MR imaging of giant intracranial aneurysm

We reviewed the clinical features and findings of magnetic resonance imaging (MRI) in 17 cases of giant intracranial aneurysm (GIA). All were confirmed by digital subtraction angiography (DSA). Seven were non-thrombosed and 10 were partially thrombosed.All thrombosed parts showed no enhancement. The majority of the lumen showed good enhancement in the post-contrast study (89%). About 80% of the partially thrombosed aneurysms had an onion skin appearance on non-contrast T1WI. On T2WI about 80% of partially thrombosed aneurysms had a low signal inside the thrombus or its wall from the susceptibility effect of blood elements such as haemosiderin. Flow void sign was noted in 88% on non-contrast T1WI and T2WI. Flow artifacts along the phase-encoding direction from the lumen of the aneurysm were noted in 41% of non-contrast T1WI, 56% of contrast-enhanced T1WI, and 29% of T2WI.Non-enhancement inside the thrombus and an onion skin appearance were important signs of thrombosis of the aneurysm. Flow artifacts along the phase-encoding direction from the lumen of the aneurysm provided an important clue of a patent lumen inside an aneurysm. The following signs provided clues to the diagnosis of patency lumen instead of thrombosis with high sensitivity and specificity: flow void sign on noncontrast T1WI (sensitivity 88%, specificity 100%), enhancement on contrast-enhanced T1WI (sensitivity 89%, specificity 100%), presence of either flow void sign or enhancement on contrast-enhanced T1WI (sensitivity 100%, specificity 100%).