MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY IN DIAGNOSIS OF INTRACRANIAL ANEURYSMS Merhemic Z¹, Gavrankapetanovic F¹, Nikšić M¹, Avdagic E¹, Delic U¹, Kadenic Z¹, Thurnher MM². ¹ Clinical Centre University Sarajevo, Bosnia & Herzegovina ²University Clinic Vienna, Austria

Intracranial aneurysms  Lesions of adult  Present years  75% in female  Found in 1-7% of the population

MRI  is non invasive diagnostic method  No x ray radiation  3D TOF MRA without contrast administration an overview of brain blood vessels

 The aim of this study is to assess the value of evaluation of T2 sequences MRI and MR angiography :  3D TOF tomography and MIP algorithm for detection and characterisation of intracranial aneurysms,  using DSA as the ''gold standard''.

 102 patents  83 patients with ac.nontraumatic hemorrhage  60 (58,8%) female, 42 (41,2%)male  Range age years  Mean age 49,4 years

 1.0 T unit  T2TSE TR 2265 TE 98 (5mm)  3D TOF TR 34 TE 10 (1mm)  DSA was performed after  Two of reader independently interpreted and graded  T2 MRI, 3D TOF tomography and MIP reconstructions and DSA findings  for presence, location and size of aneurysms.

 102 patients 110 aneurysms  96 patients 1 aneurysm  4 patients 2 aneurysms  2 patients 3 aneurysms

Aneurysms diagnosed according to DSA Calibration (mm) >25 Total Localization No % ACA ,6 3 2, ,4 MCA 3 2, ,5 8 7, ,5 PCA , ,9 3 2,7 ICA ,9 10 9,1 9 8, ,2 VBA ,5 2 1,8 1 0,9 9 8,2 Total 14 12, , ,

Aneurysms diagnosed according to T2TSE Calibration (mm) >25 Total Localization No % ACA 3 2, ,9 3 2, ,4 MCA ,6 8 7, ,9 PCA , ,9 2 1,8 ICA ,5 10 9,1 9 8, ,8 VBA ,5 2 1,8 9 8,2 Total 3 2, , , , ,1

 Sensitivity T2 TSE  for all aneurysms  For aneurysms 3-5mm  6-12mm  > 12mm 1.00

Aneurysms diagnosed according to 3D TOF tomography Calibration (mm) >25 Total Localization No % ACA 6 5, ,8 3 2, MCA ,6 8 7, ,9 PCA , ,9 3 2,7 ICA ,2 10 9,1 9 8, ,5 VBA ,5 2 1,8 1 0,9 8 7,3 Total 6 5, , , ,4

 Sensitivity 3D TOF tomography  for all aneurysms  For aneurysms 3-5 mm  6-12mm  >12mm 1.00

Aneurysms diagnosed according to MIP reconstruction Calibration (mm) >25 Total Localization No % ACA 10 9, ,8 2 1, ,7 MCA 2 1, ,6 5 4, PCA , ,9 3 2,7 ICA ,4 8 7, ,6 VBA ,5 2 1,8 1 0,9 9 8,2 Total 12 10, , ,5 10 9, ,2

 Sensitivity of MIP reconstruction  for all aneurysms  For aneurysms 6-12mm  3-5mm  >12mm 0.909

Aneurysms diagnosed according to 3D TOF tomoraphy and MIP reconstruction Calibration (mm) >25 Total Localization No % ACA ,6 3 2, ,4 MCA 2 1, ,5 8 7, ,6 PCA , ,9 3 2,7 ICA , , ,2 VBA ,5 2 1,8 1 0,9 9 8,2 Total 13 11, , , ,1

 Sensitivity of 3D TOF tomography and MIP  for all aneurysms  For aneurysms 3-5mm  >6mm 1.00  One aneurysm that is diagnosed in this study is 3mm large at bifurcation of MCA

 For evaluation of large and giant aneurysms MRI and MRA is modality of choice  Gives exact size, location, relation to other structures, extension of intramural thrombus  DSA gives us information of lumen of aneurysm

Conclusion  At each MRI brain examination at the standard T2 seq. can be diagnosed the presence of aneurysms with sensitivity of 82,7%, and for aneurysms larger then 12mm 100%.

 Wildely applied evaluation MIP reconstruction of 3DTOF MR angiography is highly sensitive 87.3%  Evaluation of 3D TOF tomography with sensitivity of 86.4% for diagnose of presence, location and size of aneurysms

 It is of great importance to evaluate 3D TOF tomography together with MIP reconstruction gives a sensitivity of 99%