, and 16.1% in patients with small, moderate, and large DWI lesions, respectively (p Ͻ 0.05). This translates to a 5.8 (2.8)-fold greater sICH risk for patients with large DWI lesions as compared with patients with small (or moderate) DWI lesions. The results were similar in the large subgroup (n ϭ 536) of patients treated with intravenous tissue plasminogen activator. DWI lesion size remained an independent risk factor when including National Institutes of Health Stroke Scale, age, time to thrombolysis, and leukoariosis in a logistic regression analysis. Interpretation: This multicenter study provides estimates of sICH risk in potential candidates for thrombolysis. The sICH risk increases gradually with increasing DWI lesion size, indicating that the potential benefit of therapy needs to be balanced carefully against the risk for sICH, especially in patients with large DWI lesions.

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Mapping the Supratentorial Cerebral Arterial Territories Using 1160 Large Artery Infarcts

et al. 2019

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IMPORTANCE Cerebral vascular territories are of key clinical importance in patients with stroke, but available maps are highly variable and based on prior studies with small sample sizes. OBJECTIVE To update and improve the state of knowledge on the supratentorial vascular supply to the brain by using the natural experiment of large artery infarcts and to map out the variable anatomy of the anterior, middle, and posterior cerebral artery (ACA, MCA, and PCA) territories. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, digital maps of supratentorial infarcts were generated using diffusion-weighted magnetic resonance imaging (MRI) of 1160 patients with acute (<1-week) stroke recruited (May 2011 to February 2013) consecutively from 11 Korean stroke centers. All had supratentorial infarction associated with significant stenosis or occlusion of 1 of 3 large supratentorial cerebral arteries but with patent intracranial or extracranial carotid arteries. Data were analyzed between February 2016 and August 2017. MAIN OUTCOMES AND MEASURES The 3 vascular territories were mapped individually by affected vessel, generating 3 data sets for which infarct frequency is defined for each voxel in the data set. By mapping these 3 vascular territories collectively, we generated data sets showing the Certainty Index (CI) to reflect the likelihood of a voxel being a member of a specific vascular territory, calculated as either ACA, MCA, or PCA infarct frequency divided by total infarct frequency in that voxel. RESULTS Of the 1160 patients (mean [SD] age, 67.0 [13.3] years old), 623 were men (53.7%). When the cutoff CI was set as 90%, the volume of the MCA territory (approximately 54% of the supratentorial parenchymal brain volume) was about 4-fold bigger than the volumes of the ACA and PCA territories (each approximately 13%). Quantitative studies showed that the medial frontal gyrus, superior frontal gyrus, and anterior cingulate were involved mostly in ACA infarcts, whereas the middle frontal gyrus and caudate were involved mostly by MCA infarcts. The PCA infarct territory was smaller and narrower than traditionally shown. Border-zone maps could be defined by using either relative infarct frequencies or CI differences. CONCLUSIONS AND RELEVANCE We have generated statistically rigorous maps to delineate territorial border zones and lines. The new topographic brain atlas can be used in clinical care and in research to objectively define the supratentorial arterial territories and their borders.

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A Digital Map of Middle Cerebral Artery Infarcts Associated With Middle Cerebral Artery Trunk and Branch Occlusion

Cited by 116 publications

References 30 publications

Heterogeneity in Infarct Patterns and Clinical Outcomes Following Internal Carotid Artery Occlusion

Heterogeneity in Infarct Patterns and Clinical Outcomes Following Internal Carotid Artery Occlusion

Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion‐weighted magnetic resonance imaging

Mapping the Supratentorial Cerebral Arterial Territories Using 1160 Large Artery Infarcts

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