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Advanced Neurology

CASE REPORT
Interpretation of infarct location in relationship

to perfusion territories using territorial arterial
spin labeling in a patient with multiple

infarctions: A case report

1
Yuehui Hong , Lixin Zhou , Bo Hou , Xiaoyuan Fan , and Jun Ni *
1
1
2
2
1 Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical
College & Peking Union Medical College, Dongcheng District, Beijing, China
2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical
College & Peking Union Medical College, Dongcheng District, Beijing, China

Abstract
We, herein, describe a 50-year-old man with steno-occlusive cerebrovascular disease
and multiple infarcts that were expected to be within the perfusion territories of the
basilar artery (BA) and left internal carotid artery. However, territorial arterial spin
labeling (T-ASL) perfusion magnetic resonance imaging showed that the infarct
lesions were only located in the perfusion territory of the BA and confirmed the
stroke etiology of large artery atherosclerosis. This case implies that the diagnostic
information provided by T-ASL is valuable for identifying the symptomatic perfusion
territories and stroke etiology. This technique is, therefore, able to guide therapeutic
management in patients with multiple infarcts.
*Corresponding author:
Jun Ni (pumchnijun@163.com)
Keywords: Etiology and mechanism; Multiple infarcts; Territorial arterial spin labeling
Citation: Hong Y, Zhou L, Hou B,
et al., 2022, Interpretation of infarct
location in relationship to perfusion
territories using territorial arterial
spin labeling in a patient with 1. Background
multiple infarctions: A case report.
Adv Neuro, 1(1): 10. Etiological diagnosis of ischemic stroke is important for the prevention of recurrent
https://doi.org/10.36922/an.v1i1.10
stroke. The relationship between the infarct location and perfusion territories is useful
Received: November 24, 2021 for identifying the thromboembolic source and stroke etiology. Multiple infarcts within
Accepted: February 23, 2022 a single perfusion territory of a brain-feeding artery are probably caused by diseases
affecting this large artery, such as atherosclerosis or artery dissection. However, multiple
Published Online: March 16, 2022
infarcts within two or more territories are more likely to result from cardiac embolism or
Copyright: © 2022 Author(s). another stroke etiology. In general, the perfusion territories of the brain-feeding arteries
This is an Open-Access article
distributed under the terms of the are based on the standard perfusion territory atlas. Nevertheless, studies have shown
Creative Commons Attribution that there is wide variability in the perfusion territories of the brain-feeding arteries,
License, permitting distribution,
and reproduction in any medium, especially in patients with cerebrovascular steno-occlusive disease. This may result from
provided the original work is collateral blood flow recruitment, which may mislead the etiological diagnosis of ischemic
properly cited. stroke. Territorial arterial spin labeling (T-ASL) perfusion magnetic resonance imaging
Publisher’s Note: AccScience (MRI) is a new noninvasive technique that can be used to determine the individual flow
Publishing remains neutral with territory of brain-feeding arteries and detect collateral blood flow patterns. We, herein,
regard to jurisdictional claims in
published maps and institutional present a case in which T-ASL helped in identification of the thromboembolic source
affiliations. and stroke etiology.

Volume 1 Issue 1 (2022) 1 https://doi.org/10.36922/an.v1i1.10