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Gd 3D MRA, intracranial pathology, case 5

Clinical history
This 19-year-old-patient was referred one year ago for acute headaches with loss of consciousness, disorientation, nausea, vomiting. Subarachnoid hemorrhage was shown on CT and emergency angiography disclosed a large basilar artery aneurysm. Unfortunately an attempt to clip surgically the aneurysm failed as no true neck could be found to this fusiform aneurysm and wrapping of the aneurysm was eventually done. In the future, this lesion was regularly monitored by MR and MRA. The patient remains up till now totally asymptomatic.

Images 1 - 2
Native T1 weighted images provided by the 3DPCA acquisition. The fusiform aneurysm of the basilar artery is clearly demonstrated thanks to the thin slice thickness of those cuts

Image 3
The "angiographic" source images of the 3DPCA acquisition are also very interesting to be studied separately.

Image 4
MIP images from the 3DPCA. Flow effects degrade lesion border definition of this large aneurysm.

Image 5
Axial source images of the 3DTOF are again most valuable to be studied one by one, in order to study the aneurysm.

Image 6
MIP from the 3DTOF. The aneurysm is shown as an inhomogeneous focal fusiform enlargement of the basilar artery.

Image 7
MIP reconstructions from the arterial bolus phase acquisition in the sagittal to coronal plan following an foot-head axial. The aneurysms is best seen without any artifacts due to flow turbulences compared to the TOF and PCA images shown first.

See also:
- Gd 3D MRA: intracranial pathology: general considerations
- Gd 3D MRA: intracranial pathology: imaging strategies
- Gd 3D MRA: intracranial pathology: representative cases
- Gd 3D MRA: intracranial pathology: conclusion

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Fig. 1

Gd 3D MRA, intracranial pathology, case 5, Fig. 1
Gd 3D MRA, intracranial pathology, case 5, Fig. 2
Gd 3D MRA, intracranial pathology, case 5, Fig. 3
Gd 3D MRA, intracranial pathology, case 5, Fig. 4
Gd 3D MRA, intracranial pathology, case 5, Fig. 5
Gd 3D MRA, intracranial pathology, case 5, Fig. 6
Gd 3D MRA, intracranial pathology, case 5, Fig. 7