The Role of 3 Tesla MRA in the Detection of Intracranial Aneurysms

Eftychia Z Kapsalaki, Christos D Rountas, Kostas N Fountas, Eftychia Z Kapsalaki, Christos D Rountas, Kostas N Fountas

Abstract

Intracranial aneurysms constitute a common pathological entity, affecting approximately 1-8% of the general population. Their early detection is essential for their prompt treatment. Digital subtraction angiography is considered the imaging method of choice. However, other noninvasive methodologies such as CTA and MRA have been employed in the investigation of patients with suspected aneurysms. MRA is a noninvasive angiographic modality requiring no radiation exposure. However, its sensitivity and diagnostic accuracy were initially inadequate. Several MRA techniques have been developed for overcoming all these drawbacks and for improving its sensitivity. 3D TOF MRA and contrast-enhanced MRA are the most commonly employed techniques. The introduction of 3 T magnetic field further increased MRA's sensitivity, allowing detection of aneurysms smaller than 3 mm. The development of newer MRA techniques may provide valuable information regarding the flow characteristics of an aneurysm. Meticulous knowledge of MRA's limitations and pitfalls is of paramount importance for avoiding any erroneous interpretation of its findings.

Figures

Figure 1
Figure 1
(a) 3D TOF MRA at 3 T at the level of the circle of Willis performed without MT or FS and without application of parallel imaging (ASSET). The scan time was 4 minutes and 53 seconds. Intraorbital fat signal is not completely compressed and is superimposed on the images, obscuring the visualization of the ophthalmic arteries. (b) 3D TOF MRA at 3 T at the level of the circle of Willis performed without MT but with FS and with the application of parallel imaging (ASSET). The scan time was 2 minutes and 34 seconds. Intraorbital fat signal is completely compressed, and only the arteries are clearly visualized. (c) 3D TOF MRA at 3 T at the level of the circle of Willis performed with MT, with FS, and with the application of parallel imaging (ASSET). The scan time was 2:03 min. The arteries are much clearly identified. All images clearly show the Acom aneurysm, but images with application of FS and MT are much clearer and required the shorter scan time.
Figure 2
Figure 2
3D TOF MRA at the level of the circle of Willis performed at 3 T with application of MT and FS clearly shows a very small (2 mm) aneurysm at the A1 segment. This finding was confirmed with the DSA.
Figure 3
Figure 3
(a) 3D TOF MRA performed at 3 T clearly shows the pericallosal aneurysm. However, MRA also shows the surrounding hemorrhage, which slightly obscured the images, even though the aneurysm is clearly depicted. (b) DSA clearly identifies the aneurysm without superimposed hemorrhage.

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