Is Conventional Angiography Always Superior to MR Angiography in Evaluatin of Cerebral Aneurysm?

ABSTRACT

Conventional angiography still remains the procedure of choice in evaluation of cerebral aneurysm. However, MRI and MR angiography can play different roles in vizualizing cerebral aneurysm. A 43-year-old male was evaluated for recurrent seizure attacks. The brain MRI showed non-enhancing iso-signal mass on T1WI, signal voiding mass with stalk-like structure on coronal T2WI in the right temporal region. MRA also revealed dark round signal. However, the conventional cerebral angiography failed to visualize it. Finally, the mass was confirmed as a huge aneurysm filled with intraluminal thrombus on operation. It should seem that contrast media could not fill the aneurysmal sac because of intraluminal thrombus in conventional angiography. But aneurysmal sac seemed to be visible on MRA as paramagnetic artifact of thrombus. So, it can be assumed that MRA is superior to the conventional angiography in some cases of cerebral aneurysm, especially when it is associated with intraluminal thrombus.