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AJNR - American Journal of Neuroradiology

Published ahead of print on May 22, 2008
doi: 10.3174/ajnr.A1124

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Characterization of Aneurysm Remnants after Endovascular Treatment: Contrast-Enhanced MR Angiography versus Catheter Digital Subtraction Angiography

R. Agid^a, R.A. Willinsky^a, S.-K. Lee^a, K.G. TerBrugge^a and R.I. Farb^a

^a From the Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada

View larger version (129K): [in this window] [in a new window]   Fig 1. A 57-year-old woman, 10 months post-subarachnoid hemorrhage and endovascular coiling of a right PcomA aneurysm. A, C, and E, Multiple oblique images taken from a rotational DSA. Although a small neck residual is noted (arrowheads in A and C), there is no evidence of contrast within the actual coil mass (short arrows in A, C, and E). Matching oblique MIP reconstructions of CE-MRA performed 29 days later reveal a much larger aneurysmal recurrence (short arrows in B, D, and F). This larger extent of recurrent aneurysm is difficult to appreciate on the rotational DSA images because it is surrounded by the coil mass, which attenuates the photons passing through it and creates the coil helmet effect. Note that the PcomA artery adjacent to the aneurysm is well demonstrated on both DSA and CE-MRA (long arrows in A–F).

View larger version (85K): [in this window] [in a new window]   Fig 2. A 72-year-old woman, 14 months post-subarachnoid hemorrhage and endovascular coiling of a left PcomA aneurysm. A–D, Axial source images of CE-MRA. E and G, Lateral (E) and anteroposterior (G) MIP reconstructions of CE-MRA demonstrate a large aneurysmal recurrence (arrowheads in A–D and arrows in E and G). F and H, DSA performed 2 months after the CE-MRA clearly shows a large aneurysmal recurrence (arrows), but the extent of this recurrence within and peripheral to the coil mass is difficult to appreciate. This aneurysm was recoiled with 9 coils. Note the excellent demonstration of the PcomA artery and its origin on the CE-MRA source images (arrows in A and B).

View larger version (43K): [in this window] [in a new window]   Fig 3. A 51-year-old woman presenting with subarachnoid hemorrhage. A, Final control left internal carotid DSA in the anteroposterior projection following endovascular coiling of an AcomA aneurysm. The coil mass is noted with only perhaps several faint tiny spots of suggested contrast within it (arrow). B, MIP reconstruction of CE-MRA in the anteroposterior projection performed 4 days later clearly shows a substantial aneurysmal body remnant filling with contrast (arrow) extending inferiorly. C–D, Axial source images of the CE-MRA show the remnant (arrows).