Create accessible and accurate 3-dimensional subcortical vascular maps.

Accurate knowledge of cerebral vascular territories forms the basis of all stroke care, yet there are major shortcomings in how neurology residents learn these vascular territories.  The current standard maps are (a) difficult to interpret, especially with regard to subcortical territories, (b) 2-dimensional, which limit their structural precision and clinical applicability, and (c) difficult to access, which prompts learners to hunt through online searches that frequently result in inaccurate images. These shortcomings undermine both education and clinical practice. To address this, we constructed 3-dimensional vascular maps of the lenticulostriate vascular distribution.

Using the free software MRIcroGL,12 lenticulostriate strokes were manually drawn on acute DWI scans and then normalized to a standard brain template (MNI-152). We only included strokes that precisely matched the topography of the lenticulostriate territory, based on the vascular atlas of Takahashi. The stroke volumes were then superimposed to create stroke density maps in which color denotes the frequency of infarction at each voxel.

The resultant 3-dimensional map shows the spatial distribution of infarct frequency within the lenticulostriate territory. The map displays the most commonly affected core, as well as the territory’s typical shape, boundaries, and variability.

The lenticulostriate territory map can be used for teaching or clinical reference. The map can be explored 3-dimensionally online or can be downloaded for viewing on MRIcroGL. Consistent with multi-modal learning theory, trainees’ learning and understanding of vascular territories will be optimized when exposed to maps that allow for 3-dimensional visual and kinesthetic exploration. Thus, the maps will improve the trainee’s ability to master vascular territory knowledge and also provide a valuable and accessible reference map for practicing neurologists.