Combined Susceptibility-Weighted Imaging and Vessel Wall Imaging of Unruptured Intracranial Aneurysms Presenting with Sentinel Headache

Background:The combinational assessment of susceptibility-weighted imaging and vessel wall imaging on magnetic resonance imaging (MRI) in patients of unruptured intracranial aneurysms presenting with sentinel headache can show microbleeds and inflammatory changes in the wall of the aneurysms and thus predict the future risk of rupture of the aneurysm. In this pilot study, we hypothesized that combination of vessel wall imaging and susceptibility-weighted imaging would be more informative to assess the changes in the wall of aneurysm in patients with sentinel headache. Materials and Methods:Fifteen patients of intracranial aneurysms with history of sentinel headache underwent advanced MRI. Susceptibility-weighted imaging images were evaluated for presence of any hypointensity suggestive of microbleeds along the wall of the aneurysm. The postcontrast vessel wall images were evaluated for presence of any wall enhancement. Results:Susceptibility foci suggestive of microbleeds on susceptibility-weighted imaging in the wall of the aneurysms were seen in 14 intracranial aneurysms. Vessel wall imaging showed enhancement of wall in 10 cases and nonenhancement in five cases. Enhancement of the wall on MRI was observed more in aneurysms imaged early after the onset of symptoms (<45 days) than in those imaged late (>45 days). Conclusion:Our observations might be indicative of temporally evolving pathologic changes in the aneurysmal wall in unruptured aneurysms with sentinel headache. Combining advanced magnetic resonance sequences can help in elucidation of the wall pathology and rupture risk assessment of unruptured aneurysms, and these observations could be incorporated in future studies.