Neurovascular Imaging (eBook)

Shoki Takahashi, MD is Professor and Chair of the Department of Diagnostic Radiology at Tohoku University Graduate School of Medicine in Sendai, Japan.

Neurovascular Imaging 1
Preface 4
Contents 6
Contributors 8
Part I: Normal Anatomy of Brain Vessels 10
1: Intracranial Arterial System: The Main Trunks and Major Arteries of the Cerebrum 11
1.1 Introduction 11
1.2 Internal Carotid Artery (ICA) 11
1.2.1 Segments of the ICA delineated by Bouthillier et al. (Fig. 1.2) [10, 23] 12
1.2.2 The Ophthalmic Artery (Fig. 1.5) 15
1.2.3 Anatomy and Aneurysms of the Paraclinoid Region 16
1.2.3.1 Anatomy of the Paraclinoid Region (Fig. 1.6) 16
1.2.3.2 Paraclinoid Aneurysms 18
1.3 The Circle of Willis 20
1.4 The Main Arteries of the Cerebrum and Their Vascular Territories 24
1.4.1 The Main Arterial Trunks and Their Branches 24
1.4.2 The Vascular Territories of the Cerebral Arteries 24
1.4.3 The Boundary Zone and Leptomeningeal Anastomoses 27
1.4.4 Arterial Supply of the Uncus/Parahippocampal Gyrus and the Hippocampal Region 31
1.4.4.1 The Uncus/Parahippocampal Gyrus 32
1.4.4.2 The Hippocampus 34
Superficial (Leptomeningeal) Hippocampal Arteries 44
Intrahippocampal Arteries 49
Microangiograms of hippocampal arteries and MR images of infarction of hippocampal region 49
References 57
2: Intracranial Arterial System: Basal Perforating Arteries 60
2.1 Introduction 60
2.2 Striate Arterial Group 60
2.2.1 Medial Striate Arteries (MSA) 60
2.2.2 Lenticulostriate Arteries 66
2.2.2.1 Origin, Course 66
2.2.2.2 Intracerebral Course and Distribution 70
2.2.2.3 Territories 70
2.2.3 Distribution of the Striate Arteries on Microangiograms 70
2.2.4 Imaging of Infarcts in the Distribution of Striate Arteries 74
2.3 Anterior Choroidal Artery and Carotid Branches 78
2.3.1 Anterior Choroidal Artery 78
2.3.1.1 Phylogenic Development 78
2.3.1.2 Origin and Segments 79
2.3.1.3 Branches, Distribution, and Microangiographic Findings 83
2.3.1.4 Subependymal Arteries (SEA) 89
2.3.1.5 Clinical Features and Imaging Findings of Infarcts in the AChA Territory 91
Box 2.1 Does the anterior choroidal artery supply the paraventricular region? 92
2.3.2 Direct Perforators of the Internal Carotid Artery 93
2.4 Thalamic Arterial Group 97
2.4.1 Generalized Anatomy of the Vascular Supply of the Thalamus with Microangiographic Findings 97
2.4.2 Thalamotuberal Artery 99
2.4.3 Thalamoperforate Artery (TPA) 102
2.4.4 Thalamogeniculate Artery (TGA) 106
2.4.5 Medial Posterior Choroidal Artery 109
2.4.6 Lateral Posterior Choroidal Artery 114
2.4.7 Vascular Supply of the Choroid Plexus of the Lateral Ventricle 119
2.4.8 Vascular Supply of the Hypothalamus 120
2.5 Anastomoses Among the Perforating Arteries of the Brain 125
2.6 Vascular Supply of the Motor Pathway and MR Imaging 125
2.6.1 Vascular Supply of the Corona Radiata and the Posterior Limb of the Internal Capsule 125
2.6.2 MR Imaging of the Basal Perforators 126
References 132
3: Intracranial Arterial System: Infratentorial Arteries 138
3.1 Introduction 138
3.2 Vertebral Artery and Basilar Artery 138
3.3 Main Branches of the Vertebro-basilar System 143
3.3.1 Posterior Inferior Cerebellar Artery (PICA) 143
3.3.2 Posterior Spinal Artery (PSA) 145
3.3.3 Anterior Spinal Artery (ASA) 146
3.3.4 Anterior Inferior Cerebellar Artery (AICA) 146
3.3.5 Internal Auditory Artery 149
3.3.6 Superior Cerebellar Artery (SCA) 149
3.4 Internal Vascular Supply of the Brainstem 150
3.4.1 Overview of Brainstem Vessels with Microangiographic Findings 150
3.4.2 Vascular Supply of the Medulla 152
3.4.2.1 The Anteromedial Group 152
3.4.2.2 The Anterolateral Group 154
3.4.2.3 The Lateral Group 161
3.4.2.4 The Posterior Group 161
3.4.3 Vascular Supply of the Pons 169
3.4.3.1 The Anteromedial Group 169
3.4.3.2 The Anterolateral Group 171
3.4.3.3 The Lateral Group 171
3.4.3.4 The Posterior Group 171
3.4.4 Vascular Supply of the Midbrain 172
3.4.4.1 Arteries that Encircle and Supply the Midbrain 172
3.4.4.2 The Anteromedial Group 172
3.4.4.3 The Anterolateral Group 176
3.4.4.4 The Lateral Group 176
3.4.4.5 The Posterior Group 176
3.4.4.6 Complementary Roles in the Vascularization of the Midbrain 180
3.5 Representative Imaging Findings in Cases with Infarcts in the Distribution of the Infratentorial Arteries (Figs. 3.26 180
References 194
4: Perforating Branches of the Anterior Communicating Artery: Anatomy and Infarction 196
4.1 The Anterior Communicating Artery (ACoA) 196
4.2 Perforating Branches of the ACoA (Figs. 4.1 and 4.2) 196
4.3 Infarcts in the Territory of the Perforating Branches of the ACoA 198
4.4 Structures Perfused Mainly by the Perforating Branches of the ACoA (Figs. 4.2 and 4.4) 200
References 202
5: Cerebral Arterial Variations and Anomalies Diagnosed by MR Angiography 204
5.1 Introduction 204
5.2 Variations and Anomalies of the Common Carotid Artery (CCA) and Internal Carotid Artery (ICA) 204
5.2.1 Brachiocephalic Trunk Origin of the Left CCA (Bovine Aortic Arch) 204
5.2.2 Unusual Level of Bifurcation of the CCA, Absence of the CCA and Absence of the Proximal External Carotid Artery (ECA) 205
5.2.3 Medial Origin and Retropharyngeal Course of the ICA 207
5.2.4Congenital Absence or Hypoplasia of the ICA 207
5.2.5 Aberrant Course of the ICA, Persistent Stapedial Artery 208
5.2.6 Fenestration of the ICA 212
5.2.7 Persistent Dorsal Ophthalmic Artery 213
5.3 Variations and Anomalies of the Anterior Cerebral Artery (ACA) and Anterior Communicating Artery 214
5.3.1 Carotid-ACA Anastomosis 214
5.3.2 Fenestration of the ACA and the Anterior Communicating Artery 215
5.3.3 Persistent Primitive Olfactory Artery 216
5.3.4 Azygos ACA, Bihemispheric ACA 218
5.3.5 Triple ACAs, Median Artery of the Corpus Callosum 218
5.4 Variations and Anomalies of the Middle Cerebral Artery (MCA) 219
5.4.1 Duplicated MCA 219
5.4.2 Accessory MCA 219
5.4.3 Early Bifurcated MCA 221
5.4.4 Fenestration of the MCA 221
5.5 Variations and Anomalies of the Posterior Cerebral Artery (PCA) 221
5.5.1 Duplicated PCA 221
5.5.2 PCA Branch Arising from the Hyperplastic Anterior Choroidal Artery 223
5.5.3 Fenestration of the PCA 223
5.6 Variations of the Circle of Willis 224
5.6.1 Unilateral Absence of A1 Segment 224
5.6.2 Unilateral or Bilateral Absence of P1 Segment 225
5.6.3 Unilateral or Bilateral Absence of the Posterior Communicating Artery 225
5.7 Variations and Anomalies of the Vertebrobasilar and Cerebellar Arteries 225
5.7.1 Variations of the Origin of the Vertebral Artery (VA) 225
5.7.2 Anterior Course of the Proximal VA 226
5.7.3 Fenestration of the Extracranial VA, Persistent First Cervical Intersegmental Artery 226
5.7.4 Cervical Origin of the Posterior Inferior Cerebellar Artery (PICA) 228
5.7.5 Fenestrations of the Intracranial Vertebrobasilar Arteries 228
5.7.6 Variations and Anomalies of the Cerebellar Arteries 232
5.8 Carotid-Vertebrobasilar Anastomoses 233
5.8.1 Proatlantal Artery Type 1 and Type 2 235
5.8.2 Persistent Hypoglossal Artery (PHA) 237
5.8.3 Persistent Otic Artery? 237
5.8.4 Persistent Trigeminal Artery (PTA), Lateral Type 238
5.8.5 PTA, Medial Type 241
5.8.6 PTA Variants 241
References 243
6: Regional MR Perfusion Topographic Map of the Brain Using Arterial Spin Labeling at 3 Tesla 247
6.1 Introduction 247
6.2 Basic Principles of ASL and Regional Perfusion Imaging 247
6.2.1 Basic Principles of ASL 247
6.2.2 Regional Perfusion Imaging 249
6.3 Regional Perfusion Topographic Images in Normal and Pathological Cases 251
6.4 Conclusions 259
References 259
7: Normal Anatomy of Intracranial Veins: Demonstration with MR Angiography, 3D-CT Angiography and Microangiographic Injection S 260
7.1 Cranial Dural Venous Sinuses (Figs. 7.1–7.3) 260
7.1.1 Superior Sinus Group 260
7.1.1.1 Superior Sagittal Sinus 260
7.1.1.2 Inferior Sagittal Sinus 263
7.1.1.3 Straight Sinus 264
7.1.1.4 Falcine Sinus (Fig. 7.7) 264
7.1.1.5 Occipital Sinus (Fig. 7.8) 265
7.1.1.6 Confluence of Sinuses 266
7.1.1.7 Transverse-Sigmoid Sinus 267
7.1.2 Inferior Sinus Group (Basal Sinus Group) (Fig. 7.3) 268
7.1.2.1 Cavernous Sinus (Figs. 7.3 and 7.10) 268
7.1.2.2 Superior Petrosal Sinus (Fig. 7.3) 268
7.1.2.3 Inferior Petrosal Sinus (Fig. 7.10) 269
7.1.2.4 Sphenoparietal Sinus (Fig. 7.3) 269
7.1.2.5 Basilar Plexus (Fig. 7.3) 269
7.1.2.6 Emissary Veins (Fig. 7.11) 269
7.2 Cerebral and Cerebellar Veins 269
7.2.1 Supratentorial Veins 270
7.2.1.1 Superficial Cerebral Veins 270
Superior Cerebral Veins (Ascending Cortical Veins) 270
Superficial Middle Cerebral Vein (Superficial Sylvian Vein) (Fig. 7.13) 272
Inferior Cerebral Veins (Descending Cortical Veins) (Fig. 7.13) 273
7.2.1.2 Parenchymal Veins 273
Superficial Parenchymal Veins (Superficial Draining Veins) 273
Deep Parenchymal Veins (Deep Draining Veins of the White Matter) 275
Transcerebral and Anastomotic Cerebral Veins 276
7.2.1.3 Deep Cerebral Veins Including the Vein of the Basal Ganglionic and Thalamic Regions 276
Tributaries of the Internal Cerebral Vein (Table 7.2, Fig. 7.18) 277
Tributaries of the Basal Vein of Rosenthal (Fig. 7.19) 279
Veins of the Basal Ganglionic Region (Fig. 7.20a, b) 279
Veins of the Thalamic Region (Figs. 7.20c, d and 7.21) 279
7.2.2 Infratentorial Veins (Veins of the Posterior Fossa) (Fig. 7.21) 282
7.3 Veins of the Cranio-Vertebral Junction (Fig. 7.22) 285
References 286
8: Mapping Superficial Cerebral Veins on the Brain Surface 289
8.1 Introduction 289
8.2 MR Imaging Techniques 289
8.2.1 Fusion Method 289
8.2.2 Rendering Method 292
References 296
Part II: Neurovascular Imagingin Pathology 297
9: Preoperative Visualization of the Lenticulostriate Arteries Associated with Insulo-Opercular Gliomas Using 3-T Magnetic Res 298
9.1 Introduction 298
9.2 Three-Dimensional MR Imaging 299
9.3 Representative Cases 299
9.3.1 Case 1 299
9.3.2 Case 2 302
9.4 Discussion 303
9.5 Conclusions 305
References 305
10: Ischemic Complications Associated with Resection of Opercular Gliomas 307
10.1 Introduction 307
10.2 Microangiographic Analysis of Vascular Supply to the Corona Radiata 307
10.3 MR Imaging Studies 308
10.4 Ischemic Complications Associated with Resection of Opercular Gliomas 310
10.4.1 Clinical Materials 310
10.4.2 Representative Cases 311
10.4.2.1 Case 1 311
10.4.2.2 Case 2 313
10.4.2.3 Case 3 315
10.5 Discussion 317
10.6 Conclusions 319
References 320
11: Imaging and Tissue Characterization of Atherosclerotic Carotid Plaque Using MR Imaging 321
11.1 Introduction 321
11.2 Histopathology of Carotid Plaque 321
11.3 Imaging of Carotid Plaque 324
11.3.1 Contrast Angiography 327
11.3.2 Computed Tomography 327
11.3.3 Ultrasonography 329
11.3.3.1 Surface Ultrasonography 329
11.3.3.2 Intravascular Ultrasonography 332
11.3.4 Magnetic Resonance Imaging 333
11.3.4.1 Hardware for MR Plaque Imaging 333
11.3.4.2 Approaches to MR Plaque Imaging 334
11.3.4.3 Interpretation of MR Plaque Imaging 335
11.3.4.4 Contrast Enhancement and Functional and Molecular Imaging for Carotid Plaque 339
11.3.4.5 Application to Treatment Strategies 341
11.4 Future Perspectives 342
References 342
12: MR Imaging of Cerebral Aneurysms 346
12.1 Saccular (Berry) Aneurysm 346
12.1.1 MR Imaging 351
12.1.2 MR Angiography 352
12.2 Dissection and Dissecting Aneurysm 356
12.2.1 MR Imaging 358
12.2.2 MR Angiography 359
12.3 Fusiform Aneurysm 365
12.3.1 MR Imaging and MR Angiography 365
12.4 Infectious Aneurysm 367
12.4.1 MR Imaging and MR Angiography 368
12.5 Traumatic Aneurysm 369
12.5.1 MR Imaging and MR Angiography 370
References 370
13: MR Imaging of Vascular Malformations 374
13.1 Arteriovenous Malformation (AVM) 374
13.1.1 Clinical Overview 374
13.1.2 Characteristic Imaging Features and Diagnostic Points of AVM 375
13.1.2.1 Findings in Cases with and Without Bleeding 375
13.1.2.2MR Imaging Findings of AVM 375
AVM Grading System 376
Associated Aneurysms 377
Follow-Up Study After Treatment 377
13.1.3 Case of Arteriovenous Malformation (AVM) 377
13.2 Dural Arteriovenous Fistula (dAVF) 380
13.2.1 Definition and Overview 380
13.2.2 Classification and Treatment Strategies 381
13.2.2.1 Classification Systems 381
13.2.2.2 Treatment Options and Prognosis 381
13.2.3 Points and Characteristic Features of Diagnostic Imaging 382
13.2.3.1 Findings on Conventional Images 382
13.2.3.2 MRA and MRDSA for the Diagnosis of dAVF 382
13.2.4 Case of dAVF 383
13.3 Vein of Galen Malformation 383
13.3.1 Clinical Overview 383
13.3.2 Points of Diagnostic Imaging 384
13.3.3 Case of Vein of Galen Malformation 385
13.4 Cavernous Malformation 385
13.4.1 Clinical Overview 385
13.4.2 Points of Diagnostic Imaging 387
13.4.3 Case of Cavernous Malformation 387
13.5 Capillary Telangiectasia 389
13.5.1 Clinical Overview 389
13.5.2 Points of Diagnostic Imaging 389
13.5.3 Case of Capillary Telangiectasia 389
References 391
14: Cerebral Venous Malformations 395
14.1 Classification of Cerebral Vascular Malformations 395
14.2 Terminology of Venous Malformations 395
14.3 Histology 396
14.4 Etiology 397
14.5 Symptoms and Treatment 397
14.6 Imaging 398
14.6.1 Angiographic (DSA) Findings with Consideration of the Pathomechanism of MVMs 398
14.6.2 CT Findings 400
14.6.3 MR Imaging 401
14.6.4 Radionuclide Study 406
References 407
15: Thrombosis of the Cerebral Veins and Dural Sinuses 409
15.1 Introduction 409
15.2 Symptoms and Pathogenesis 409
15.3 Imaging 411
15.3.1 Cranial CT 411
15.3.2CT Venography 416
15.3.3MR Imaging 417
15.3.4MR Venography 420
15.3.5Cerebral Angiography (DSA) 420
15.4 CSVT Associated with Dural Arteriovenous Shunt (AVS) 421
References 422
Part III: Anatomy and Imagingof Spinal Vessels 424
16: Vessels of the Spine and Spinal Cord: Normal Anatomy 425
16.1 Introduction 425
16.2 Arterial System 425
16.2.1 Design for the Development of Spinal Cord Arteries (Fig. 16.1) 425
16.2.2 Spinal Arteries 427
16.2.3 Radicular Arteries 429
16.2.3.1 Classification 429
16.2.3.2 Radiculopial/Radiculomedullary Arteries and the Adamkiewicz Artery (AKA) 430
16.2.4 Superficial Arteries of the Spinal Cord 431
16.2.4.1 Anterior Spinal Artery (ASA) 433
16.2.4.2 Posterior Spinal Arteries 433
16.2.4.3 Pial Arterial Network (Vasocoronal Network) 435
16.2.5 Intrinsic Arteries of the Spinal Cord 435
16.2.5.1 Sulcal (Central) Arteries 435
16.2.5.2 Peripheral System (Vasocorona) 436
16.2.5.3 Distribution of the Arteries of the Spinal Cord (Fig. 16.12) 436
16.3 Venous System 439
16.3.1 Spinal Cord Veins 439
16.3.1.1 Intraparenchymal Veins 440
16.3.1.2 Transmedullary Venous Anastomoses 440
16.3.1.3 Superficial Veins 442
16.3.2 Vertebral Venous Plexus (Batson’s Venous Plexus) 442
16.3.3 Vein Valves and a System for Preventing Reflux 444
References 448
17: MDCT of the Artery of Adamkiewicz 449
17.1 Introduction 449
17.2 Computed Tomographic Imaging of the Artery of Adamkiewicz 450
17.2.1 Imaging Technique 450
17.2.2 Computed Tomography Protocol 450
17.2.3 Image Processing 454
17.2.4 Identification of the Artery of Adamkiewicz by MDCT 454
17.2.4.1 Detection of the Artery of Adamkiewicz 454
17.2.4.2 Differentiating the Spinal Artery and Vein 457
17.2.4.3 Visualization of the Artery of Adamkiewicz by MDCT with Intra-Arterial Contrast Injection 457
17.2.4.4 Rate of Detecting the Artery of Adamkiewicz by MDCT 458
17.2.4.5 Clinical Utility of Visualization of the Artery of Adamkiewicz by MDCT 458
Preoperative Visualization of the AKA Before Open Aortic Surgery 458
The AKA and Aortic Stent-Graft Insertion 458
17.2.4.6 Limitations of MDCT in Visualizing the Artery of Adamkiewicz 459
References 459
18: Magnetic Resonance Angiography of the Spinal Cord Blood Supply 462
18.1Introduction 462
18.2 Vascular anatomy 463
18.2.1 Spinal cord arteries 463
18.2.2 Spinal cord veins 464
18.3Clinical relevance 464
18.4 MR angiography 465
18.4.1 Imaging requirements 465
18.4.2 Image acquisition techniques 466
18.4.3 Image postprocessing and interpretation 470
18.4.4 Detection results 474
18.4.5 Clinical implementation of MR angiography 475
18.5 Outlook 480
18.6 Conclusions 481
References 481
19: Magnetic Resonance Imaging of Spinal Vascular Lesions 483
19.1 Introduction 483
19.2 Classification 483
19.3 Imaging Techniques 488
19.4 Characteristic Features of Common Spinal Vascular Lesions 490
19.4.1 Dural AVFs (Type I, Intradural Dorsal AVFs) 490
19.4.1.1 Synonyms 490
19.4.1.2 General Issues 490
19.4.1.3 Clinical Presentation and Pathophysiology 490
19.4.1.4 MR Findings 492
19.4.2 Perimedullary AVFs (Type IV, Intradural Ventral AVFs) 492
19.4.2.1 Synonyms 492
19.4.2.2 General Issues 492
19.4.2.3 Clinical Presentation and Pathophysiology 494
19.4.2.4 MR Findings 494
19.4.3 Intramedullary AVMs 498
19.4.3.1 Synonyms 498
19.4.3.2 General Issues 498
19.4.3.3 Clinical Presentation and Pathophysiology 498
19.4.3.4 MR Findings 499
References 501
Index 502
Index 502