Case Report
Ruptured Cerebral Microaneurysm Diagnosed by 3-Dimensional Fast Spin-Echo T1 Imaging with Variable Flip Angles

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.031Get rights and content

Cerebral microaneurysms, which are 2 mm or small in size, are a rare cause of subarachnoid hemorrhage (SAH). The authors present 2 cases with ruptured microaneurysms, in which 3-dimensional (3D) fast spin-echo T1 imaging with variable flip angles (CUBE T1) using gadolinium-diethylenetriaminepentaacetic acid (Gd) enhancement was useful in diagnosing the microaneurysms as the source of bleeding. Case 1 was a 61-year-old woman who had an SAH localized to the left Sylvian fissure. A small bulge (1.4 mm) at the bifurcation of left middle cerebral artery (MCA), which was detected by 3D angiography, was well enhanced by CUBE T1 with Gd enhancement. The patient was successfully treated by trapping of the lower division of the left M2 segment with superficial temporal artery–M3 bypass. The intraoperative findings indicated that the microaneurysm at the bifurcation of the left MCA was the ruptured site. Case 2 was a 41-year-old man who had a diffuse SAH. A small bulge (1.5 mm) at the inferolateral wall of the left internal carotid artery (ICA), which was detected by 3D angiography, was well enhanced by CUBE T1 with Gd enhancement. The patient was treated by trapping of the left ICA with external carotid artery–saphenous vein graft–M2 bypass without complications. The intraoperative findings indicated that the microaneurysm at the inferolateral wall of the left ICA was the ruptured site. CUBE T1 with Gd enhancement was useful as an adjunctive tool for the diagnosis of ruptured cerebral microaneurysms. This sequence might enable neurosurgeons to perform curative surgery with certainty for ruptured microaneurysms.

Section snippets

History and Examination

A 61-year-old woman presented with a 3-day history of persistent headaches with vomiting. Computed tomography showed SAH localized in the left Sylvian fissure (Fig 1, A). Conventional angiography did not detect any vascular lesion causing SAH (not shown). Three-dimensional rotational angiography showed a small bulge, 1.4 mm in maximum diameter, at the bifurcation of the left middle cerebral artery (MCA; Fig 1, B). CUBE T1 was acquired on a 3T magnetic resonance imaging scanner (Signa HDxt3.0T;

History and Examination

A 41-year-old man presented with complaints of sudden onset of severe headache. Computed tomography demonstrated diffuse SAH that was slightly preponderant in the left basal cistern (Fig 2, A). Conventional angiography did not detect any vascular lesions causing SAH (not shown). Three-dimensional rotational angiography showed a small bulge, 1.5 mm in maximum diameter, at the inferolateral wall of the nonbranching site of the left internal carotid artery (ICA; Fig 1, B). CUBE T1 with Gd

Discussion

Recently, magnetic resonance vessel wall imaging has been reported to be useful in detecting ruptured cerebral aneurysms.5, 6 In these reports, the ruptured aneurysms demonstrated vessel wall enhancement.5, 6 The present cases indicated that ruptured microaneurysms also demonstrated vessel wall enhancement by CUBE T1 sequence. Nagahata et al6 recently investigated precontrast and postcontrast 3-dimensional turbo spin-echo sequence with motion-sensitized driven equilibrium imaging of the 117

Conclusions

CUBE T1 with Gd enhancement is useful as an adjunctive tool for the diagnosis of ruptured cerebral microaneurysms. This sequence might enable neurosurgeons to perform curative surgery with certainty for ruptured microaneurysms.

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