MRI SPACE sequence confirmation of occluded MCA M2 dissection stump masquerading as a ruptured MCA aneurysm

Khattar, Nicolas K; White, Andrew C.; Adams, Shawn; Aljuboori, Zaid; Wilder, Michael J; Downs, Richard K.; James, Robert F.

doi:10.1136/bcr-2018-013996

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…This patient can be judged as an unstable aneurysm from both SR value and enhancement signal intensity, and annular enhancement is more likely to rupture than focal enhancement. 33 This patient also presented significant annular enhancement and was in urgent need of treatment, which was consistent with the conclusion of some scholars 34–36 that tumor wall enhancement and SR value could be used as independent risk factors for aneurysm rupture. Aneurysm size has also been considered an important factor in determining stability.…”

Section: Discussionsupporting

confidence: 89%

The Application of Multiple Magnetic Resonance Scanning Techniques in Evaluating the Stability of Intracranial Aneurysms

Ma¹,

Li²,

Feng³

et al. 2023

IJGM

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Purpose To evaluate the stability of unruptured intracranial aneurysm (UIA) with high-resolution magnetic resonance imaging of the vessel wall (HR-VWI). Materials and Methods A total of 92 UIA patients were enrolled. After MRA, HR-VWI imaging, the reconstruction of volume rendering (VR) and maximum intensity projection (MIP) were performed to observe the location and size of aneurysms, AR value (ratio of aneurysm height to aneurysmal diameter), SR value (ratio of maximum tumor depth to proximal parent artery diameter), and signal intensity were measured. Results There were 7 aneurysms with UIA located in the anterior cerebral artery, 31 aneurysms with UIA in the middle cerebral artery, 1 aneurysm with UIA in the posterior cerebral artery, 18 aneurysms with UIA in the anterior communication, 5 aneurysms with UIA in the posterior communication, 34 aneurysms with UIA in the intracranial segment of the internal carotid artery and 3 aneurysms with UIA in the vertebral artery. Among them, 8 patients had more than two multiple aneurysms. The lesion size was 2–38mm (6.3 ± 5.09). There are 46 aneurysms with wall enhancement: the maximum SR value was 7.03 and the minimum 1.2, and the maximum AR value was 7.5 and the minimum 1.0. Fifty-five aneurysms showed no enhancement of the tumor wall. The maximum SR value was 4.55 and the minimum 0.58, and the maximum AR value was 4.0 and the minimum 0.6, respectively. Patients were divided into a stable group and an unstable group according to the aneurysm wall. The enhancement rate, SR value, and AR value in the stable aneurysm group were significantly lower than those in the unstable aneurysm group (P < 0.05). Conclusion MRA and HR-VWI can objectively reflect the stability of aneurysms by judging the morphology, SR value, and signal enhancement of UIA, and can provide a certain basis for diagnosis and treatment, which has become routine examination.

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Section: Discussionsupporting

confidence: 89%

The Application of Multiple Magnetic Resonance Scanning Techniques in Evaluating the Stability of Intracranial Aneurysms

Ma¹,

Li²,

Feng³

et al. 2023

IJGM

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“…Highresolution MRI vessel-wall imaging can be utilized to make the diagnosis of MCA dissection. 11,12 From an endovascular perspective, interventionalists should be aware of these variants because of the high risk of vessel injury during endovascular manipulation at the level of the fenestrations. This risk is especially high in the setting of emergent endovascular management of acute large vessel occlusion stroke where no prior information of the anatomical configurations is available.…”

Section: Discussionmentioning

confidence: 99%

Middle cerebral artery fenestration: Thromboembolic and hemorrhagic complications

et al. 2019

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Cerebral artery fenestrations are rare anatomical variants usually detected incidentally on cross-sectional imaging or cerebral angiography. Although considered benign findings, many reports have described their association with vascular abnormalities such as aneurysms or arteriovenous malformations, and to a lesser extent with ischemic or hemorrhagic complications. We report a case of middle cerebral artery fenestration associated with subarachnoid hemorrhage and middle cerebral artery thrombosis. To our knowledge, there has been no prior report of middle cerebral artery fenestration with a similar presentation.

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“…6,7,10,11 Therefore, in these particular cases, special attention should be taken regarding clinical presentation (ischemia vs. SAH), location, and radiologic studies (DSA, MRI, MRA). [7][8][9]19 Our case represents the first case of an occlusion of an anterior cerebral artery mimicking an AcomA aneurysm, which allows us to consider this special differential diagnosis along any vascular territory.…”

Section: Specific Anatomical Segmentsmentioning

confidence: 82%

“…6 MRI sampling perfection with application-optimized contrasts using different flip angle evolution (MRI-SPACE) is a nuclear magnetic sequence that can be used to analyze the spatial structure of intracranial blood vessels, the components of blood vessel walls, and the surrounding tissues, which are all important parameters to establish a proper diagnosis. 19 In our case, during DSA, the anteroposterior (AP) view of the injection of the right ICA (►Fig. 1e) showed the presence of moyamoya vessels and absence of flow along the right A1, whereas the AP view of the injection of the left ICA demonstrated the presence of a good and patent AcomA that provided flow to the right A2, and a berry-like protrusion arising from the junction between the right A2 and the AcomA complex, which was considered a saccular aneurysm due to its convex shape.…”

Section: Radiologic Characteristicsmentioning

confidence: 99%

Occlusion of the Anterior Cerebral Artery Mimicking a Cerebral Aneurysm: Clinical Presentation and Literature Review

Liu

Guo

Zhu

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Intracranial aneurysms may be misdiagnosed with other vascular lesions such as vascular loops, infundibulum, or the stump of an occluded artery (very rare and reported compromising only the middle cerebral artery and the posterior circulation territory). Our aim was to describe a unique case of occlusion of an anterior cerebral artery mimicking a cerebral aneurysm in a probable moyamoya disease patient, and to highlight its clinical presentation, diagnosis, and management, and to perform an extensive literature review. Case A 67-year-old man suffering from recurrent dizziness for 3 months. Previous medical history was unremarkable. Brain magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) demonstrated occlusion of the right middle cerebral artery (MCA) associated with a “probable moyamoya disease” and an aneurysm-like shadow protruding lesion at the anterior communicating artery (AcomA). Perfusion images showed ischemia along the right temporo-occipital lobe. Due to MCA occlusion with perfusion deficits and unspecific symptoms, we offered a right side encephalo-duro-myo-synangiosis (EDMS) and clipping of the AcomA aneurysm in one session. Intraoperatively, there was no evidence of the AcomA aneurysm; instead, this finding corresponded to the stump of the occluded right anterior cerebral artery (A1 segment). This segment appeared to be of yellowish color due to atherosclerosis and lacked blood flow. The patient underwent as previously planned a right side EDMS and the perioperative course was uneventful without the presence of additional ischemic attacks. Conclusion Arterial branch occlusions can sometimes present atypical angiographic characteristics that can mimic a saccular intracranial aneurysm. It is relevant to consider this radiographic differential diagnosis, especially when aneurysm treatment is planned.

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MRI SPACE sequence confirmation of occluded MCA M2 dissection stump masquerading as a ruptured MCA aneurysm

Cited by 5 publications

References 14 publications

The Application of Multiple Magnetic Resonance Scanning Techniques in Evaluating the Stability of Intracranial Aneurysms

The Application of Multiple Magnetic Resonance Scanning Techniques in Evaluating the Stability of Intracranial Aneurysms

Middle cerebral artery fenestration: Thromboembolic and hemorrhagic complications

Occlusion of the Anterior Cerebral Artery Mimicking a Cerebral Aneurysm: Clinical Presentation and Literature Review

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