Frontiers in neurology · 2026
The middle cerebral artery early branches classification (MCA-EB): a novel imaging-based approach.
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Kacała Arkadiusz, Milnerowicz-Bescond Małgorzata, Ziomek Maciej, Łukasiewicz Marek, Noszczak Łukasz, Wrona Weronika, Wdowiak Wiktoria, Dorochowicz Mateusz, Litwinowicz Kamil, Zimny Anna, Guziński Maciej
Аннотация
BACKGROUND: The middle cerebral artery (MCA) is one of the most clinically relevant cerebral vessels. Although early branches (EBs) of the MCA have been described, existing classifications are limited by small sample sizes and incomplete representation of anatomic variants.
PURPOSE: To propose and validate a revised imaging-based classification (MCA-EB) of early branches of the MCA using computed tomographic angiography (CTA).
MATERIALS AND METHODS: This retrospective study included 200 adult patients who underwent computed tomographic angiography (CTA) between 2020-2024. Patients with intracranial arterial lesions, stenosis, mass effect, or poor contrast opacification were excluded. Morphometric measurements of MCA EBs were performed with dedicated software. Presence, type, and dimensions of early temporal (ETB) and frontal branches (EFB) were assessed. A revised classification system (MCA-EB) was developed based on EB number and distribution. Statistical analyses included Kendall's tau-b, Spearman correlation, and Cohen's kappa for reproducibility analysis.
RESULTS: A total of 271 EBs were identified in 215 MCAs (53.25%). ETBs were more frequent (197/271, 72.7%) than EFBs (74/271, 27.3%). Mean diameter was 0.86 mm for ETBs and 0.83 mm for EFBs. No significant correlation was found between EB diameter and distance from MCA origin (ETB1 τ = -0.009, p = 0.86; EFB1 τ = -0.148, p = 0.09). The MCA-EB classification comprised four types with distinct subtypes, ranging from absence of EBs (Type I, 46.3%) to combined ETB and EFB variants (Type IV, 9%).
CONCLUSION: MCA-EB provides a simplified and standardized classification of MCA early branches. This system may aid in surgical planning, improve recognition of anatomic variants, and support future research on the clinical relevance of MCA EBs.
PURPOSE: To propose and validate a revised imaging-based classification (MCA-EB) of early branches of the MCA using computed tomographic angiography (CTA).
MATERIALS AND METHODS: This retrospective study included 200 adult patients who underwent computed tomographic angiography (CTA) between 2020-2024. Patients with intracranial arterial lesions, stenosis, mass effect, or poor contrast opacification were excluded. Morphometric measurements of MCA EBs were performed with dedicated software. Presence, type, and dimensions of early temporal (ETB) and frontal branches (EFB) were assessed. A revised classification system (MCA-EB) was developed based on EB number and distribution. Statistical analyses included Kendall's tau-b, Spearman correlation, and Cohen's kappa for reproducibility analysis.
RESULTS: A total of 271 EBs were identified in 215 MCAs (53.25%). ETBs were more frequent (197/271, 72.7%) than EFBs (74/271, 27.3%). Mean diameter was 0.86 mm for ETBs and 0.83 mm for EFBs. No significant correlation was found between EB diameter and distance from MCA origin (ETB1 τ = -0.009, p = 0.86; EFB1 τ = -0.148, p = 0.09). The MCA-EB classification comprised four types with distinct subtypes, ranging from absence of EBs (Type I, 46.3%) to combined ETB and EFB variants (Type IV, 9%).
CONCLUSION: MCA-EB provides a simplified and standardized classification of MCA early branches. This system may aid in surgical planning, improve recognition of anatomic variants, and support future research on the clinical relevance of MCA EBs.