Distribution of cerebral blood flow in the nucleus caudatus, nucleus lentiformis, and thalamus: A study of territorial arterial spin-labeling MR imaging

Purpose: To investigate the effect of variations in anatomic features of the circle of Willis on the perfusion territory to deep structures, including the nucleus caudatus, the nucleus lentiformis, and the thalamus. Materials and Methods: The ethics committee of the study institution approved the study protocol. A total of 159 patients with first-time clinical symptoms of cerebral ischemia were recruited. Contributions to the perfusion territory were visualized with territorial arterial spin-labeling magnetic resonance (MR) imaging. The anatomic features of the circle of Willis were evaluated with time-of-flight MR angiography. Perfusion territory contributions were compared among circle of Willis variants by using the Cochran-Mantel-Haenszel test. Results: The perfusion territory contributions to the deep-brain structures could be evaluated in 119 of 159 patients (75%). With a fetal-type circle of Willis (41 of 238 hemispheres; 17%), there was a contribution from the ipsilateral internal carotid artery to the thalamus in all 41 hemispheres (100%), compared with 96 of the 197 hemispheres (49%) without a fetal-type circle of Willis. In the 19 patients with a hypoplastic A1 segment, there was more often a contribution of the contralateral internal carotid artery to the perfusion of the nucleus caudatus (10 of 19; 53%) and the nucleus lentiformis (5 of 19; 26%). Conclusion: The perfusion territory contributions to deep-brain structures vary widely. These differences can be partly explained by variations in the anatomic features of the circle of Willis.