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Research ArticleADULT BRAIN

HARMless: Transient Cortical and Sulcal Hyperintensity on Gadolinium-Enhanced FLAIR after Elective Endovascular Coiling of Intracranial Aneurysms

S. Suthiphosuwan, C.C.-T. Hsu and A. Bharatha
American Journal of Neuroradiology April 2018, 39 (4) 720-726; DOI: https://doi.org/10.3174/ajnr.A5561
S. Suthiphosuwan
aFrom the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.S., C.C.-T.H., A.B.)
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C.C.-T. Hsu
aFrom the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.S., C.C.-T.H., A.B.)
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A. Bharatha
aFrom the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.S., C.C.-T.H., A.B.)
bDivision of Neurosurgery, Department of Surgery (A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Abstract

BACKGROUND AND PURPOSE: Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR has been increasingly recognized after iodinated contrast medium exposure during angiographic procedures. The goal of this study was to assess the relationship of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR against various variables in patients following elective endovascular treatment of intracranial aneurysms.

MATERIALS AND METHODS: We performed a retrospective review of 58 patients with 62 MR imaging studies performed within 72 hours following endovascular treatment of intracranial aneurysms. Patient demographics, aneurysm location, and vascular territory distribution of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR were documented. Analysis of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR with iodinated contrast medium volume, procedural duration, number of angiographic runs, and DWI lesions was performed.

RESULTS: Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR was found in 32/62 (51.61%) post-endovascular treatment MR imaging studies, with complete resolution of findings in all patients on the available follow-up studies (27/27). Angiographic iodinated contrast medium injection and arterial anatomy matched the vascular distribution of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR. No significant association was found between cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR with iodinated contrast medium volume (P = .56 value) and the presence of DWI lesions (P = .68). However, a significant association was found with procedural time (P = .001) and the number of angiographic runs (P = .019). No adverse clinical outcomes were documented.

CONCLUSIONS: Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is a transient observation in the arterial territory exposed to iodinated contrast medium during endovascular treatment of intracranial aneurysms. Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is significantly associated with procedural time, and the frequency of angiographic runs suggesting a potential technical influence on the breakdown of the BBB, but no reported adverse clinical outcome or association with both iodinated contrast medium volume and DWI lesions was found. Recognition of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR as a benign incidental finding is vital to avoid unnecessary investigation.

ABBREVIATIONS:

ACA
anterior cerebral artery
CSHF
cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR
EVT
endovascular treatment
Gd-FLAIR
gadolinium-enhanced FLAIR
HARM
hyperintense acute reperfusion marker
ICM
iodinated contrast medium
IQR
interquartile range
PCA
posterior cerebral artery
VA
vertebral artery
  • © 2018 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 39 (4)
American Journal of Neuroradiology
Vol. 39, Issue 4
1 Apr 2018
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HARMless: Transient Cortical and Sulcal Hyperintensity on Gadolinium-Enhanced FLAIR after Elective Endovascular Coiling of Intracranial Aneurysms
S. Suthiphosuwan, C.C.-T. Hsu, A. Bharatha
American Journal of Neuroradiology Apr 2018, 39 (4) 720-726; DOI: 10.3174/ajnr.A5561

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HARMless: Transient Cortical and Sulcal Hyperintensity on Gadolinium-Enhanced FLAIR after Elective Endovascular Coiling of Intracranial Aneurysms
S. Suthiphosuwan, C.C.-T. Hsu, A. Bharatha
American Journal of Neuroradiology Apr 2018, 39 (4) 720-726; DOI: 10.3174/ajnr.A5561
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