J Korean Neurosurg Soc.  2015 Aug;58(2):155-158. 10.3340/jkns.2015.58.2.155.

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

• Chun DH
• Kim ST
• Jeong YG
• Jeong HW

• KMID: 2191327
• DOI: http://doi.org/10.3340/jkns.2015.58.2.155

Abstract

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.

Keyword

Aneurysm; Dissecting; Vertebral Artery; Magnetic resonance imaging

MeSH Terms

Aneurysm
Aneurysm, Dissecting*
Magnetic Resonance Imaging*
Vertebral Artery Dissection
Vertebral Artery*

Figure

• 

  Fig. 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). 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). 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. G : Double-stenting was performed (white arrows indicate the distal markers of the first deployed stent, whereas black arrows indicate the distal markers of the second deployed stent).

• 

  Fig. 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 7.5 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). 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 length of the hidden pseudolumen was 7 mm, compared with that noted on digital subtraction angiography. Furthermore, the hidden pseudolumen and intramural hematoma were located on the opposite side of the dissecting aneurysm that was identified on angiography. F : Angiography after stent-assisted coiling in the working angle indicates a relatively well-preserved vertebral artery.

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