[논문]High-Resolution Magnetic Resonance Imaging of Intracranial Vertebral Artery Dissecting Aneurysm for Planning of Endovascular Treatment

Chun, Dong Hyun; Kim, Sung Tae; Jeong, Young Gyun; Jeong, Hae Woong

doi:10.3340/jkns.2015.58.2.155

High-Resolution Magnetic Resonance Imaging of Intracranial Vertebral Artery Dissecting Aneurysm for Planning of Endovascular Treatment 원문보기

Journal of Korean Neurosurgical Society = 대한신경외과학회지, v.58 no.2, 2015년, pp.155 - 158

Chun, Dong Hyun (Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine) , Kim, Sung Tae (Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine) , Jeong, Young Gyun (Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine) , Jeong, Hae Woong (Department of Diagnostic Radiology, Busan Paik Hospital, Inje University College of Medicine)

Abstract ▼ AI-Helper

The equipment and techniques associated with magnetic resonance imaging (MRI) have rapidly evolved. The development of 3.0 Tesla MRI has enabled high-resolution imaging of the intracranial vessel wall. High-resolution MRI (HRMRI) can yield excellent visualization of both the arterial wall and lumen, thus facilitating the detection of the primary and secondary features of intracranial arterial dissection. In the present report, we describe the manner in which HRMRI affected our endovascular treatment planning strategy in 2 cases with unruptured intracranial vertebral artery dissection aneurysm. HRMRI provides further information about the vessel wall and the lumen of the unruptured intracranial vertebral artery dissecting aneurysm, which was treated by an endovascular approach in the 2 current cases.

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가설 설정

2. A : Computed tomography angiography indicates a dissecting aneurysm at the intradural segment of the left vertebral artery. The length of the dilated segment was 7.
1. A : Magnetic resonance angiography (time of flight image) indicates aneurysmal dilatation at the intradural segment (V4) of the right vertebral artery (arrow indicates the aneurysm). B : Digital subtraction angiography confirms the presence of aneurysmal dilatation at the same level (the hallow indicates the aneurysm).
5 mm (the arrow indicates the aneurysm). B : Digital subtraction angiography confirms the presence of a dissecting aneurysm at the same level with proximal stenosis (the arrow indicates the aneurysm). C : An axial image with a proton-density sequence at the level of the vertebral artery dissecting aneurysm obtained through high-resolution magnetic resonance imaging (HRMRI).
A : Magnetic resonance angiography (time of flight image) indicates aneurysmal dilatation at the intradural segment (V4) of the right vertebral artery (arrow indicates the aneurysm). B : Digital subtraction angiography confirms the presence of aneurysmal dilatation at the same level (the hallow indicates the aneurysm). The anterior spinal artery is incorporated into the aneurysmal sac (the arrow indicates the anterior spinal artery).
C : An axial image with a proton-density (PD) sequence at the level of the vertebral artery dissecting aneurysm (VADA) obtained through high-resolution magnetic resonance imaging (HRMRI). D : The PD sequence along the dotted line on C shows a long pseudolumen and intimal flap. The ostia of the anterior spinal artery and posterior inferior cerebellar artery are detected at the vertebral artery distal to the VADA (the white arrow indicates the ostium of the anterior spinal artery, whereas the black arrow indicates the ostium of the posterior inferior cerebellar artery).
C : An axial image with a proton-density sequence at the level of the vertebral artery dissecting aneurysm obtained through high-resolution magnetic resonance imaging (HRMRI). D : Three-dimensional rotation angiography and digital subtraction angiography of the left vertebral artery show a dissecting aneurysm (the arrow indicates the real inlet of the dissecting segment). E : HRMRI shows the hidden pseudolumen.
The ostia of the anterior spinal artery and posterior inferior cerebellar artery are detected at the vertebral artery distal to the VADA (the white arrow indicates the ostium of the anterior spinal artery, whereas the black arrow indicates the ostium of the posterior inferior cerebellar artery). E : Three-dimensional rotation angiography and digital subtraction angiography of the right vertebral artery show a dissecting aneurysm (arrows indicate the real inlet of the dissecting segment). F : HRMRI shows the hidden pseudolumen and intramural hematoma.
E : Three-dimensional rotation angiography and digital subtraction angiography of the right vertebral artery show a dissecting aneurysm (arrows indicate the real inlet of the dissecting segment). F : HRMRI shows the hidden pseudolumen and intramural hematoma. The length of the hidden pseudolumen was 9 mm, compared with that noted on digital subtraction angiography.

제안 방법

Stent-assisted coiling was then performed, using an Enterprise stent with a size of 4.5×28 mm and 9 detachable coils (length, 36 cm) (Fig. 2F).
Three-dimensional (3D) time-of-flight angiography (TOF) of the intracranial region was performed. The intracranial VADA that was identified by 3D TOF MRA, was subsequently assessed with HRMRI. A 3D MRA localizer was used to ensure that the cross-sectional images were perpendicular to the VADA.
The patients were placed in a neutral position for imaging with a 3-T MRI scanner (Achieva; Philips Healthcare, Best, The Netherlands) with a 32-channel head. Three-dimensional (3D) time-of-flight angiography (TOF) of the intracranial region was performed. The intracranial VADA that was identified by 3D TOF MRA, was subsequently assessed with HRMRI.

대상 데이터

A 37-year-old man presented with a sudden occipital headache. An unruptured intracranial VADA was detected on CTA and DSA.
A 49-year-old man presented with a sudden occipital headache. An unruptured intracranial VADA was detected on MRA and DSA (Fig.
The patients were placed in a neutral position for imaging with a 3-T MRI scanner (Achieva; Philips Healthcare, Best, The Netherlands) with a 32-channel head. Three-dimensional (3D) time-of-flight angiography (TOF) of the intracranial region was performed.

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