Zonal frequency analysis of infarct extent. Part II: Anterior and posterior cerebral artery infarctions

Abstract

The object of the study was to test the hypotheses that analysis of the anatomic zones affected by single anterior (A), posterior (P), and middle (M) cerebral artery (CA) infarcts, and by dual- and triple-vessel infarcts, will disclose (i) sites most frequently involved by each infarct type (peak sites), (ii) sites most frequently injured by multiple different infarct types (vulnerable zones), and (iii) anatomically overlapping sites in which the relative infarct frequency becomes equal for two or more different infarct types and/or in which infarct frequency shifts greatly between single and multivessel infarcts (potential border zones). Precise definitions of each vascular territory were adopted. CT and MRI studies from 20 ACA, 20 PCA, three dual ACA-PCA, and four triple ACA-PCA-MCA infarcts were mapped onto a standard template (Part I). Relative infarct frequencies in each zone were analyzed within and across infarct types to identify the centers and peripheries of each infarct type, the zones most frequently affected by multiple different infarct types, the zones where relative infarct frequency was equal for different infarcts, and the zones where infarct frequency shifted markedly from single- to multiple-vessel infarcts. Zonal frequency analysis provided quantitative data on the relative infarct frequency in each anatomic zone for each infarct type. It displayed zones of peak infarct frequency for each infarct, zones more vulnerable to diverse types of infarct, peripheral "overlap" zones of equal infarct frequency, and zones where infarct frequency shifted markedly between single- and multiple-vessel infarcts. It is concluded that the hypotheses are correct.

Digital Probabilistic Atlas of the Border Region between the Middle and Posterior Cerebral Arteries

“…It does not have a wedge shape with the apex pointing at the occipital horn and the base spreading to the superficial cortex as seen in the traditional depictions of the posterior borderzone [3, 9, 15, 28]. Because the template by Naidich et al [25,26,27] presented data mainly on infarcts surrounding the parasagittal area, comparison with our map was not possible. In the upper slices these investigators showed that the inferior parietal and part of the superior parietal lobules were infrequently involved by borderzone infarcts.…”

“…There has been surprisingly little discussion about the size of the ‘traditional’ borderzone region in the maps created by previous investigators [3, 9, 15, 17,25,26,27,28]. We examined whether the size of the rim around each infarct affected our findings.…”

“…The digital atlas was compared to the infarct templates of Bogousslavsky and Regli [9], Donnan et al [24], Naidich et al [25,26,27], Torvik [28], Wodarz [15] and Zulch [3]. We did not compare our atlas against the arterial maps by Tatu et al [29] and van der Zwan et al [19] because those are maps of perfused arterial territory and are not maps of the borderzones.…”

Application of principal component analysis to study topography of hypoxic–ischemic brain injury

“…This is the presumed site of the borderzone between the territories of the anterior and middle cerebral arteries (ACA and MCA). The internal borderzone is the white matter region surrounding the centrum semiovale (Bogousslavsky and Regli, 1986;Donnan et al, 2002;Naidich and Brightbill, 2003;Naidich et al, 2003aNaidich et al, , 2003bTorvik, 1984;Wodarz, 1980;Zulch and Hossmann, 1989).…”

Anterior Cerebral Artery Stroke: Role of Collateral Systems on Infarct Topography

“…studies, some predating modern perfusion and magnetic resonance imaging (MRI); some were based on autopsies remote from the stroke event [2][3][4][10][11][12][13][14][15] or studies which used arterial template to infer infarct territory. 16 These prior studies, undertaken poststroke, have provided little information on the topography at stroke onset, the impact of collateral systems in modifying the arterial territory and the effect of this transformed territory on motor outcome.…”