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Blood Flow Mimicking Aneurysmal Wall Enhancement: A Diagnostic Pitfall of Vessel Wall MRI Using the Postcontrast 3D

E Kalsoum1, A Chabernaud Negrier1, T Tuilier1

  • 1From the Departments of Neuroradiology (E.K., A.C.N., T.T., A.B., S.G., A.G., P.B., J.H.).

AJNR. American Journal of Neuroradiology
|March 31, 2018
PubMed

Insights

Conventional SPACE sequences are better for detecting aneurysmal wall enhancement in unruptured intracranial aneurysms than motion-sensitized driven equilibrium-prepared SPACE sequences. This finding has implications for patient care.

Area of Science:

  • Radiology
  • Medical Imaging
  • Neuroimaging

Background:

  • Unruptured intracranial aneurysms require accurate assessment for patient management.
  • Detecting aneurysmal wall enhancement is crucial for identifying high-risk lesions.
  • Conventional 3D T1-weighted TSE SPACE sequences are commonly used for neuroimaging.

Purpose of the Study:

  • To compare the detectability of aneurysmal wall enhancement in unruptured intracranial aneurysms.
  • To evaluate conventional SPACE sequences versus motion-sensitized driven equilibrium-prepared SPACE sequences.
  • To assess the impact of sequence type on the interpretation of intracranial aneurysms.

Main Methods:

  • Twenty-two patients with 30 unruptured intracranial aneurysms underwent 3T MRI scans.
  • Comparison of aneurysmal wall enhancement detection between conventional and motion-sensitized driven equilibrium-prepared SPACE sequences.
  • Analysis of contrast-to-noise ratio (CNR) between the two sequence types.

Main Results:

  • Aneurysmal wall enhancement was significantly more detectable with conventional SPACE sequences (10/30) compared to motion-sensitized driven equilibrium-prepared SPACE sequences (2/30; P < .0001).
  • No significant difference in contrast-to-noise ratio was observed between the sequences (P = .51).
  • Flowing blood in conventional SPACE sequences may mimic true aneurysmal wall enhancement.

Conclusions:

  • Conventional SPACE sequences demonstrate superior detectability of aneurysmal wall enhancement in unruptured intracranial aneurysms.
  • Motion-sensitized driven equilibrium-prepared SPACE sequences may reduce false-positive findings of enhancement.
  • Careful interpretation is needed with conventional sequences due to potential artifactual enhancement from blood flow.

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