Twig-like middle cerebral artery Ó? pathophysiology and imaging approach

Objective: A twig-like middle cerebral artery is an infrequent congenital disturbance that is difficult to distinguish from moyamoya disease.Cerebral angiography is essential for the differential diagnosis of stenotic-occlusive vasculopathies involving the middle cerebral artery.Methods: We explored the prevalence of the twig-like middle cerebral artery in our institution's angiography unit and reviewed the literature to clarify the imaging criteria.Results: The prevalence calculated in our anonymous database was 0.21%, which is in the frequency range described in the literature.Two cases that meet the diagnostic criteria and differ in clinical imaging characteristics are described in detail.Conclusions: Adequate imaging description allows precise diagnosis and approximation of the underlying etiopathogenic mechanism.