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FIG 5. A 45-year-old woman presented with SAH due to rupture of an anterior communicating artery aneurysm.
A, Diagnostic IA-DSA of left common cartotid artery, frontal projection. The anterior communicating artery aneurysm is seen, but its relationship with the left A2 segment is not clear. A submental vertical projection was not obtained.
B, TOF-MIP MRA (100/20/1), submental vertical projection. It can now be appreciated that there is a bifid anterior communicating artery (long arrow). The aneurysm (short arrow) arises from the junction between the left A2 and the upper limb of the anterior communicating artery. On the MIP-MRA image, the aneurysm appears tubular and of narrower calibre than is suggested by the IA-DSA image.
C, TOF-3D-isosurface MRA (100/20/1), similar projection to that of B. The lower limb of the anterior communicating artery is again clearly visible (long arrow). The morphologic characteristics of the aneurysm (short arrow) depicted by this technique are more similar to those shown by IA-DSA.
D, IA-DSA of the anterior communicating artery aneurysm post GDC embolization. Prior manipulation of the MRA has allowed the appropriate projection to be chosen. Only the distal part of the aneurysm would retain a coil, leaving a significant remnant.
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