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Rule Out (R/O) Intracranial Aneurysm

P. Ellen Grant¹, R. Gilberto Gonzalez¹, Pamela W. Schaefer¹

¹Massachusetts General Hospital, Boston, Massachusetts

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A1.2

DOI:

10.1002/0471142719.mia0102s06

Online Posting Date:

November, 2002

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Abstract

When imaging patients for intracranial aneurysm, the goals are: (1) to assess the contour of the intracranial arteries, particularly in he regions of the ACOM (anterior communicating artery), PCOM (posterior communicating artery), ICA (internal carotid artery) bifurcation, MCA (middle cerebral artery) trifurcation, basilar tip, and PICA (posterior inferior cerebellar artery); (2) to assess the anatomy of the Circle of Willis and direction of flow, and; (3) to determine if there is evidence of a recent subarachnoid bleed. This unit describes a Basic Protocol that can be used for standard imaging of aneurysm in stable patients. An Alternate Protocol is described for situations when there is concern for vasospasm and infarction.

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Unit Introduction
Basic Protocol: Standard Imaging for Aneurysm Detection
Alternate Protocol: Aneurysm Screen and Assessment for Vasospasm/Infarction
Commentary
Literature Cited
Figures
Tables

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Materials

Alternate Protocol: Aneurysm Screen and Assessment for Vasospasm/Infarction

Materials

Normal saline (0.9% NaCl), sterile
Gadolinim-DTPA contrast agent (e.g., Magnevist, Omniscan, or Prohance)

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Figures

Figure A1.2.1

Transverse FLAIR images at the level of the basal cisterns (A) and level of the basal ganglia (B). Increased signal is seen throughout the subarachnoid spaces including the anterior interhemispheric fissure, basal cisterns and bilateral sylvian fissures. High signal material is also seen layering in the posteriorly in the trigones of lateral ventricles in (B). The high signal is due to acute subarachnoid and intraventricular blood.

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Figure A1.2.2

MIP of the right anterior circulation, ACOM and left A2 segment (A) from the same patient shown in Figure A1.2.1. A small aneurysm arising from the right ACOM/A2 junction, is seen pointing inferiorly and to the right (arrow). (B) MIP of the left anterior circulation in a different patient shows a small aneurysm (arrow) arising from the left ICA just above the origin of the ophthalmic artery.

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Literature Cited

Literature Cited
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	Bakshi, R., Kamran, S., Kinkel, P.R., Bates, V.E., Mechtler, L.L., Janardhan, V., Belani, S.L., and Kinkel, W.R. 1999. Fluid-attenuated inversion-recovery MR imaging in acute and subacute cerebral intraventricular hemorrhage. Am. J. Neuroradiol. 20:629-636.
	Inagawa, T. and Hirano, A. 1990. Autopsy study of unruptured incidental intracranial aneurysms. Surg. Neurol. 34:361-365.
	Ingall, T.J., Whisnant, J.P., Wiebers, D.O., and O'Fallon, W.M. 1989. Has there been a decline in subarachnoid hemorrhage mortality Stroke 20:718-724.
	International Study of Unruptured Intracranial Aneurysms Investigators. 1998. Unruptured intracranial aneurysms: Risk of rupture and risks of surgical intervention. N. Engl. J. Med. 339:1725-1733.
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