Differentiation between intradural and extradural locations of juxta-dural ring aneurysms by using contrast-enhanced 3-dimensional time-of-flight magnetic resonance angiography

• Published in: Surgical neurology Vol. 67; no. 4; pp. 381 - 387
• Main Authors: Tsuboi, Toshiyuki, MD, Tokunaga, Koji, MD, Shingo, Tetsuro, MD, Itoh, Takahiko, MD, Mandai, Shinya, MD, Kinugasa, Kazushi, MD, Date, Isao, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2007; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Carotid Artery, Internal; Cavernous sinus; Contrast Media; Contrast-enhanced MRA; Diagnosis, Differential; Dura Mater; Extradural aneurysm; Female; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - surgery; Intradural aneurysm; Juxta-dural ring aneurysm; Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Neurology; Neurosurgery; Reproducibility of Results; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time-of-flight MRA; volume rendering; Contrast-enhanced MRA; fast spin echo; SHA; MPR; 3-D CTA; carotico-oculomotor membrane; cavernous sinus; DSA; Intradural aneurysm; echo time; FSE; repetition time; spoiled gradient-recalled acquisition in the steady state; Juxta-dural ring aneurysm; computed tomography angiography; TOF; FOV; field of view; SPGR; three-dimensional CTA; MIP; cerebrospinal fluid; time-of-flight; SAH; VR; contrast-to-noise ratio; magnetization transfer contrast; CNR; Extradural aneurysm; CSF; RF coil; internal carotid artery; COM; S sat pulse; Time-of-flight MRA; ICA; CE-MRA; digital subtraction angiography; maximum intensity projection; superior hypophyseal artery; CS; CTA; radiofrequency coil; TE; multiplanar reconstruction; subarachnoid hemorrhage; superior saturation pulse; contrast-enhanced magnetic resonance angiography; MTC; TR; Cavernous sinus; Nervous system diseases; Flight; Aneurysm; Cardiovascular disease; Intradural; Vascular disease; Extradural; Ring; Surgery; Dura mater; NMR angiography
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2006.08.006

Background Juxta-dural ring aneurysms of the ICA have different clinical outcomes and risks for SAH, which are dependent on their position in the intradural or extradural space. The aim of this study was to reveal the precise location of such aneurysms by using CE-MRA. Methods Contrast-enhanced MRA studies were performed in 21patients with 24 juxta-dural ring aneurysms. The locations were evaluated by source images of CE-MRA and MPR images. We evaluated the accuracy of preoperative MRI findings by comparing imaging results with intraoperative findings in 7 cases. Results The CS was clearly enhanced in the CE-MRA technique, which allowed the precise identification of these aneurysms as intradural or extradural. Intracavernous aneurysms were diagnosed when the greater hyperintensity of the aneurysm was located within the less hyperintense region of the contrast-enhanced CS. Nine of the cases were diagnosed as intradural aneurysms, and 15 aneurysms were noted as extradural based on the findings of CE-MRA. Surgery was performed in 7 cases, which included 4 intradural and 3 extradural aneurysms, and the preoperative MRI findings corresponded with the intraoperative findings in all cases. Conclusion Contrast-enhanced MRA and MPR are very useful techniques for determining the location of juxta-dural ring aneurysms.