HARMless: Transient Cortical and Sulcal Hyperintensity on Gadolinium-Enhanced FLAIR after Elective Endovascular Coiling of Intracranial Aneurysms

Abstract

Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is a transient observation in the arterial territory exposed to iodinated contrast medium during endovascular treatment of intracranial aneurysms. Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is significantly associated with procedural time, and the frequency of angiographic runs suggesting a potential technical influence on the breakdown of the BBB, but no reported adverse clinical outcome or association with both iodinated contrast medium volume and DWI lesions was found. Recognition of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR as a benign incidental finding is vital to avoid unnecessary investigation.

Leptomeningeal Enhancement Is Associated with Transient Neurologic Deficits after Flow Diversion of Intracranial Aneurysms

“…Traditionally neurological complications were thought to be ischemic in nature. However, in our study DWI was not associated with development of neurologic complications on statistical analysis, consistent with prior studies 4,5 . DWI is the gold standard for identifying ischemic stroke and therefore these findings suggest alternative mechanisms may explain transient neurological deficits seen after NEI.…”

“…Neurological deficits following NEI are surprisingly common, yet the etiology of these events remains poorly understood. In this prospective study, we identified BBB impairment manifesting radiographically as LME on pcFLAIR imaging 5 as an independent predictor for developing transient neurological deficits post-NEI (p<0.0001).…”

“…PcFLAIR imaging augments visualization of the leptomeninges and enables interrogation of BBB permeability. This technique has previously been shown to identify BBB breakdown following ischemic stroke [4][5][6] . In the post-NEI setting, the differential diagnosis of pcFLAIR LME includes subarachnoid hemorrhage, BBB disruption, and cerebral dysautoregulation 7,8 .…”

“…This finding suggests that other non-ischemic mechanisms may contribute to post-procedural neurological deficits in some cases and exposes the need for a reliable imaging marker of cerebrovascular dysfunction following NEI. Post-contrast FLAIR (pcFLAIR) imaging has been established as an important radiographic marker of BBB impairment after ischemic stroke 5 . The presence of LME on pcFLAIR imaging increases the risk of reperfusion hemorrhage and indicates poorer neurological outcomes after ischemic stroke due to an incompetent BBB 5 .…”

“…Post-contrast FLAIR (pcFLAIR) imaging has been established as an important radiographic marker of BBB impairment after ischemic stroke 5 . The presence of LME on pcFLAIR imaging increases the risk of reperfusion hemorrhage and indicates poorer neurological outcomes after ischemic stroke due to an incompetent BBB 5 . Therefore in this study, we utilize pcFLAIR imaging to evaluate the incidence of BBB disruption after NEI and investigate the correlation with development of reversible neurological complications post-procedure.…”