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Three-Dimensional Angioarchitecture of Rete Middle Cerebral Artery Anomalies and the Clinical Significance

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Abstract

Purpose

Rete middle cerebral artery (MCA) anomaly is characterized by a web-like network of arteries involving the first MCA segment (M1) and a normal downstream MCA. The detailed composition of this anomaly and the hemodynamic impacts on cerebral perfusion are rarely addressed. The purpose of this study was to elucidate the anatomical and hemodynamic perspectives of the rete MCA anomaly.

Methods

From August 2020 to December 2021, 4 rete MCA anomalies were identified at Shuang Ho hospital. Clinical information, perfusion magnetic resonance (MR) imaging, and angiographic images were collected. Detailed angioarchitecture, including types of arterial feeders and extent of rete involvement, were analyzed based on three-dimensional volume-rendering reconstruction images obtained from the catheter-based angiographies.

Results

Despite their variable clinical presentations (two hemorrhage, one ischemia, and one asymptomatic), all cases shared common angiographic findings as follows: (1) the internal carotid artery did not connect directly to the rete, (2) the anterior choroidal artery (AChA) was the artery constantly supplying the rete and (3) there was a watershed zone shift toward MCA territory. The perfusion MR cerebral blood flow map was symmetric in all studied cases.

Conclusion

The AChA is an artery constantly supplying the rete, which suggests that the angioarchitectural features associated with this anomaly may be the result of both congenital and acquired compensatory processes. Cerebral perfusion remains preserved at the lesion side, despite angiographic evidence of watershed zone shift. These findings will be important for making better clinical judgments about this condition.

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Acknowledgements

This study is funded by the Taipei Medical University (TMU109-AE1-830).

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Authors and Affiliations

  1. Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China

    Hui-Tzung Luh, Shung-Tai Yang, Yu-Chun Lu, Yong-Kwang Tu & I-Chang Su

  2. Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, Province of China

    Hui-Tzung Luh, Shung-Tai Yang, Yu-Chun Lu, Yong-Kwang Tu & I-Chang Su

  3. Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan, Province of China

    Hui-Tzung Luh

  4. Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Province of China

    Shung-Tai Yang & I-Chang Su

  5. Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China

    Yueh-Hsun Lu

  6. Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Province of China

    Yueh-Hsun Lu

  7. Department of Neurosurgery, Hospital Lam Wah Ee, Georgetown, Penang, Malaysia

    Jun-Yeen Chan

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  1. Hui-Tzung Luh
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Corresponding author

Correspondence to I-Chang Su.

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Conflict of interest

H.-T. Luh, S.-T. Yang, Y.-H. Lu, Y.-C. Lu, J.-Y. Chan, Y.-K. Tu and I.-C. Su declare that they have no competing interests.

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Luh, HT., Yang, ST., Lu, YH. et al. Three-Dimensional Angioarchitecture of Rete Middle Cerebral Artery Anomalies and the Clinical Significance. Clin Neuroradiol 33, 319–325 (2023). https://doi.org/10.1007/s00062-022-01211-9

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  • DOI: https://doi.org/10.1007/s00062-022-01211-9

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