Clinico-radiological spectrum of giant intracranial aneurysms

Vorkapic, Peter; Czech, Thomas; Pendl, G.; Öztürk, Enis; Horaczek, A

doi:10.1007/bf00383260

Cited by 12 publications

(5 citation statements)

References 14 publications

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“…In their series of giant aneurysms, Vorkapic et Al performed MRI in four patients with partially thrombosed aneurysms and found perianeurysmal bleeding in one, rim enhancement in all four patients and an onion-skin appearance in all patients that demonstrated layers of fresh thrombus within the periphery, whereas older thrombus as detected by MRI criteria was present in the central parts. Surrounding edema was present in nearly all cases 12 .…”

Section: Neuroimagingmentioning

confidence: 97%

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

et al. 2007

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Within the group of giant and large aneurysms the subgroup of the so-called “partially thrombosed” aneurysms can be differentiated according to clinical and neuroimaging findings. The present study was carried out to determine the site of bleeding of these aneurysms and what implications concerning their pathomechanism can be drawn from these findings. Twenty patients aged two to 77 (mean 44) years who exhibited a partially thrombosed aneurysm that had recently bled were included. Images (MRI including T1 pre- and postcontrast and T2 weighted images in multiple planes, CT and digital subtraction angiography) and patients' charts were reviewed. MRI showed an onion-skin appearance of the thrombus in 19 patients, rim enhancement of the aneurysm wall (either partial or complete) in 17, and a perifocal edema in 16 patients. The acute hemorrhage was typically crescent-shaped and located at the periphery of the aneurysm, distant from the perfused lumen of the aneurysm within the thrombosed part of the aneurysm. The current denomination “partially thrombosed” intracranial arterial aneurysms leads to the presumption that thrombus is present endoluminal whereas in fact the site of hemorrhage is within the vessel wall. A more accurate nomination would, therefore, be “aneurysms with intra mural hemorrhage”. The enhancing wall and the edematous reaction of the adjacent brain parenchyma might be a sign for an inflammatory pathomechanism which is reinforced by histological and pathophysiological studies. This disease should be regarded as a clinical entity separate from saccular or non-thrombosed giant or large aneurysms.

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Section: Neuroimagingmentioning

confidence: 97%

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

et al. 2007

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“…A low signal in the center and a high signal in the peripheral side were highly suggestive of a partially thrombosed aneurysm. Such aneurysms showed layers of fresh thrombus within the peripheral side, whereas older thrombus was present in the central parts (15). A study using ultra-high-field MRI is required to confirm it.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Thrombus Signal Intensity and Aneurysm Wall Thickness in Partially Thrombosed Intracranial Aneurysms Using 7T Magnetization-Prepared Rapid Acquisition Gradient Echo Magnetic Resonance Imaging

et al. 2022

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ObjectiveThe objective of this study is to investigate the relationship between the thrombus signal intensity and aneurysm wall thickness in partially thrombosed intracranial aneurysms in vivo with magnetization-prepared rapid acquisition gradient echo (MPRAGE) taken using 7T magnetic resonance imaging (MRI) and correlate the findings to wall instability.MethodsSixteen partially thrombosed intracranial aneurysms were evaluated using a 7T whole-body MR system with nonenhanced MPRAGE. To normalize the thrombus signal intensity, its highest signal intensity was compared to that of the anterior corpus callosum of the same subject, and the signal intensity ratio was calculated. The correlation between the thrombus signal intensity ratio and the thickness of the aneurysm wall was analyzed. Furthermore, aneurysmal histopathological specimens from six tissue samples were compared with radiological findings to detect any correlation.ResultsThe mean thrombus signal intensity ratio was 0.57 (standard error of the mean [SEM] 0.06, range 0.25–1.01). The mean thickness of the aneurysm wall was 1.25 (SEM 0.08, range 0.84–1.55) mm. The thrombus signal intensity ratio significantly correlated with the aneurysm wall thickness (p < 0.01). The aneurysm walls with the high thrombus signal intensity ratio were significantly thicker. In histopathological examinations, three patients with a hypointense thrombus had fewer macrophages infiltrating the thrombus and a thin degenerated aneurysmal wall. In contrast, three patients with a hyperintense thrombus had abundant macrophages infiltrating the thrombus.ConclusionThe thrombus signal intensity ratio in partially thrombosed intracranial aneurysms correlated with aneurysm wall thickness and histologic features, indicating wall instability.

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“…In postcontrast acquisitions, they may show a peripheral ring enhancement in the aneurysmal wall, attributed to proliferated intramural capillaries or recent hemorrhages from these vessels. [ 14 19 20 ] the presence of peripheral calcifications and the “target sign” also suggests intraluminal thrombosis,[ 14 19 20 ] even though the latter is absent in totally thrombosed lesions.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous thrombosis of giant intracranial aneurysm and posterior cerebral artery followed by also spontaneous recanalization

et al. 2016

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Background:Spontaneous complete thrombosis of a giant aneurysm and its parent artery is a rare event. Their spontaneous recanalization is even rarer, with few reports.Case Description:A 17-year-old male patient presenting blurred vision and headache, with a history of seizures, was referred to our service. After further investigation with cranial computed tomography, magnetic resonance imaging (MRI), and cerebral angiography (CAG), it was diagnosed a thrombosed aneurysm of the posterior cerebral artery (PCA) and also complete thrombosis of the PCA. Three years later, he experienced visual worsening. A new MRI scan indicated flow both through the aneurysm and the left PCA, which was further confirmed by CAG. We decided for a noninterventional treatment combined with strict clinical follow-up. The patient continues to present with the previous neurological deficit, without recurrence of headaches.Conclusions:Thrombosis is not the final event in the natural history of giant aneurysms, and partial thrombosis does not preclude the risk of rupture. Thrombosed aneurysms may display additional growth brought about by wall dissections or intramural hemorrhages. Their treatment may be either surgical or involve endovascular procedures such as embolization. Thrombosed giant aneurysms are dynamic and unstable lesions. A noninterventional treatment is feasible, but aneurysmal growth or recanalization may suggest the need for a more active intervention.

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Clinico-radiological spectrum of giant intracranial aneurysms

Cited by 12 publications

References 14 publications

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

Growth and Rupture Mechanism of Partially Thrombosed Aneurysms

Correlation Between Thrombus Signal Intensity and Aneurysm Wall Thickness in Partially Thrombosed Intracranial Aneurysms Using 7T Magnetization-Prepared Rapid Acquisition Gradient Echo Magnetic Resonance Imaging

Spontaneous thrombosis of giant intracranial aneurysm and posterior cerebral artery followed by also spontaneous recanalization

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