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Peer-reviewedCC BYAJNR: American Journal of Neuroradiology

Imaging Modalities to Visualize Deep Cerebral Perforating Arteries: A Systematic Review and Meta-Analysis

  • Yasmin Sadigh1,2
  • Renske Gahrmann3
  • Jeroen Hendrikse4
  • Clemens M.F. Dirven5
  • Diederik W.J. Dippel6
  • Joost W. Schouten1,2
  • Ruben Dammers1,2
  • Victor Volovici1,2
6 affiliations
  1. 1From the Department of Neurosurgery (Y.S., J.W.S., R.D., V.V.), Erasmus MC Stroke Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands
  2. 2Center for Complex Microvascular Surgery (Y.S., J.W.S., R.D., V.V.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
  3. 3Department of Radiology and Nuclear Medicine (R.G.), Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, the Netherlands
  4. 4Department of Radiology and Nuclear Medicine (J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
  5. 5Department of Neurosurgery (C.M.F.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
  6. 6Department of Neurology (D.W.J.D.), Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, the Netherlands
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Abstract

BACKGROUND: The reliable visualization of deep cerebral perforating arteries is a challenge. Despite the advancements in high-resolution imaging, the optimal technique to depict deep cerebral perforating arteries remains unclear. PURPOSE: The purpose of this systematic review was to provide an overview of the imaging modalities used to visualize perforating arteries and to evaluate their diagnostic performance. DATA SOURCES: EMBASE, Ovid Medline, the Web of Science Core Collection, Google Scholar, and Cochrane Central Register of Controlled Trials were searched from database inception to April 15, 2025. STUDY SELECTION: Original studies using imaging modalities to depict perforating arteries in human subjects were included. The search strategy yielded 3857 articles, of which 1725 remained after removing duplicates. After the initial sift phase, 215 articles remained to be assessed for eligibility based on full-text sifting. Finally, 106 studies (6785 participants; 14,041 hemispheres) were included. DATA ANALYSIS: As a performance measure, detection rate was defined as the percentage of participants in which at least 1 perforating artery in 1 arterial territory could be detected. Pooled estimate (%) of detection rate per imaging technique was calculated using a random-effects model with 95% CI. DATA SYNTHESIS: = 84%) for 3T MRA/MRI. One 3T MRA study performed an in vivo diagnostic validation study by direct intraoperative evaluation. LIMITATIONS: Our findings have not been validated in vivo. CONCLUSIONS: Multiple imaging modalities, including 7T, 3T, and 1.5T MRA/MRI, CTA, and DSA, have been used to visualize deep cerebral perforating arteries. High-resolution MRI, particularly 7T MRA, shows the highest detection rates (up to 94%), although most studies were performed in healthy volunteers and lacked anatomic validation. Consequently, reported detection rates may overestimate true vessel visualization. Future research should prioritize rigorous in vivo validation of these techniques to establish their clinical reliability.

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Cite

BibTeXRIS
BibTeX
@article{sadigh2026imaging,
  title = {{Imaging Modalities to Visualize Deep Cerebral Perforating Arteries: A Systematic Review and Meta-Analysis}},
  author = {Yasmin Sadigh and Renske Gahrmann and Jeroen Hendrikse and Clemens M.F. Dirven and Diederik W.J. Dippel and Joost W. Schouten and Ruben Dammers and Victor Volovici},
  journal = {AJNR: American Journal of Neuroradiology},
  year = {2026},
  month = nov,
  doi = {10.3174/ajnr.a9312},
  url = {https://doi.org/10.3174/ajnr.a9312},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Imaging Modalities to Visualize Deep Cerebral Perforating Arteries: A Systematic Review and Meta-Analysis
AU  - Yasmin Sadigh
AU  - Renske Gahrmann
AU  - Jeroen Hendrikse
AU  - Clemens M.F. Dirven
AU  - Diederik W.J. Dippel
AU  - Joost W. Schouten
AU  - Ruben Dammers
AU  - Victor Volovici
PY  - 2026
DA  - 2026/11/06
JO  - AJNR: American Journal of Neuroradiology
DO  - 10.3174/ajnr.a9312
UR  - https://doi.org/10.3174/ajnr.a9312
AB  - BACKGROUND: The reliable visualization of deep cerebral perforating arteries is a challenge. Despite the advancements in high-resolution imaging, the optimal technique to depict deep cerebral perforating arteries remains unclear. PURPOSE: The purpose of this systematic review was to provide an overview of the imaging modalities used to visualize perforating arteries and to evaluate their diagnostic performance. DATA SOURCES: EMBASE, Ovid Medline, the Web of Science Core Collection, Google Scholar, and Cochrane Central Register of Controlled Trials were searched from database inception to April 15, 2025. STUDY SELECTION: Original studies using imaging modalities to depict perforating arteries in human subjects were included. The search strategy yielded 3857 articles, of which 1725 remained after removing duplicates. After the initial sift phase, 215 articles remained to be assessed for eligibility based on full-text sifting. Finally, 106 studies (6785 participants; 14,041 hemispheres) were included. DATA ANALYSIS: As a performance measure, detection rate was defined as the percentage of participants in which at least 1 perforating artery in 1 arterial territory could be detected. Pooled estimate (%) of detection rate per imaging technique was calculated using a random-effects model with 95% CI. DATA SYNTHESIS: = 84%) for 3T MRA/MRI. One 3T MRA study performed an in vivo diagnostic validation study by direct intraoperative evaluation. LIMITATIONS: Our findings have not been validated in vivo. CONCLUSIONS: Multiple imaging modalities, including 7T, 3T, and 1.5T MRA/MRI, CTA, and DSA, have been used to visualize deep cerebral perforating arteries. High-resolution MRI, particularly 7T MRA, shows the highest detection rates (up to 94%), although most studies were performed in healthy volunteers and lacked anatomic validation. Consequently, reported detection rates may overestimate true vessel visualization. Future research should prioritize rigorous in vivo validation of these techniques to establish their clinical reliability.
SN  - 0195-6108
SN  - 1936-959X
ER  -