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Vessel Wall Magnetic Resonance Imaging Identifies the Site of Rupture in Patients With Multiple Intracranial Aneurysms: Proof of Principle

Matouk, Charles C. MD*,‡; Mandell, Daniel M. MD§; Günel, Murat MD*; Bulsara, Ketan R. MD*; Malhotra, Ajay MBBS; Hebert, Ryan MD*; Johnson, Michele H. MD*,‡; Mikulis, David J. MD§; Minja, Frank J. MD*

doi: 10.1227/NEU.0b013e31827d1012
Concepts, Innovations, and Techniques

BACKGROUND: High-resolution magnetic resonance vessel wall imaging (MR-VWI) is increasingly used to study steno-occlusive cerebrovascular disease, but has not yet been applied to patients with aneurysmal subarachnoid hemorrhage (SAH).

OBJECTIVE: To study the ability of high-resolution MR-VWI to determine the site of rupture in patients with aneurysmal SAH.

METHODS: Medical records of patients admitted with aneurysmal SAH between December 2011 and May 2012 were reviewed. MR-VWI was routinely performed for patients treated in the IMRIS Neurovascular Suite immediately before definitive treatment of the ruptured aneurysm.

RESULTS: We report for the first time high-resolution MR-VWI in 5 patients with aneurysmal SAH. Three patients harbored multiple intracranial aneurysms. The ruptured aneurysms demonstrated thick vessel wall enhancement in all cases. None of the associated unruptured aneurysms demonstrated this MR imaging finding.

CONCLUSION: High-resolution MR-VWI identified the site of rupture in patients with aneurysmal SAH, including those patients harboring multiple intracranial aneurysms. It may represent a useful tool in the investigation of aneurysmal SAH.

ABBREVIATIONS: AComA, anterior communicating artery aneurysm

MCA, middle cerebral artery

MR-VWI, magnetic resonance vessel wall imaging

PComA, posterior communicating artery

SAH, subarachnoid hemorrhage

*Department of Neurosurgery, Neurovascular & Stroke Programs, Yale University School of Medicine, New Haven, Connecticut

Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut

§Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada

Correspondence: Charles C. Matouk, MD, Departments of Neurosurgery and Diagnostic Radiology, Neurovascular & Stroke Programs, Yale University School of Medicine, 333 Cedar St, TMP402, New Haven, CT 06510. E-mail:

Sources of Funding: Dr Matouk gratefully acknowledges support from Yale University, jointly from the School of Medicine and Department of Neurosurgery, and the Brain Tumor Gift Fund.

Received June 11, 2012

Accepted October 23, 2012

Copyright © by the Congress of Neurological Surgeons