重复大脑中动脉及副大脑中动脉变异的流行病学特点及磁共振血管成像特征

王娟  张勇  尚伟

doi:10.16098/j.issn.0529-1356.2025.04.010

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解剖学报 ›› 2025, Vol. 56 ›› Issue (4) : 452-458. DOI: 10.16098/j.issn.0529-1356.2025.04.010

解剖学

重复大脑中动脉及副大脑中动脉变异的流行病学特点及磁共振血管成像特征

王娟¹ 张勇² 尚伟^1*

作者信息 +

Epidemiological characteristics and magnetic resonance angiography features of duplicated and accessory middle cerebral artery

WANG Juan¹ ZHANG Yong² SHANG Wei^1*

Author information +

文章历史 +

摘要

目的探讨重复大脑中动脉（DMCA）及副大脑中动脉（AMCA）变异的流行病学特点及磁共振血管成像(MRA)特征，提高对该血管变异的认识。方法收集2023年4~8月于我院进行颅脑MRI及MRA检查的8131例患者的影像学资料，筛查DMCA及AMCA变异患者，分析DMCA及AMCA的流行病学特点、MRA特征及分型，同时观察有无合并其他脑血管变异或病变情况。结果 8131例患者中检出113例出现DMCA或AMCA血管变异119支，DMCA 64支，包括A型24支和B型40支；AMCA 55支，包括1型38支和2型17支。DMCA-A型管径相对大小明显大于DMCA-B型及AMCA-1型和2型，差异有统计学意义（P<0.05）。DMCA及AMCA合并其他脑血管变异的发生率分别为54.69%、34.69%。结论 MRA简单易行，且能够直观地显示DMCA及AMCA，可作为其诊断的重要方法。DMCA及AMCA变异使相关手术变得复杂，且该变异在其相关性脑梗死的预后中发挥不可忽视的作用，对于指导神经外科及神经内科医师制定合理的治疗方案具有十分重要的意义。

Abstract

Objective To explore the epidemiological characteristics and magnetic resonance angiography (MRA) features of duplicated and accessory middle cerebral artery (DMCA and AMCA), and to raise awareness of this vascular variation.

Methods Imaging data of 8131 patients underwent cranial MRI and MRA examinations in Anyang People’s Hospital from April 2023 to August 2023 were collected, and DMCA or AMCA variation were investigated. The epidemiological characteristics, MRA features and classification of DMCA and AMCA were analyzed. Meanwhile the concurrent other cerebrovascular variations were observed. Results Totally 113 of 8131 patients were detected to have 119 DMCA or AMCA vascular variants. There were 64 DMCA including 24 type A and 40 type B, and there were 55 AMCA including 38 of type 1 and 17 of type 2. The relative diameter of type A DMCA was larger than that of type B DMCA, type 1 and type 2 AMCA. The difference was statistically significant(P<0.05). The incidence of DMCA and AMCA combined with other cerebrovascular variations was 54.69% and 34.69%, respectively. Conclusion MRA is simple and practicable, and can intuitively display DMCA or AMCA. So, it can be used as an important method for the diagnostic of DMCA or AMCA. The DMCA and AMCA variation make related surgeries more complex, and it plays an undeniable role in the prognosis of related cerebral infarction. This vascular variation has important clinical significance for guiding neurosurgeons and neurologists to formulate reasonable treatment plans.

导出引用

王娟张勇尚伟. 重复大脑中动脉及副大脑中动脉变异的流行病学特点及磁共振血管成像特征[J]. 解剖学报. 2025, 56(4): 452-458 https://doi.org/10.16098/j.issn.0529-1356.2025.04.010

WANG Juan ZHANG Yong SHANG Wei. Epidemiological characteristics and magnetic resonance angiography features of duplicated and accessory middle cerebral artery[J]. Acta Anatomica Sinica. 2025, 56(4): 452-458 https://doi.org/10.16098/j.issn.0529-1356.2025.04.010

中图分类号： R322.81 R445.2

参考文献

［1］Crompton MR. The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes［J］. Lancet, 1962, 2(7253): 421-425.

［2］Teal JS, Rumbaugh CL, Bergeron RT, et al. Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation［J］. Am J Roentgenol Radium Ther Nucl Med, 1973, 118(3): 567-575.

［3］Zhang WL. Microanatomy of the middle cerebral artery［J］. Acta Anatomica Sinica, 1981,12 (4): 367-375. (in Chinese)

张为龙. 大脑中动脉的显微解剖学［J］. 解剖学报, 1981, 12(4): 367-375.

［4］Tsuyama K, Miyamoto N, Shindo A, et al. Analysis for stroke etiology in duplicated/accessory MCA-related cerebral infarction: two case report and brief literature review［J］. Diagnostics (Basel), 2021, 11(2): 205.

［5］Alliez JR, Manera L. Aneurysm Arising at the Origin of a Duplicated Middle Cerebral Artery［J］. Case Rep Neurol, 2021, 13(2): 446-450.

［6］Uchino A, Irie T. Accessory posterior cerebral artery(hyperplastic anterior choroidal artery) associated with contralateral accessory middle cerebral artery incidentally diagnosed by magnetic resonance angiography［J］. Surg Radiol Anat, 2024, 46(3): 313-316.

［7］Wang L, Zhang Z. Endovascular stenting to treat an acute stroke caused by severe stenosis of the duplicated middle cerebral artery［J］. BMC Neurol, 2023, 23(1): 411.

［8］Tsuchiya A, Tsukiyama A, Matsumoto S, et al. Cerebral infarction due to occlusion of main trunk of middle cerebral artery in patient with accessory middle cerebral artery［J］. Asian J Neurosurg, 2022, 17(3): 495-499.

［9］Chang HY, Kim MS. Middle cerebral artery duplication: classification and clinical implications［J］. J Korean Neurosurg Soc, 2011, 49(2): 102-106.

［10］Zhang SQ, Kang ChX, Zhang PY, et al. Molecular mechanism underlying vascular development in the brain［J］. Acta Anatomica Sinica, 2022, 53(5): 680-686. (in Chinese)

张思琦, 康晨曦, 张佩艳, 等. 脑血管发育的分子机制［J］. 解剖学报, 2022, 53(5): 680-686.

［11］Ota T, Komiyama M. Embryological lateral striate artery variants: revised concept of recurrent artery of Heubner, the perforators to the anterior perforated substance and middle cerebral artery variants［J］. Clin Neuroradiol, 2021, 31(1): 73-78.

［12］Gunnal SA, Farooqui MS, Wabale RN. Study of middle cerebral artery in human cadaveric brain［J］. Ann Indian Acad Neurol, 2019, 22(2): 187-194.

［13］Wang J, Cheng JL, Zhang Y, et al. Manifestations of duplicated middle cerebral artery in three dimensional time of flight MR angiography and their clinical significance［J］. Chinese Journal of Neuromedicine, 2018, 17(11): 1120-1124. (in Chinese)

王娟, 程敬亮, 张勇, 等. 重复大脑中动脉的3D-TOF-MRA表现及其临床意义研究［J］. 中华神经医学杂志, 2018, 17(11): 1120-1124.

［14］Uchiyama N. Anomalies of the middle cerebral artery［J］. Neurol Med Chir (Tokyo), 2017, 57(6): 261-266.

［15］Phuyal S, Thapa L, Mishra BM, et al. Rare case of duplicated middle cerebral artery and acute ischaemic stroke managed successfully with mechanical thrombectomy［J］. BMJ Case Rep, 2023, 16(11): e251221.

［16］Akiyama T, Okuda T, Inoha S. Lessons learned from mechanical thrombectomy of an acute occlusion of a duplicated middle cerebral artery: a case report［J］. J Neuroendovasc Ther, 2022, 16(10): 510-514.

［17］Arakawa T, Hiramatsu H, Kida S, et al. A case of acute embolism of the accessory middle cerebral artery treated using ADAPT thrombectomy without lesion passing［J］. NMC Case Rep J, 2021, 8(1): 805-810.

［18］Zhang ChF, Lü H, Wang L, et al. Duplicated middle cerebral artery complicated with migraine, Case report［J］. Chinese Journal of Clinical Neurosurgery, 2022, 27(6): 525. (in Chinese)

张超峰, 吕桦, 王莉, 等. 重复大脑中动脉急性闭塞致脑梗死1例［J］. 中国临床神经外科杂志, 2022, 27(6): 525.

［19］Stojanoviｃ＇ NN, Kostiｃ＇ A, Miti R, et al. Correlation between multiple cerebral aneurysms and a rare type of segmental duplication of the middle cerebral artery［J］. BMC Neurol, 2020, 20(1): 3.