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Middle cerebral artery territory in ASPECTS study

Case contributed by Dr Subash Thapa

A. CT Axial slice at the level of thalamus and basal ganglion which includes 4 deep and 3 cortical territories.

B. CT Axial slice at the level adjacent to the most superior margin of the ganglionic structures which includes 3 cortical MCA territories.

Case Discussion

A. CT axial slice at the level of thalamus and basal ganglion (Includes 4 deep* and 3 cortical territories):

  • C - caudate head*
  • LN - lentiform nucleus*
  • IC - internal capsule*
  • I - insular cortex*
  • M1 - anterior MCA cortex
  • M2 - MCA cortex lateral to insular ribbon
  • M3 - posterior MCA cortex

("A" - anterior circulation, "P" - posterior circulation)

B. CT axial slice at the level adjacent to the most superior margin of the ganglionic structures (Includes 3 cortical territories):

  • M4, M5, M6 - anterior, lateral and posterior MCA territories, respectively (approximately 2cm superior to M1, M2 and M3 respectively)

Practical points:

  • total 10 MCA territory allotted where each area equals to 1 point 1
  • normal CT scan received an ASPECTS of 10 points 1
  • a score of <7 is equal to one-third of the MCA territory 1
  • a score of zero indicates diffuse ischemia involvement throughout the MCA territory 1
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Case information

rID: 40018
Published: 4th Oct 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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