AJDRAJNR - American Journal of Neuroradiology

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Satoh, T.
Right arrow Articles by Date, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Satoh, T.
Right arrow Articles by Date, I.

Influence of Perianeurysmal Environment on the Deformation and Bleb Formation of the Unruptured Cerebral Aneurysm: Assessment with Fusion Imaging of 3D MR Cisternography and 3D MR Angiography

Toru Satoha, Megumi Omib, Chika Ohsakob, Atsushi Katsumatac, Yusuke Yoshimotoc, Shoji Tsuchimotoc, Keisuke Onodad, Koji Tokunagad, Kenji Sugiud and Isao Dated

a Department of Neurological Surgery , Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan
b Department of Diagnostic Radiology , Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan
c Department of Neurological Surgery , Onomichi Municipal Hospital, Japan
d Department of Neurological Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmacy, Okayama, Japan



View larger version (80K):

[in a new window]
  		FIG 1. Case 1, a 75-year-old woman with an unruptured internal carotid-posterior communicating artery aneurysm.

A, Maximum intensity projection (MIP) image of the source CT angiography (CTA), superoinferior projection, shows aneurysmal complex and cranial base bone.

B, 3D CT angiogram (CTA), posteroanterior projection, shows the aneurysm (AN), posterior communicating artery (PCom), posterior clinoid process (PCP), dorsum sellae (DS), and petroclinoidal dural fold (PF). Arrowheads (1, 2) indicate the blebs.

C, Minimum intensity projection (MinIP) image of the MR cisternography (MRC), superoinferior projection, shows the aneurysm (AN) and perianeurysmal structures. A1 indicates the first segment of the anterior cerebral artery; M1, the first segment of the middle cerebral artery; C2, the second segment of the internal carotid artery; PCom, posterior communicating artery; PCP, posterior clinoid process; DS, dorsum sellae; PF, petroclinoidal dural fold; TL, temporal lobe.

D, 3D MRC, similar projection to 3D CTA in B, viewed from the basal cistern, shows the spatial expansion and contact of the aneurysm with the perianeurysmal structures. CN III indicates oculomotor nerve.

E, 3D MR angiogram (MRA), coordinated projection as to the 3D MRC in D, shows the aneurysm with 3 blebs (arrowheads 1–3).

F, Fusion image of the 3D MRC and MRA coordinated projection as to the 3D MRC in D shows the spatial relationship of the dome blebs to the adjacent structures.



View larger version (84K):

[in a new window]
  		FIG 2. Case 3, a 60-year-old man with an unruptured internal carotid-posterior communicating artery aneurysm.

A, Operative photograph (OP), caudal view, shows the aneurysm (AN). C2 indicates the second portion of the internal carotid artery; M1, first segment of the middle cerebral artery; ON, optic nerve.

B, Digital subtraction angiogram (DSA) is in right lateral projection.

C, Serial source images of MR cisternography (MRC), superoinferior projection, show aneurysmal complex and perianeurysmal structures. BA indicates the basilar artery; TL, temporal lobe; M1, first segment of the middle cerebral artery; ON, optic nerve; PS, pituitary stalk; CN III, oculomotor nerve; AN, aneurysm; C2, second segment of the internal carotid artery; PCP, posterior clinoid process.

D, 3D MRC, right posterolateral projection, is viewed from the basal cistern. CN III indicates oculomotor nerve; TL, temporal lobe; AN, aneurysm; C2, second segment of the internal carotid artery; PCP, posterior clinoid process.

E, 3D MR angiogram (MRA), coordinated projection as to the 3D MRC in D, shows the aneurysm with a bleb (arrowhead).

F, Fusion image of the 3D MRC and MRA shows spatial relationship of the dome bleb to the adjacent oculomotor nerve.



View larger version (114K):

[in a new window]
  		FIG 3. Case 7, a 76-year-old woman with an unruptured anterior communicating artery aneurysm.

A, Minimum intensity projection (MinIP) image of MR cisternography (MRC), superoinferior projection, shows the aneurysm (AN) and perianeurysmal structures. RtA2 indicates the second segment of the right anterior cerebral artery; Chiasm, optic chiasm; RtA1, first segment of the right anterior cerebral artery; LtON, left optic nerve.

B, 3D MRC, inferosuperoposterior projection, viewed from the bottom of the basal cistern, shows the firm contact of the aneurysm with the optic nerves and chiasm. RtA2, second segment of the right anterior cerebral artery; LtA2, second segment of the left anterior cerebral artery; RtON, right optic nerve; LtON, left optic nerve; FL, frontal lobe; PS, pituitary stalk.

C, 3D MR angiogram (MRA), coordinated projection as to the 3D MRC in B, shows the aneurysm with deformed dome and a bleb. LtA1 indicates the first segment of the left anterior cerebral artery; LtA2, second segment of the left anterior cerebral artery; RtA1, first segment of the right anterior cerebral artery; RtA2, second segment of the right anterior cerebral artery.

D, Fusion image of the 3D MRC and MRA shows the spatial relationship of the dome to the adjacent optic nerves and chiasm.



View larger version (87K):

[in a new window]
  		FIG 4. Case 8, a 67-year-old-woman with a middle cerebral artery aneurysm.

A, Digital subtraction angiogram (DSA), anteroposterior projection, shows the aneurysm (AN) and parent arteries. M2-s indicates the superior branch of the second segment of the right middle cerebral artery; M2-i, inferior branch of the right middle cerebral artery; M1, the first segment of the middle cerebral artery.

B, Reconstructed coronal image of MR cisternography (MRC) with MR signal intensity histogram shows the aneurysmal complex and surrounding superficial veins. AN indicates aneurysm; M2, second segment of the middle cerebral artery; SV, superficial middle cerebral veins.

C, Source axial image of MRC, superoinferior projection, shows a view position (encircled arrow) for 3D MRC in D. SV indicates superficial middle cerebral vein.

D, 3D MRC, left anteroinferior projection, viewed from the sphenoidal compartment of the deep sylvian fissure as indicated in C, shows the spatial relationship of the aneurysm (AN), temporal lobe (TL), and superficial middle cerebral veins (SV). Arrowheads indicate contact of the dome with the adjacent temporal lobe; M1, first segment of the middle cerebral artery; M2, second segment of the middle cerebral artery.

E, 3D MR angiogram (MRA), coordinated projection as to the 3D MRC in D, shows the arterial components of the aneurysmal complex.

F, Fusion image of the 3D MRC and MRA shows a part of the dome contact with the adjacent temporal lobe (arrowheads).



View larger version (113K):

[in a new window]
  		FIG 5. Case 12, a 70-year-old-woman with a basilar artery top aneurysm resulting in rupture.

A, 3D CT angiogram (CTA), posteroanterior projection, shows the aneurysm and cranial base bone.

B, 3D MR cisternogram (MRC), posteroanterior projection viewed from the interpeduncular cistern, shows the spatial relationship of the aneurysm with dome blebs, parent arteries, and caudal aspect of the diencephalon and the third ventricle. DE indicates diencephalon; IIIrd V, the third ventricle; CP, cerebral peduncle; LtP1, first segment of the left posterior cerebral artery; RtP1, first segment of the right posterior cerebral artery; LtSCA, left superior cerebellar artery; RtSCA, right superior cerebellar artery; BA, basilar artery. Arrowhead indicates the bleb.

C, 3D MR angiogram (MRA), coordinated projection as to the 3D MRC in B, shows the arterial components of the aneurysmal complex.

D, Fusion image of the 3D MRC and MRA shows the contact of the dome bleb with the floor of the adjacent third ventricle (diencephalon).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X