Zonal frequency analysis of the gyral and sulcal extent of cerebral infarcts. Part�III: Middle cerebral artery and watershed infarcts

Abstract

We tested the hypothesis that frequency analysis of the anatomic zones affected by single anterior (A), posterior (P), and middle (M) cerebral artery (CA), multivessel, and watershed infarcts will disclose specific sites (peak zones) most frequently involved by each type, sites most frequently injured by multiple different types (vulnerable zones), and overlapping sites of equal relative frequency for two or more different types of infarct (equal frequency zones). We adopted precise definitions of each vascular territory. CT and MRI studies of 50 MCA, 20 ACA-MCA, three PCA-MCA, and 30 parasagittal watershed infarcts were mapped onto a standard template. Relative infarct frequencies in each zone were analyzed within and across infarct types to identify the centers and peripheries of each, vulnerable zones, and equal frequency zones. These data were then correlated with the prior analysis of 47 ACA, PCA, dual ACA-PCA, and ACA-PCA-MCA infarcts. Zonal frequency data for MCA and watershed infarcts, the sites of peak infarct frequency, the sites of vulnerability to diverse infarcts, and the overlapping sites of equal infarct frequency are tabulated and displayed in standardized format for direct comparison of different infarcts. This method successfully displays the nature, sites, and extent of individual infarct types, illustrates the shifts in zonal frequency and lesion center that attend dual and triple infarcts, and clarifies the relationships among the diverse types of infarct.

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.…”

“…In the upper slices these investigators showed that the inferior parietal and part of the superior parietal lobules were infrequently involved by borderzone infarcts. By contrast, the precentral gyrus was shown to be frequently involved by MCA territorial and borderzone infarcts in that study [25]. …”

“…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).…”