Angiographic localisation of the Rolandic sulcus by internal cerebral venous structures

Background: Accurate identification of the Rolandic sulcus is critical for neurointerventional procedures, particularly in ischemic stroke, where timely reperfusion of the primary motor cortex strongly influences clinical outcome. We propose the PeriRolandic Integrated Strip for Mapping Angiography (PRISMA), a novel venous-based angiographic system for localizing the Rolandic sulcus. Methods: We retrospectively analyzed 100 consecutive patients who underwent cerebral angiography and MRI (SWI and 3D FLAIR). For each angiographic study, a Central Venous Line was defined by connecting the ventral and dorsal points of the internal cerebral vein. From its midpoint, a perpendicular line to the cranial vault was used to generate the Angiographic Rolandic Line, which, after transposition of the venous segment length, outlined the PRISMA region. MRI-based sulcal landmarks were used to define the True Rolandic Line. Angiographic and MRI data were co-registered, and the overlap between PRISMA and the True Rolandic Line was assessed. Statistical analysis included regression modeling and spatial probability mapping of the True Rolandic Line distribution. Results: In the majority of cases, the Rolandic sulcus fell within the PRISMA boundaries. Heat-map analysis demonstrated a high spatial probability of correspondence between the Rolandic line and the PRISMA region. Conclusions: The PRISMA provides a simple, reproducible method for identifying the Rolandic sulcus in angiography. This system may enhance neurointerventional orientation in both elective and emergency settings, offering a practical adjunct to existing imaging approaches. Prospective validation with clinical correlation is warranted to assess its applicability in guiding stroke thrombectomy.