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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Contrast enhancement special sequence MRI of the aneurysm wall can be a predictor to treat

Meeting Abstract

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  • Athanasios K. Petridis - Heinrich Heine University Duesseldorf, Department of Neurosurgery, Duesseldorf, Deutschland
  • Jan Frederick Cornelius - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich Heine Universität, Duesseldorf, Deutschland
  • Hans-Jakob Steiger - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Bernd Turowski - Uniklinik Düsseldorf, Radiologie, Neuroradiologie, Düsseldorf, Deutschland
  • Rebecca May - Institut für Diagnostische und Interventionelle Radiologie, Dormagen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.13.04

doi: 10.3205/17dgnc073, urn:nbn:de:0183-17dgnc0730

Published: June 9, 2017

© 2017 Petridis et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: There is still controversy on when to treat a cerebral aneurysm. Size, shape etc. are factors which influence the treatment decision. However additional factors like inflammation of the aneurysm wall are still to be evaluated. With contrast enhancing MRI there is the possibility to identify such aneurysm wall inflammation and to specify if this inflammation could indicate a risk of rupture.

Methods: Eight patients with cerebral aneurysms were evaluated with a black blood sequence MRI with contrast enhancement (CE) to identify any contrast enhancing areas in the aneurysm wall. The blood signal in this MRI sequence is suppressed and the contrast enhancement in the aneurysm wall is well visualized. The patients were treated in our hospital in 2016.

Results: Of the eight patients (mean age: 53 years) one patient suffered a subarachnoid haemorrhage and received the MRI after stent and coil embolization. The rest of the patients (N=7) received the MRI imaging before treatment. Three patients were treated conservatively. One patient with a giant MCA aneurysm (3 cm) who was moribund and could not be treated (82 y.o.) is under MRI controls for 2 years and has no progression of his aneurysm nor has he a CE of the aneurysm wall. A second patient with MCA aneurysms (mirror aneurysms) did not receive treatment since the aneurysms are < 5mm. Both aneurysms show no CE in their walls and no progression in the last 12 months. The third patient has a fusiform aneurysm of the PICA and in the first MRI the wall of the aneurysm was strongly CE positive. After Aspirin (ASS 100 mg) the CE in the aneurysm wall was decreasing and the aneurysm size was regressive (in 2 months follow up). Four patients received endovascular treatment. In all four patients the aneurysms were > 8 mm and showed a CE in their walls. In two cases there was an aneurysm growth in the time of 2 months.

Conclusion: Although the data are preliminary there is a CE in the aneurysm wall in aneurysms which grow and in aneurysms > 8 mm. In aneurysms of stable size there was no CE in their walls. CE could become a predictor for aneurysm growth and a parameter for the decision to treat a cerebral aneurysm.