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3-T Contrast-Enhanced MR Angiography in Evaluation of Suspected Intracranial Aneurysm: Comparison with MDCT Angiography

¹ Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, 10945 Le Conte Ave., Suite 3371, Los Angeles, CA 90095-7206.
² Siemens Medical Solutions, Malvern, PA.

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —27-year-old woman with exacerbated chronic headache. Coronal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (B and D) show small 2.3 x 2.1 x 2.4 mm (transverse x anteroposterior x craniocaudal) aneurysm arising from cavernous portion of right internal carotid artery. Aneurysm was detected by both readers on contrast-enhanced MR angiography but was not identified initially on CT angiograms by reader 2. Subsequent analysis of data set revealed that aneurysm (arrow) was clearly present on CT angiograms but was overlooked during initial reading.

View larger version (69K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —27-year-old woman with exacerbated chronic headache. Coronal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (B and D) show small 2.3 x 2.1 x 2.4 mm (transverse x anteroposterior x craniocaudal) aneurysm arising from cavernous portion of right internal carotid artery. Aneurysm was detected by both readers on contrast-enhanced MR angiography but was not identified initially on CT angiograms by reader 2. Subsequent analysis of data set revealed that aneurysm (arrow) was clearly present on CT angiograms but was overlooked during initial reading.

View larger version (50K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —27-year-old woman with exacerbated chronic headache. Coronal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (B and D) show small 2.3 x 2.1 x 2.4 mm (transverse x anteroposterior x craniocaudal) aneurysm arising from cavernous portion of right internal carotid artery. Aneurysm was detected by both readers on contrast-enhanced MR angiography but was not identified initially on CT angiograms by reader 2. Subsequent analysis of data set revealed that aneurysm (arrow) was clearly present on CT angiograms but was overlooked during initial reading.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —27-year-old woman with exacerbated chronic headache. Coronal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (B and D) show small 2.3 x 2.1 x 2.4 mm (transverse x anteroposterior x craniocaudal) aneurysm arising from cavernous portion of right internal carotid artery. Aneurysm was detected by both readers on contrast-enhanced MR angiography but was not identified initially on CT angiograms by reader 2. Subsequent analysis of data set revealed that aneurysm (arrow) was clearly present on CT angiograms but was overlooked during initial reading.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —35 year-old woman with history of fibromuscular dysplasia. Coronal maximum-intensity-projection image obtained in 20 seconds at contrast-enhanced MR angiography shows all supraaortic arteries.

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —35 year-old woman with history of fibromuscular dysplasia. Coronal (B and D) and sagittal (C and E) maximum-intensity-projection images from contrast-enhanced MR angiography (B and C) and CT angiography (D and E) show three aneurysms including one saccular aneurysm (arrowhead, B and D) at distal right middle cerebral artery (M2 segment), one saccular aneurysm (large arrow, B and D) at left anterior cerebral artery (A2 segment), and one fusiform aneurysm (small arrow, C and E) at tip of basilar artery. CT angiography was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was performed with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —35 year-old woman with history of fibromuscular dysplasia. Coronal (B and D) and sagittal (C and E) maximum-intensity-projection images from contrast-enhanced MR angiography (B and C) and CT angiography (D and E) show three aneurysms including one saccular aneurysm (arrowhead, B and D) at distal right middle cerebral artery (M2 segment), one saccular aneurysm (large arrow, B and D) at left anterior cerebral artery (A2 segment), and one fusiform aneurysm (small arrow, C and E) at tip of basilar artery. CT angiography was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was performed with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —35 year-old woman with history of fibromuscular dysplasia. Coronal (B and D) and sagittal (C and E) maximum-intensity-projection images from contrast-enhanced MR angiography (B and C) and CT angiography (D and E) show three aneurysms including one saccular aneurysm (arrowhead, B and D) at distal right middle cerebral artery (M2 segment), one saccular aneurysm (large arrow, B and D) at left anterior cerebral artery (A2 segment), and one fusiform aneurysm (small arrow, C and E) at tip of basilar artery. CT angiography was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was performed with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —35 year-old woman with history of fibromuscular dysplasia. Coronal (B and D) and sagittal (C and E) maximum-intensity-projection images from contrast-enhanced MR angiography (B and C) and CT angiography (D and E) show three aneurysms including one saccular aneurysm (arrowhead, B and D) at distal right middle cerebral artery (M2 segment), one saccular aneurysm (large arrow, B and D) at left anterior cerebral artery (A2 segment), and one fusiform aneurysm (small arrow, C and E) at tip of basilar artery. CT angiography was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was performed with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —30-year-old woman with history of headache. Sagittal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (CTA) (B and D) show fusiform aneurysm at right posterior Sylvian branches (M3) measuring 4.3 x 4.2 x 9 mm (transverse x anteroposterior x craniocaudal) detected by both reviewers on contrast-enhanced MR angiography and CTA. CTA was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was acquired with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —30-year-old woman with history of headache. Sagittal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (CTA) (B and D) show fusiform aneurysm at right posterior Sylvian branches (M3) measuring 4.3 x 4.2 x 9 mm (transverse x anteroposterior x craniocaudal) detected by both reviewers on contrast-enhanced MR angiography and CTA. CTA was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was acquired with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —30-year-old woman with history of headache. Sagittal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (CTA) (B and D) show fusiform aneurysm at right posterior Sylvian branches (M3) measuring 4.3 x 4.2 x 9 mm (transverse x anteroposterior x craniocaudal) detected by both reviewers on contrast-enhanced MR angiography and CTA. CTA was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was acquired with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —30-year-old woman with history of headache. Sagittal oblique 2D multiplanar reformation and 3D volume-rendered projections from contrast-enhanced MR angiography (A and C) and CT angiography (CTA) (B and D) show fusiform aneurysm at right posterior Sylvian branches (M3) measuring 4.3 x 4.2 x 9 mm (transverse x anteroposterior x craniocaudal) detected by both reviewers on contrast-enhanced MR angiography and CTA. CTA was performed with 0.35 x 0.35 x 0.8 mm voxels in 17 seconds. MR angiography was acquired with 0.7 x 0.7 x 0.8 mm voxels in 20 seconds.

View larger version (64K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —60-year-old woman with headache and visual disturbance. Coronal oblique 3D volume-rendered projections from contrast-enhanced MR angiography (A) and CT angiography (B) show small (1.3 x 2.1 mm [anteroposterior x transverse]) saccular aneurysm (arrow) at anterior communicating artery. Three A2 branches are present, one of which arises from aneurysm (arterial incorporation).

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —60-year-old woman with headache and visual disturbance. Coronal oblique 3D volume-rendered projections from contrast-enhanced MR angiography (A) and CT angiography (B) show small (1.3 x 2.1 mm [anteroposterior x transverse]) saccular aneurysm (arrow) at anterior communicating artery. Three A2 branches are present, one of which arises from aneurysm (arterial incorporation).

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Scatterplot shows significant correlation (r = 0.94; 95% CI, 0.92–0.97) for aneurysm dimension measurements between CT angiography and contrast-enhanced MR angiography.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Bland-Altman plot shows differences of no more than 1 mm between aneurysm dimension measurements on contrast-enhanced MR angiography and measurements on CT angiography.

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