Medcyclopaedia Home E-learningLibraryLexical IndexLexical TopicsGlossaryFace-a-CaseSpinal CordCerebral TumorsMR Neuro AngiographyAchondroplasiaBilateral internal carotid artery occlusionCerebral Arteriovenous MalformationsCervical Occlusive Arterial DiseasesDevelopmental Venous AnomaliesExtrinsic Dural Sinus CompressionGadolinium Enhanced 3d Mra Recent Clinical ApplicationsGiant Intracranial AneurysmIntracranial Dural Arteriovenous ShuntsIntracranial Dural Sinus ThrombosisIntracranial Occlusive Arterial DiseaseJuxtasinusal MeningiomasMoyamoya DiseasePre Therapeutic Vascular MappingSaccular Cerebral AneurysmsSpinal Vascular MalformationsTextbook of RadiologyTextbook of Radiology (e-paper)Medical Imaging Made EasyDownloadsMedcyclOasisAbout MedcyclopaediaContact Us
MedcycloPoll
Did you get the help you required from Medcyclopaedia™ during today's visit?
Yes
 
 (84.5%)
No
 
 (10.9%)
Undecided
 
 (4.6%)
You must be logged on to vote.
Please log in or register.
 
 
 

Multiple giant cerebral saccular aneurysm

This 75 year old female presented with a history of repeated transient ischemic attacks referable to the vertebro-basilary circulation.
The initial CT scan was normal without intraparenchymal lesions, however two large extraaxial lesions, located at the right carotid siphon and the basilar artery tip, were clearly demonstrated. A combined MRI-MRA examination was performed and confirmed the two vascular lesions, consistent with giant saccular aneurysms. The patient's clinical status contraindicated surgical treatment and therefore conventional angiography was not performed.

Multiple giant cerebral saccular aneurysms (1,5 T)
Fig.1 The transverse T1-weighted spin-echo image shows two large extraaxial lesions, one in conjunction with the right internal carotid artery siphon and the other with the basilar artery, both suggesting the diagnosis of giant saccular aneurysms. The lesions exhibit inhomogeneous signal intensity (hypo- and isointense to brain parenchyma), possibly due both fast and slow flow within the aneurysm and/or partial intraluminal thrombosis.
Fig.2 The 3D TOF MR angiogram fails to demonstrate the aneurysm of the right internal carotid artery siphon, probably due to signal loss, related to saturation of slow flowing spins. Conversely, the basilar tip aneurysm is partially seen (arrow), suggesting faster intraaneurysmal flow.
Fig.3 Using the 2D TOF MRA technique, both aneurysms become visible. In slow flow lesions, spin saturation and subsequent intravascular signal loss is less likely to occur with the 2D TOF technique.
Fig.4 Repeating the 3D TOF MRA acquisition after intravenous Gadolinium injection (in order to avoid spin saturation effects), allows clear demonstration of the right internal carotid siphon aneurysm. The poor visualization of the basilar tip aneurysm (arrow), raises the possibility of an acute intraaneurysmal thrombus.
Fig.5 Comparison of the employed three different TOF MRA techniques: 2D TOF (above), 3D TOF (middle) and Gadolinium-enhanced 3D TOF (below).

 

The ESNR CD-Rom Series

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig. 1

Multiple giant cerebral saccular aneurysm, Fig. 1
Multiple giant cerebral saccular aneurysm, Fig. 2
Multiple giant cerebral saccular aneurysm, Fig. 3
Multiple giant cerebral saccular aneurysm, Fig. 4
Multiple giant cerebral saccular aneurysm, Fig. 5