LizhangChen, Neurologist, West China Hospital, Sichuan University
ChangweiZhang, Neurosurgical Doctor, West China Hospital, Sichuan University
HongboZheng, Neurologist, West China Hospital, Sichuan University
Submitted December 03, 2019
We read the Teaching NeuroImages article by Colombo et al.1 with great interest. We agree that recognition of rete middle cerebral artery (MCA) anomaly is important. However, we think the index case needs further evaluation.
The authors reported a case of rete-like MCA using CT angiography and 3D reconstruction. Indeed, we could not see the vascular structure of the right MCA clear in the figure. Compared with conventional digital subtraction angiography (DSA), CT images have relatively low spatial resolution to show such vascular structure clearly. Besides, 3D reconstruction may lose important information. Moreover, it is too difficult to distinguish from isolated severe middle cerebral artery stenosis or occlusion, just according to the CT angiography, because such pattern of radiological features has been reported in patients with isolated severe middle cerebral artery stenosis or occlusion.2,3
Therefore, as a rare variation, we think the diagnosis of rete MCA should be warned and further evaluation (DSA and high-resolution magnetic resonance vessel wall imaging) is advised to avoid diagnostic pitfalls.
To understand the rete MCA better, we would like to share a case of rete MCA that is diagnosed by DSA (figure).
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Colombo E, Brinjikji W, Klaas J, Lanzino G. Teaching NeuroImages: Rete-like middle cerebral artery. Neurology 2019;93:e1919–e1920.
Edgell RC, Boulos AS, Borhani Haghighi A, Bernardini GL, Yavagal DR. Middle Cerebral Artery Stenosis Associated with Moyamoya Pattern Collateralization. Front Neurol 2010;1:119.
Cho KC, Kim JJ, Jang CK, et al. Rete middle cerebral artery anomalies: A unifying name, case series, and literature review. J Neurosurg 2018;131:453–461.
We read the Teaching NeuroImages article by Colombo et al.1 with great interest. We agree that recognition of rete middle cerebral artery (MCA) anomaly is important. However, we think the index case needs further evaluation.
The authors reported a case of rete-like MCA using CT angiography and 3D reconstruction. Indeed, we could not see the vascular structure of the right MCA clear in the figure. Compared with conventional digital subtraction angiography (DSA), CT images have relatively low spatial resolution to show such vascular structure clearly. Besides, 3D reconstruction may lose important information. Moreover, it is too difficult to distinguish from isolated severe middle cerebral artery stenosis or occlusion, just according to the CT angiography, because such pattern of radiological features has been reported in patients with isolated severe middle cerebral artery stenosis or occlusion.2,3
Therefore, as a rare variation, we think the diagnosis of rete MCA should be warned and further evaluation (DSA and high-resolution magnetic resonance vessel wall imaging) is advised to avoid diagnostic pitfalls.
To understand the rete MCA better, we would like to share a case of rete MCA that is diagnosed by DSA (figure).
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References