Standard clinical computed tomography fails to precisely visualise presence, course and branching points of deep cerebral perforators

Background: Standard computed tomography (CT) images have earned a well-established position in neuroimaging. Despite that, CT is somehow limited by its resolution, which does not enable to distinctively visualise structures smaller than 300 mu m in diameter. Perforating arteries, most of which measure 100-400 mu m in diameter, supply important subcortical structures (thalamus, basal ganglia, internal capsule). Consequently, pathologies affecting these vessels (e.g. lacunar strokes) can have a devastating clinical outcome. The aim of our study was to assess standard CT's ability to visualise perforators and compare it with microscopic and micro-CT pictures. Materials and methods: We have obtained 6 brainstem and 17 basal ganglia specimens. We infused them with barium sulphate contrast medium adminis-tered into either vertebral or internal cerebral artery. After that, the specimens were fixed in formalin and subsequently a series of CT, micro-CT and microscopic examinations were performed.Results: The median number of visualised perforators in brainstem and basal ganglia specimens was 8 and 3, respectively for CT and 18 and 7 for micro-CT (p < 0.05). Standard CT failed to clearly visualise branching points and vessels smaller than 0.25-0.5 mm (1-2 voxels) in diameter. Parallel vessels, like lenticu- lostriate arteries could not be differentiated in standard CT due to their proximity being smaller that the resolution.Conclusions: Basing on our results, we infer that CT is a poor modality for imaging of the perforators, presenting both quantitative and qualitative flaws in contrast with micro-CT. (Folia Morphol 2023; 82, 1: 37-41)

Automated summary

The aim of this study was to assess the ability of standard CT images to visualize perforating arteries and compare it with microscopic and micro-CT pictures. The results showed that standard CT failed to clearly visualize branching points and vessels smaller than 0.25-0.5 mm in diameter. Therefore, compared to micro-CT, CT has quantitative and qualitative flaws in imaging perforating arteries.