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Accuracy of Non-Contrast Brain CT in Pre-Embolization Evaluation of the Middle Meningeal ArteryAbstract
250 words
Manuscript
2052 words
References
30
Figures
4
Tables
3
List of abbreviations
AVF
Arteriovenous fistulas
AVM
Arteriovenous malformations
CSDH
Chronic subdural hematoma
CT
Computed Tomography
DSA
Digital Subtraction Angiography
FS
Foramen Spinosum
MMA
Middle Meningeal Artery
SD
Standard Deviation
TX
Texas
USA
United States of America
ABSTRACT (250 words)
Purpose
Chronic subdural hematoma (cSDH) is typically diagnosed on non-contrast brain CT. Embolization of the middle meningeal artery (MMA) has become an effective and increasingly adopted treatment. However, pre-procedural understanding of MMA anatomy remains crucial, as anatomical variations—such as atypical origins or accessory branches—can affect procedural safety and strategy. This study evaluated whether three-dimensional (3D) reconstructions from routine non-contrast CT can accurately depict MMA anatomy compared with digital subtraction angiography (DSA), the current reference standard.
Materials and Methods
In this retrospective study, 76 patients (91 MMAs) who underwent both non-contrast CT and DSA were analyzed. The anterior, posterior, and middle branches were assessed. Branch dominance was categorized as Type I (anterior), Type II (posterior), or Type III (mixed), and posterior branch origin as proximal (A), intermediate (B), or distal (C). The Extended-Adachi classification was used for overall anatomical patterns. The foramen spinosum (FS) and MMA tortuosity were also evaluated. Concordance rates between CT and DSA were calculated.
Results
On CT, the anterior, posterior, and middle branches were visible in 100%, 94.5%, and 96.7% of cases, respectively. CT–DSA concordance was high for branch identification (91.1% anterior, 85.7% posterior, 78.0% middle) and moderate for dominance (45.5%) and posterior origin (39.3%). Absence of the FS on CT was strongly associated with anatomical variants (3 of 4 cases).
Conclusion
3D reconstructions from non-contrast CT allow visualization of the main MMA branches and the foramen spinosum. FS assessment on CT provides a valuable indirect marker for identifying anatomical variations and should be systematically included in pre-embolization evaluation.
Key Words:
Chronic Subdural Hematoma
CT scan
angiography
middle meningeal artery
embolization
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Key Points
1) 3D non-contrast CT reliably identifies major branches of the middle meningeal artery (MMA) and the foramen spinosum, making it a valuable tool for initial anatomical assessment.
2) Absence of the foramen spinosum on CT may serve as an indicator of anatomical variants potentially affecting embolization feasibility.
3) Concordance between CT and angiography is low for MMA dominance, posterior branch origin, and full anatomical pattern classification.
Importance of the study:
This is the first study to quantitatively assess the concordance between non-contrast CT and angiography in evaluating MMA anatomy prior to embolization in patients with chronic subdural hematoma. As embolization becomes increasingly used, especially in high-risk or elderly populations, identifying reliable, non-invasive preoperative imaging modalities is critical. The study highlights the strengths and limitations of CT imaging in this context, reinforcing its role in early screening while affirming the necessity of angiographic evaluation for procedural planning.
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INTRODUCTION (273 words)
Chronic subdural hematoma (cSDH) is a frequent neurosurgical condition, particularly in the elderly, with an incidence of up to 58 per 100,000 individuals over the age of 65 [1]. This rate is expected to rise with population aging and the increased use of anticoagulants and antiplatelet agents [2–6]. Although often triggered by minor trauma, the persistence and recurrence of cSDH are mainly driven by chronic inflammation, angiogenesis within the neomembrane, and recurrent microhemorrhages [7, 8].
Surgical evacuation through burr holes remains the standard treatment, but recurrence occurs in 10%–20% of patients, sometimes requiring repeated procedures [9–12]. These limitations have prompted exploration of adjunctive or alternative approaches that address the biological mechanisms underlying recurrence.
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Embolization of the middle meningeal artery (MMA) has emerged as an effective minimally invasive treatment that targets the vascular supply to the outer hematoma membrane [13, 14]. Recent randomized controlled trials, including STEM [15], EMBOLISE [16], and MAGIC-MT [17], have demonstrated reduced recurrence rates when combined with surgery, and marked reductions in recurrence for embolization alone. As the technique gains widespread adoption, accurate understanding of MMA anatomy has become critical for procedural safety and efficacy [18–20].Digital subtraction angiography (DSA) remains the reference standard for evaluating MMA anatomy but is invasive. Conversely, non-contrast cranial CT, already part of the routine diagnostic workup for cSDH, could offers a simple and non-invasive means of assessing the bony course of the MMA through high-resolution bone-window reconstructions.
This study aimed to determine whether three-dimensional reconstructions from routine non-contrast CT can accurately depict MMA anatomy compared with DSA. We hypothesized that non-contrast CT 3D reconstructions can reliably identify key anatomical landmarks relevant to pre-embolization planning.
METHODS (834 words)
Study Population
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This was a retrospective, single-center anatomical study conducted at the University Hospital of Purpan (Toulouse, France). Patients were included if they underwent both cerebral angiography and non-contrast-enhanced cranial CT with bone window acquisition between March 2023 and April 2024.Inclusion/Exclusion Criteria
Participants eligible for inclusion were adults aged 18 years or older who underwent high-resolution, non-contrast cranial computed tomography (CT) with an intact cranial vault, along with cerebral angiography sufficient to allow for the assessment of the middle meningeal artery (MMA). Exclusion criteria comprised individuals younger than 18 years, those with skull fractures or discontinuities of the cranial vault, and cases lacking either CT or angiographic imaging in the hospital’s picture archiving and communication system (PACS). Additional exclusions included anatomical distortion due to arteriovenous fistulas (AVFs) or arteriovenous malformations (AVMs), as well as patients with bone flap interference or post-craniectomy alterations impeding reliable MMA evaluation.
Ethical Considerations
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This study was conducted in accordance with the Declaration of Helsinki and was approves by insitutionnal review board (n° IRB00011687 Collège de neurochirurgie IRB #1: 2025/43). A
Due to its retrospective non interventional design and exclusive use of anonymized data obtained during routine clinical care, informed consent was waived. Prior to imaging procedures, patients had been informed that their imaging data could be used for research purposes.Imaging Acquisition
All patients underwent non-contrast-enhanced CT scans with bone window reconstruction at millimetric slice thickness. Three-dimensional volume-rendered reconstructions were generated using Change Healthcare Radiology Solutions software (McKesson, Irving, TX, USA). Each skull was segmented in the sagittal plane to isolate right and left MMA territories. MMA anatomy was assessed based on the osseous grooves and canals visualized. Cerebral digital subtraction angiography (DSA) was performed in all patients and used as the reference modality. Selective injection of the external carotid artery allowed direct visualization of the MMA and its branches.
Image Evaluation
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Each imaging modality was reviewed by a dedicated rater, blinded to the other modality. Side-specific evaluation of the MMA was performed to assess concordance between CT and angiography findings. The anatomical evaluation included assessment of the presence or absence of the anterior, oblique, and posterior branches of the middle meningeal artery (MMA), as well as the dominance pattern based on the Adachi classification [21]. The origin of the posterior branch was classified according to the Shotar system [19]. A combined anatomical pattern was determined using the Extended-Adachi classification (E-AC) [19]. Additional parameters included the tortuosity of the MMA, the presence of a petrosal branch, and the presence or absence of the foramen spinosum.Anatomical Classification
MMA dominance was defined according to Adachi’s model (1928) [19, 22], which classifies MMA branching based on the origin of the middel (obelic) branch: Type I, in which the middle (obelic) branch arises from the anterior branch; Type II, where it originates from the posterior branch; and Type III, characterized by a dual origin from both the anterior and posterior branches. This model focuses on anatomical distribution rather than vessel caliber. The posterior branch origin was classified per Shotar et al.: Type A, indicating a proximal origin near the foramen spinosum; Type B, representing an intermediate origin; and Type C, defined by a distal origin beyond the orbital apex. Combining both systems, a total of nine MMA patterns were defined (E-AC Classification): IA, IB, IC, IIA, IIB, IIC, IIIA, IIIB, and IIIC. Each MMA was categorized on CT and angiography accordingly (Fig. 1).
Fig. 1
Anatomical Variants of Middle Meningeal Artery (MMA) Branching According to the Extended Adachi Classification by Shotar et al [19].
Diagram of the projection of the middle meningeal artery (MMA) on a lateral skull radiograph. Dominance is not determined by the relative calibers of the anterior and posterior branches, but rather by the origin of the obelic terminal branches. The anterior branch is shown in red; the obelic branch in orange; and the posterior branch in purple.
Panels (a, d, g) demonstrates anterior dominance (Type I) MMA with anterior branch dominance, giving rise to the obelic branch (in yellow). Panels (b, e, h) illustrate posterior dominance (Type II); and panels (c, f, i) depict codominance of anterior and posterior branches (Type III). The origin of the posterior branch is also subclassified: proximal origin (Type A; a–c), intermediate origin (Type B; d–f), and distal origin (Type C; g–i). MMA: Middle Meningeal Artery
Primary and Secondary Endpoints
The primary outcome was the concordance in the presence or absence of the anterior, obelic, and posterior branches of the middle meningeal artery (MMA) as well as the presence or absence of the foramen spinosum on CT, used as an indirect indicator of MMA origin variants. Secondary endpoints included the pattern concordance rate (E-AC classification) between CT and angiography as well as the concordance of the posterior branch origin type (A, B, or C). A pattern was considered concordant when both modalities identified the same subclass (Fig. 2). Additional endpoints involved evaluating concordance in the classification of the MMA course as tortuous versus straight, with tortuosity defined by the presence of three or more visible curvatures and used as an indicator of challenging MMA catheterization. The detection of petrosal branches, were also recorded.
Fig. 2
Concordance Between CT and Angiography
Left and Center: Internal view of a left cranial vault showing the middle meningeal artery (MMA) reconstructed in 3D using volume rendering from non-contrast CT. Right: Cerebral angiography from the same patient, with contrast injection into the left external carotid artery, demonstrating the patient's MMA.
The MMA pattern identified as Type IIC on CT (a) (distal bifurcation with posterior branch dominance) shows concordance with angiographic findings. Additionally, a tortuous anterior branch is visible (b).
(MMA: Middle Meningeal Artery; CT: Computed Tomography)
Statistical Analysis
Digital subtraction angiography (DSA) was considered the reference standard for all comparisons. For each anatomical parameter, concordance between CT and DSA was recorded in binary fashion (1 = match, 0 = mismatch). Descriptive statistics were used to summarize the degree of agreement.
The concordance rate was defined as the proportion of middle meningeal arteries (MMAs) showing identical findings on both CT and DSA. The corresponding failure rate represented the proportion of MMAs with discrepancies between the two modalities. Each discordant case was reviewed to identify systematic trends in misclassification.
Comparisons of detection rates, such as the presence or absence of individual branches, were performed using the McNemar test. A p-value below 0.05 was considered statistically significant.
Finally, Pearson correlation analyses were conducted between the number of CT slices and the accuracy of MMA dominance, posterior branch origin, and overall anatomical classification to evaluate whether higher imaging resolution improved interpretive performance.
RESULTS (331 words)
Population
Of 300 patients screened, 77 met inclusion criteria, yielding 91 evaluable MMAs (42 right, 49 left). Mean age was 58.9 years (SD = 20.2, range 19–88); 64 male, 27 female (Fig. 3).
Fig. 3
Flow Chart
(MMA: Middle Meningeal Artery; CT: Computed Tomography)
CT-based anatomical visualization
The anterior branch was visible in 100% of cases, posterior in 94.5%, and middle (obelic) in 96.7% (Table 1). A petrosal branch was seen in 25.3%, and a tortuous main trunk in 38.5%. The FS was absent in 4.4% (4/91). The posterior branch originated proximally (Type A) in 20.7%, intermediately (Type B) in 32,2%, and distally (Type C) in 47,1%. Dominance was anterior (Type I) in 48,4%, posterior (Type II) in 14,3%, and mixed (Type III) in 37,4%.
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Table 1
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Proportion of Different Branches According to Imaging Modality Groups
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CT group
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Angiography group
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p – value
(McNemar)
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Concordance rate
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Presence of anterior B.
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91/91 (100%)
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82/90 (91,1%%)
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0,005
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82/90 (91,1%)
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Presence of posterior B.
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86/91 (94,5%)
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83/91 (91,2%)
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0,405
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78/91(85,7%)
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Presence of middle B.
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88/91 (96,7%)
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72/91 (79,1%)
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< 0,001
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71/91 (78%)
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Presence of petrous B.
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72/91 (79,1%)
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59/88 (67%)
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< 0,001
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33/88 (37,5%)
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(B: Branch; CT: Computed Tomography)
Angiographic Findings
On DSA, the anterior branch was visible in 91.1%, posterior in 91.2%, and obelic in 79.1%. The posterior branch originated proximally (Type A) in 21.6%, intermediately (Type B) in 13.6%, and distally (Type C) in 64.8%. Dominance was anterior (Type I) in 45.5%, posterior (Type II) in 44.3%, and mixed (Type III) in 10.2%. McNemar analysis demonstrated significant discordance between CT and angiography for the anterior, middle (obelic), and petrosal branches, indicating systematic overestimation on CT, whereas no significant difference was observed for the posterior branch, which showed the highest concordance between modalities (Table 2).
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Table 2
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Proportion of patterns by imaging modality
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CT group
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Angiography group
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Concordance rate
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Origin
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33/84 (39,3%)
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A
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18/87 (20,7%)
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19/88 (21,6%)
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5/18 (27,8%)
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B
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28/87 (32,2%)
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12/88 (13,6%)
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2/12 (16,7%)
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C
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41/87 (47,1%)
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57/88 (64,8%)
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26/54 (48,1%)
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Dominance
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40/88 (45,5%)
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I
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44/91 (48,4%)
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40/88 (45,5%)
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26/39 (66 7%)
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II
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13/91 (14,3%)
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39/88 (44,3%)
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9/39 (23,1%)
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III
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34/91 (37,4%)
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9/88 (10,2%)
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4/9 (44,4%)
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Pattern
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15/84 (17,9%)
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IA
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7/87 (8%)
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7/88 (8%)
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0%
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IB
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13/87 (14,9%)
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5/88 (5,7%)
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0%
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IC
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20/87 (23%)
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28/88 (31,8%)
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8/24 (33,3%)
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IIA
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4/87 (4,6%)
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9/88 (10,2%)
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1/9 (11,1%)
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IIB
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3/87 (3,4%)
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5/88 (5,7%)
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0%
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IIC
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6/87 (6,9%)
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25/88 (28,4%)
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4/25 (16%)
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IIIA
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6/87 (6,9%)
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3/88 (3,4%)
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1/3 (33,3%)
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IIIB
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12/87 (13,8%)
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2/88 (2,3%)
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0%
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IIIC
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16/87 (18,4%)
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4/88 (4,5%)
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1/4 (25%)
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| (MMA: Middle Meningeal Artery; CT: Computed Tomography) | |||||
| NB: In the CT group, the origin of the MMA could not be determined in four cases due to lack of visibility. These four MMAs were later identified on angiography as one Type A and three Type C, accounting for the loss of one Type A and three Type C cases in the concordance rate calculations. For the same reason, only 24 MMAs classified as pattern IC could be compared between CT and angiography. | |||||
| CT-Angiography concordance | |||||
| Concordance was high for identifying major branches (91.1% anterior, 85.7% posterior, 78.0% middle) but lower for dominance (45.5%) and posterior origin (39.3%). Complete E-AC pattern agreement occurred in 17.9% of MMAs. Type C origins were best recognized (48.1%), while Type B was most frequently misclassified. Dominance Type II was the most error-prone, often labeled Type III. MMA tortuosity concordance was 65.2%, with CT tending to overestimate tortuosity. No significant correlation was found between the number of CT slices and classification accuracy. | |||||
| DISCUSSION (487 words) | |||||
| This study is, to our knowledge, the first to directly compare MMA anatomy using both non-contrast CT 3-D reconstructions and DSA. We found that while CT reliably delineates the main branches and the foramen spinosum. | |||||
| Branch Identification and Prevalence | |||||
| The detection of anterior and posterior branches (> 90%) aligns with historical anatomical data from Chandler et Derezinski. [23], who reported anterior branch presence in nearly all cases and posterior branch presence in approximately 89%, and supports the reliability of bone-window CT for gross MMA mapping. | |||||
| Foramen Spinosum and Anatomical Variants | |||||
| Absence of the FS was rare (4.4%) but consistently associated with major variants, including ophthalmic origin of the MMA. This finding emphasizes the clinical importance of verifying FS presence on pre-embolization CT to anticipate potential arterial anomalies and avoid non-target embolization (fig .4). | |||||
Foramen Spinosum Variations
In the four cases lacking a visible FS on CT, three had major anatomical variants on DSA (absence of a main MMA trunk or ophthalmic origin), highlighting the FS as a reliable indirect marker.
Fig. 4
Right chronic subdural hematoma in a patient who underwent digital subtraction angiography with selective injection of the right internal carotid artery (a). The angiogram demonstrates a right middle meningeal artery (MMA) originating from the ophthalmic artery (white arrows) (b). Review of the bone-window CT shows absence of the right foramen spinosum (black arrow) (c).
Classification of Posterior Branch Origin
Posterior origin Type C predominated in both CT and DSA, though CT underestimated its frequency. Misclassification mainly occurred between Types B and C, reflecting the difficulty of tracing distal grooves in 3-D reconstructions without contrast enhancement
MMA Dominance Patterns
CT overestimated mixed (Type III) dominance, likely due to confusion between the obelic and posterior branches. Similar variability was noted by Shotar et al. [19] (κ = 0.53). This suggests that non-contrast CT alone cannot distinguish dominance patterns requiring dynamic flow information.
Anthropological data support low prevalence of mixed dominance, with more balanced proportions between anterior and posterior patterns [24, 25]. These findings are congruent with our angiographic results and underscore the limited reliability of CT-based dominance classification in the absence of vascular contrast (Table 3)
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Anthropological series classifying middle meningeal artery dominance
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Study
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Number of subjects
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Type I (%)
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Type II (%)
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Type III (%)
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Toida (1934) [28]
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192
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48,3 (112)
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34,0 (79)
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17,7 (41)
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Adachi (1928) [21]
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100
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51,0 (51)
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40,0 (40)
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9,0 (9)
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Akiba (1925) [29]
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219
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43,8 (96)
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53,4 (117)
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2,8 (6)
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Giuffrida-Ruggeri (1913) [30]
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119
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59,6 (71)
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37,8 (45)
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2,5 (3)
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Rothman (1937) [24]
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191
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37,7 (72)
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60,2 (115)
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2,1 (4)
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Rothman (1937) [24]
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212
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41,5 (88)
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55,7 (118)
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2,8 (6)
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| NB: Rothman et al. (1937) compared two different cohorts, one consisting of Caucasian American subjects (n = 191) and the other of African American subjects (n = 212). | ||||
| Anatomical and Technical Considerations | ||||
| The MMA enters the cranial cavity via the foramen spinosum and courses along the floor of the middle cranial fossa before bifurcating near the pterion. The MMA’s course within osseous canals varies substantially [25–27]. In some cases, bony coverage may obscure surface grooves, explaining partial CT misidentification. We found no evidence that higher spatial resolution improved classification accuracy, underscoring that interpretive limitations, not imaging quality, are the main barrier. | ||||
| Clinical Implications | ||||
| Incorporating CT-based assessment of the FS and major branch course into pre-procedural workflow could enhance safety screening before DSA and embolization. However, full morphological classification still requires angiographic evaluation. | ||||
| Study Limitations | ||||
| This retrospective design limited control of imaging parameters. This study is limited by the absence of interobserver and intraobserver reproducibility analysis, which may influence the interpretation of the reported concordance results. Cohen’s kappa was not reported, as the aim of this study was to assess the ability of non-contrast CT to identify MMA branches relative to angiography as a reference standard, rather than to evaluate interobserver agreement. In addition, the highly unbalanced distribution of several categorical variables could have resulted in misleading kappa estimates. Some angiographic examinations were performed for indications other than detailed MMA assessment, which may have affected the visualization and interpretation of specific anatomical features. Furthermore, bone-based classification may not fully correspond to intraluminal arterial anatomy. | ||||
| CONCLUSION (127 words) | ||||
| This study, the first to directly compare non-contrast CT 3D reconstructions with angiography for middle meningeal artery (MMA) assessment, shows that routine bone-window CT can reliably identify key anatomical features relevant to embolization. Among all evaluated parameters, the foramen spinosum (FS) proved to be a particularly powerful marker: its absence on CT was strongly associated with major MMA variants, including ophthalmic origin. | ||||
| Because non-contrast CT is already performed in every patient with chronic subdural hematoma, systematic FS evaluation offers a simple, non-invasive, and immediately applicable way to anticipate challenging anatomy before angiography or embolization. These findings introduce a practical imaging marker that has not been previously reported and may enhance procedural planning and patient selection. | ||||
| Future work may refine this approach using higher-resolution CT or automated segmentation. | ||||
| LEGENDS | ||||
Table 3
Figure 1.
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Anatomical Variants of Middle Meningeal Artery (MMA) Branching According to the Extended Adachi Classification by Shotar et al. [19]Diagram of the projection of the middle meningeal artery (MMA) on a lateral skull radiograph Dominance is not determined by the relative calibers of the anterior and posterior branches, but rather by the origin of the obelic terminal branches. The anterior branch is shown in red; the obelic branch in orange; and the posterior branch in purple.
Panels (a, d, g) demonstrates anterior dominance (Type I) MMA with anterior branch dominance, giving rise to the obelic branch (in yellow). Panels (b, e, h) illustrate posterior dominance (Type II); and panels (c, f, i) depict codominance of anterior and posterior branches (Type III). The origin of the posterior branch is also subclassified: proximal origin (Type A; a–c), intermediate origin (Type B; d–f), and distal origin (Type C; g–i).
MMA: Middle Meningeal Artery)
Figure 2. Concordance Between CT and Angiography
Left and Center: Internal view of a left cranial vault showing the middle meningeal artery (MMA) reconstructed in 3D using volume rendering from non-contrast CT. Right: Cerebral angiography from the same patient, with contrast injection into the left external carotid artery, demonstrating the patient's MMA.The MMA pattern identified as Type IIC on CT (A) (distal bifurcation with posterior branch dominance) shows concordance with angiographic findings. Additionally, a tortuous anterior branch is visible (B).
(MMA: Middle Meningeal Artery; CT: Computed Tomography)
Figure 3. Flow Chart
(MMA: Middle Meningeal Artery; CT: Computed Tomography)
Figure 4. Right chronic subdural hematoma in a patient who underwent digital subtraction angiography with selective injection of the right internal carotid artery.
The angiogram demonstrates a right middle meningeal artery (MMA) originating from the ophthalmic artery. Review of the bone-window CT shows absence of the right foramen spinosum.
Table 1: Proportion of Different Branches According to Imaging Modality Groups
(B: Branch; CT: Computed Tomography)
Table 2: Proportion of patterns by imaging modality
(MMA: Middle Meningeal Artery; CT: Computed Tomography)
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Table 5: Anthropological series classifying middle meningeal artery dominance [23, 24]A
Author Contribution
Conceptualization : L.K, A.DB and G.B; Methodology: L.K, A.DB and G.B Formal analysis and investigation : L.K, A.DB, G.B, V.G, M.P; Writing - original draft preparation : L.K, A.DB and G.BWriting - review and editing: P.C, J.CS, F-E.R, A.DB, G.BSupervision: P.C, J.CS, F-E.R, A.DB, G.B
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Data Availability
All data supporting the findings of this study are available. Anonymized original data from this manuscript will be made available upon reasonable request to the corresponding author.
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Acknowledgement
We would like to thank the patients. Then, the authors wish to acknowledge all neuroradiologists, neurosurgeons, and all those who participated in this collaborative work.
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Tables
|
Table 1
|
||||
|---|---|---|---|---|
|
Proportion of Different Branches According to Imaging Modality Groups
|
||||
|
CT group
|
Angiography group
|
p – value
(McNemar)
|
Concordance rate
|
|
|
Presence of anterior B.
|
91/91 (100%)
|
82/90 (91,1%%)
|
0,005
|
82/90 (91,1%)
|
|
Presence of posterior B.
|
86/91 (94,5%)
|
83/91 (91,2%)
|
0,405
|
78/91(85,7%)
|
|
Presence of middle B.
|
88/91 (96,7%)
|
72/91 (79,1%)
|
< 0,001
|
71/91 (78%)
|
|
Presence of petrous B.
|
72/91 (79,1%)
|
59/88 (67%)
|
< 0,001
|
33/88 (37,5%)
|
|
Table 2
|
|||||
|---|---|---|---|---|---|
|
Proportion of patterns by imaging modality
|
|||||
|
CT group
|
Angiography group
|
Concordance rate
|
|||
|
Origin
|
33/84 (39,3%)
|
||||
|
A
|
18/87 (20,7%)
|
19/88 (21,6%)
|
5/18 (27,8%)
|
||
|
B
|
28/87 (32,2%)
|
12/88 (13,6%)
|
2/12 (16,7%)
|
||
|
C
|
41/87 (47,1%)
|
57/88 (64,8%)
|
26/54 (48,1%)
|
||
|
Dominance
|
40/88 (45,5%)
|
||||
|
I
|
44/91 (48,4%)
|
40/88 (45,5%)
|
26/39 (66 7%)
|
||
|
II
|
13/91 (14,3%)
|
39/88 (44,3%)
|
9/39 (23,1%)
|
||
|
III
|
34/91 (37,4%)
|
9/88 (10,2%)
|
4/9 (44,4%)
|
||
|
Pattern
|
15/84 (17,9%)
|
||||
|
IA
|
7/87 (8%)
|
7/88 (8%)
|
0%
|
||
|
IB
|
13/87 (14,9%)
|
5/88 (5,7%)
|
0%
|
||
|
IC
|
20/87 (23%)
|
28/88 (31,8%)
|
8/24 (33,3%)
|
||
|
IIA
|
4/87 (4,6%)
|
9/88 (10,2%)
|
1/9 (11,1%)
|
||
|
IIB
|
3/87 (3,4%)
|
5/88 (5,7%)
|
0%
|
||
|
IIC
|
6/87 (6,9%)
|
25/88 (28,4%)
|
4/25 (16%)
|
||
|
IIIA
|
6/87 (6,9%)
|
3/88 (3,4%)
|
1/3 (33,3%)
|
||
|
IIIB
|
12/87 (13,8%)
|
2/88 (2,3%)
|
0%
|
||
|
IIIC
|
16/87 (18,4%)
|
4/88 (4,5%)
|
1/4 (25%)
|
||
| NB: In the CT group, the origin of the MMA could not be determined in four cases due to lack of visibility. These four MMAs were later identified on angiography as one Type A and three Type C, accounting for the loss of one Type A and three Type C cases in the concordance rate calculations. For the same reason, only 24 MMAs classified as pattern IC could be compared between CT and angiography. | |||||
Table 3
|
Anthropological series classifying middle meningeal artery dominance
|
||||
|---|---|---|---|---|
|
Study
|
Number of subject
|
|||
|
Type I (%)
|
Type II (%)
|
Type III (%)
|
||
|
Toida (1934)
|
192
|
48,3 (112)
|
34,0 (79)
|
17,7 (41)
|
|
Adachi (1928)
|
100
|
51,0 (51)
|
40,0 (40)
|
9,0 (9)
|
|
Akiba (1925)
|
219
|
43,8 (96)
|
53,4 (117)
|
2,8 (6)
|
|
Giuffrida-Ruggeri (1913)
|
119
|
59,6 (71)
|
37,8 (45)
|
2,5 (3)
|
|
Rothman (1937)
|
191
|
37,7 (72)
|
60,2 (115)
|
2,1 (4)
|
|
Rothman (1937)
|
212
|
41,5 (88)
|
55,7 (118)
|
2,8 (6)
|
NB : Rothman et al. (1937) compared two different cohorts, one consisting of Caucasian American subjects (n = 191) and the other of African American subjects (n = 212).