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MRI in multiple vascular lesions: identification of the ruptured malformation
K L Mourier1, F Gelbert, E Assouline
1Department of Neurosurgery, Hôpital Lariboisière, Paris, France.
Abstract:
4 patients were recently admitted for subarachnoid haemorrhage with multiple vascular lesions. 3 of them presented with multiple aneurysms, and one with an aneurysm associated with an arteriovenous malformation. In these 4 cases identification of the ruptured lesion was difficult in spite of clinical examination, CT scan, and complete panangiography; on magnetic resonance imaging (MRI) was found a signal hyperintensity, mainly on T2 weighted views, corresponding to blood clots around the ruptured aneurysm. This signal hyperintensity was completely absent in the vicinity of the associated vascular lesion, which appeared only as a signal void corresponding to the blood flow inside the unruptured lesion. Therefore MRI can be used in such cases to identify the ruptured lesion, so permitting the choice of the best approach and strategy of treatment.
Insights
Identifying the source of bleeding in subarachnoid hemorrhage can be challenging. Magnetic resonance imaging (MRI) effectively distinguishes ruptured aneurysms from unruptured lesions by detecting blood clots.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Subarachnoid hemorrhage (SAH) presents diagnostic challenges, especially with multiple vascular lesions.
- Accurate identification of the ruptured lesion is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the utility of magnetic resonance imaging (MRI) in identifying the ruptured vascular lesion in patients with subarachnoid hemorrhage and multiple vascular abnormalities.
Main Methods:
- Case series of 4 patients with SAH and multiple vascular lesions.
- Utilized clinical examination, CT scans, panangiography, and MRI (T2-weighted sequences).
Main Results:
- MRI revealed signal hyperintensity (blood clots) around the ruptured aneurysm.
- Unruptured lesions showed signal void (blood flow) without surrounding hyperintensity.
- Distinguishing the ruptured lesion was difficult with conventional methods alone.
Conclusions:
- MRI, particularly T2-weighted imaging, is a valuable tool for differentiating ruptured from unruptured vascular lesions in complex SAH cases.
- This differentiation aids in selecting appropriate treatment strategies.