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MRI of unruptured infectious intracranial aneurysms in infective endocarditis. A case-control study

Monique Boukobza1, Emila Ilic-Habensus2, Xavier Duval3

  • 1Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard, Hospital, 46 rue Henri Huchard, Paris 75018, France.

Journal of Neuroradiology = Journal De Neuroradiologie
|January 9, 2023
PubMed
Abstract

Insights

T2* and FLAIR MRI sequences effectively detect unruptured infectious intracranial aneurysms (UIIAs) in infective endocarditis (IE). Combining these sequences offers 100% sensitivity and specificity for identifying UIIAs, regardless of their characteristics.

Area of Science:

  • Neuroradiology
  • Infectious Diseases
  • Vascular Imaging

Background:

  • Infective endocarditis (IE) poses a risk for developing infectious intracranial aneurysms (IIAs).
  • Accurate detection of unruptured IIAs (UIIAs) is crucial for timely intervention and improved patient outcomes.
  • Conventional MRI sequences may not always reliably detect UIIAs.

Purpose of the Study:

  • To assess the diagnostic utility of T2* and FLAIR MRI sequences for detecting UIIAs in patients with IE.
  • To explore the correlation between subarachnoid space lesion patterns and the presence of UIIAs.
  • To evaluate the combined effectiveness of T2* and FLAIR sequences in UIIA identification.

Main Methods:

  • Retrospective analysis of 15 patients with definite IE and diagnosed IIAs via DSA.
  • Review of MRI sequences including FLAIR, T2*, DWI, CE-MRA, 3D-T1, and CE-3DT1.
  • Comparison with a control group of 15 IE patients without IIAs.

Main Results:

  • T2* sequences showed a susceptibility vessel sign in 88.2% of UIIAs, correlating with DSA findings.
  • Identified three distinct hyposignal patterns on T2* (signet-ring, homogeneous, heterogeneous).
  • FLAIR demonstrated hyperintensity in the lumen (35.3%) and adjacent cortex (53%). Combined T2* and FLAIR achieved 100% sensitivity and specificity.

Conclusions:

  • The susceptibility vessel sign on T2* MRI is a frequent finding at the site of UIIAs in IE.
  • T2* and FLAIR sequences are valuable tools for depicting UIIAs in IE patients.
  • The combination of T2* and FLAIR MRI enhances the detection of UIIAs, irrespective of their location or morphology.
Keywords:
Gradient-echoT2Infectious intracranial aneurysmsInfective endocarditisT2*GREUnruptured intracranial aneurysmssusceptibility-weighted imaging

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