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Wall enhancement patterns of thrombosed intracranial aneurysms in 7T MRI – insights into pathophysiology of aneurysm stability
Kontrastmittelaufnahme der Wand thrombosierter intrazerebraler Aneurysmata im 7T MRT – Einblicke in die Pathophysiologie der Aneurysmastabilität
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Veröffentlicht: | 8. Mai 2019 |
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Objective: To assess gadolinium contrast wall enhancement patterns of thrombosed intracranial aneurysms using in-vivo 7 Tesla MRI in correlation with histopathological findings.
Methods: The study group comprised 13 patients (14 aneurysms) who were recruited between January 2011 and October 2018. Images were acquired on a 7T whole-body MRI system (Magnetom Siemens Healthcare, Erlangen, Germany) equipped with a 32-channel Tx/Rx head coil (Nova Medical, Wilmington, USA). The scanner is equipped with a gradient system of 45 mT/m maximum amplitude and a slew rate of 200 mT/m/ms. Pulse sequences included dedicated high resolution MPRAGE, TOF and T2-TSE sequences before and after intravenous gadolinium contrast application. Two experienced raters assessed the wall enhancement patterns and perifocal edema in consensus reading. The correlation between imaging characteristics and histopathology (H&E, EVG, Prussian Blue and CD 68) was evaluated in 4 cases.
Results: All aneurysms showed wall enhancement adjacent to the thrombus. Additional wall enhancement adjacent to the cortex (double rim) was seen in cases with perifocal edema (n=7). Histopathology suggested that neovascularization of the intima and the interface between the inner wall and the thrombus caused the inner contrast enhancement seen in all cases. Vasa vasorum and macropahge infiltration into the adventitia correlated with outer layer wall enhancement. Extent of perifocal edema was also associated with extent of outer layer wall enhancement.
Conclusion: In-vivo gadolinium enhanced 7T MRI can visualize distinct wall enhancement patterns in thrombosed intracranial aneurysms and allows insights into pathophysiology of aneurysm instability known from histopathology.
Figure 1 [Fig. 1]