1. 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

2. Intracranial aneurysms  Lesions of adult  Present 40-60 years  75% in female  Found in 1-7% of the population

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

4.  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''.

5.  102 patents  83 patients with ac.nontraumatic hemorrhage  60 (58,8%) female, 42 (41,2%)male  Range age 12-76 years  Mean age 49,4 years

6.  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.

7.  102 patients 110 aneurysms  96 patients 1 aneurysm  4 patients 2 aneurysms  2 patients 3 aneurysms

8. Aneurysms diagnosed according to DSA Calibration (mm) 3-5 6-1213-25>25 Total Localization No % ACA11 10 15 13,6 3 2,7 0 0 29 26,4 MCA 3 2,7 27 24,5 8 7,3 0 0 38 34,5 PCA 0 0 2 1,8 0 0 1 0,9 3 2,7 ICA 0 0 12 10,9 10 9,1 9 8,2 31 28,2 VBA 0 0 6 5,5 2 1,8 1 0,9 9 8,2 Total 14 12,7 62 56,4 23 20,9 11 10 110 100

9. Aneurysms diagnosed according to T2TSE Calibration (mm) 3-5 6-1213-25>25 Total Localization No % ACA 3 2,7 12 10,9 3 2,7 0 0 18 16,4 MCA 0 0 26 23,6 8 7,3 0 0 34 30,9 PCA 0 0 1 0,9 0 0 1 0,9 2 1,8 ICA 0 0 5 4,5 10 9,1 9 8,2 24 21,8 VBA 0 0 5 4,5 2 1,8 9 8,2 Total 3 2,7 49 44,5 23 20,9 12 10,9 87 79,1

10.  Sensitivity T2 TSE  for all aneurysms 0.827  For aneurysms 3-5mm 0.520  6-12mm 0.820  > 12mm 1.00

11. Aneurysms diagnosed according to 3D TOF tomography Calibration (mm) 3-5 6-1213-25>25 Total Localization No % ACA 6 5,5 13 11,8 3 2,7 0 0 22 20 MCA 0 0 26 23,6 8 7,3 0 0 34 30,9 PCA 0 0 2 1,8 0 0 1 0,9 3 2,7 ICA 0 0 9 8,2 10 9,1 9 8,2 28 25,5 VBA 0 0 5 4,5 2 1,8 1 0,9 8 7,3 Total 6 5,5 55 49,9 23 20,9 11 10 95 86,4

12.  Sensitivity 3D TOF tomography  for all aneurysms 0.864  For aneurysms 3-5 mm 0.603  6-12mm 0.887  >12mm 1.00

13. Aneurysms diagnosed according to MIP reconstruction Calibration (mm) 3-5 6-1213-25>25 Total Localization No % ACA 10 9,1 13 11,8 2 1,8 0 0 25 22,7 MCA 2 1,8 26 23,6 5 4,5 0 0 33 30 PCA 0 0 2 1,8 0 0 1 0,9 3 2,7 ICA 0 0 11 10 7 6,4 8 7,3 26 23,6 VBA 0 0 6 5,5 2 1,8 1 0,9 9 8,2 Total 12 10,9 58 52,7 16 14,5 10 9,1 96 87,2

14.  Sensitivity of MIP reconstruction  for all aneurysms 0.873  For aneurysms 6-12mm 0.935  3-5mm 0.859  >12mm 0.909

15. Aneurysms diagnosed according to 3D TOF tomoraphy and MIP reconstruction Calibration (mm) 3-5 6-1213-25>25 Total Localization No % ACA 11 10 15 13,6 3 2,7 0 0 29 26,4 MCA 2 1,8 27 24,5 8 7,3 0 0 37 33,6 PCA 0 0 2 1,8 0 0 1 0,9 3 2,7 ICA 0 0 12 10,9 10 9 9 8,2 31 28,2 VBA 0 0 6 5,5 2 1,8 1 0,9 9 8,2 Total 13 11,8 62 56,4 23 20,9 11 10 109 99,1

16.  Sensitivity of 3D TOF tomography and MIP  for all aneurysms 0.991  For aneurysms 3-5mm 0.929  >6mm 1.00  One aneurysm that is diagnosed in this study is 3mm large at bifurcation of MCA

17.  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

18. 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%.

19.  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

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