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A Diagnostic Pitfall for Intracranial Aneurysms in Time-of-Flight MR Angiography: Small Intracranial Lipomas

Andre Kemmling1, Ingo Noelte1, Lars Gerigk1, Stephan Singer2, Christoph Groden1 and Johann Scharf1

1 Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
2 Institute of Pathology, University of Heidelberg, Heidelberg, Germany.


Figure 1
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  		Fig. 1A —57-year-old man with headache who was referred for workup of suspected basilar aneurysm (case 8, Table 1). Small hyperintense lesion (arrowhead) adjacent to tip of basilar artery is displayed on time-of-flight MR angiogram. Lesion was surrounded by dark and unbroken rim.

 

Figure 2
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  		Fig. 1B —57-year-old man with headache who was referred for workup of suspected basilar aneurysm (case 8, Table 1). On fat-saturated T1-weighted MR image, small interpeduncular lipoma (arrowhead) is revealed by signal loss.

 

Figure 3
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  		Fig. 2A —44-year-old man with vertigo and headache who was referred for digital subtraction angiography of suspected basilar aneurysm on MRI (case 9, Table 1). Time-of-flight source image shows small hyperintense lesion (arrowhead) with dark rim adjacent to tip of basilar artery.

 

Figure 4
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  		Fig. 2B —44-year-old man with vertigo and headache who was referred for digital subtraction angiography of suspected basilar aneurysm on MRI (case 9, Table 1). CT scan obtained after A reveals small interpeduncular lipoma (arrowhead).

 

Figure 5
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  		Fig. 3A —64-year-old man with vertigo and headache who was referred for digital subtraction angiography of suspected aneurysm on MR angiography (MRA) (case 10, Table 1). Time-of-flight MRA source image shows small hyperintense lesion (arrowhead) surrounded by dark rim close to left posterior vasculature.

 

Figure 6
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  		Fig. 3B —64-year-old man with vertigo and headache who was referred for digital subtraction angiography of suspected aneurysm on MR angiography (MRA) (case 10, Table 1). Cranial CT image confirms lipid density of small quadrigeminal lipoma (arrowhead).

 

Figure 7
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  		Fig. 4A —Time-of-flight (TOF) images of excised fatty cadaveric specimen in saline solution. In vitro out-of-phase images (TE, 7 ms) show consistent and unbroken dark fringe surrounding lipomas (A) and appendices epiploicae (B) known as "india ink artifact." Asterisks in A show specimen lacking fibrous capsule.

 

Figure 8
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  		Fig. 4B —Time-of-flight (TOF) images of excised fatty cadaveric specimen in saline solution. In vitro out-of-phase images (TE, 7 ms) show consistent and unbroken dark fringe surrounding lipomas (A) and appendices epiploicae (B) known as "india ink artifact." Asterisks in A show specimen lacking fibrous capsule.

 

Figure 9
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  		Fig. 4C —Time-of-flight (TOF) images of excised fatty cadaveric specimen in saline solution. On in-phase images (TE, 5 ms) corresponding to A and B, chemical shift artifact, which is variable depending on orientation of lipid-water interface, remains.

 

Figure 10
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  		Fig. 4D —Time-of-flight (TOF) images of excised fatty cadaveric specimen in saline solution. On in-phase images (TE, 5 ms) corresponding to A and B, chemical shift artifact, which is variable depending on orientation of lipid-water interface, remains.

 

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