Clinical Neuroradiology

, Volume 27, Issue 2, pp 175–183 | Cite as

High-Resolution Vessel Wall Magnetic Resonance Imaging in Angiogram-Negative Non-Perimesencephalic Subarachnoid Hemorrhage

  • J. M. Coutinho
  • R. H. Sacho
  • J. D. Schaafsma
  • R. Agid
  • T. Krings
  • I. Radovanovic
  • C. C. Matouk
  • D. J. Mikulis
  • D. M. Mandell
Original Article



Standard magnetic resonance imaging (MRI) rarely identifies the cause of hemorrhage in patients with an angiogram-negative, non-perimesencephalic subarachnoid hemorrhage (SAH). Yet up to 10 % of these patients have recurrent hemorrhage. The aim of the study was to explore the potential role of high-resolution contrast-enhanced 3-Tesla vessel wall-MRI in patients with angiogram-negative SAH.


We performed intracranial vessel wall-MRI of the circle of Willis using a 3-Tesla scanner in consecutive patients presenting with a spontaneous, angiogram-negative, non-perimesencephalic SAH. Vessel wall-MRI included T1-, T2-, and gadolinium-enhanced T1-weighted two-dimensional black-blood sequences in multiple planes (voxel size 0.4 × 0.4 × 2.0 mm). Two neuroradiologists independently scored abnormalities of the arterial wall.


In all, 11 patients (mean age 59 years) underwent vessel wall-MRI. A total of seven patients had vessel wall abnormalities despite normal catheter angiography. Two patients had focal abnormalities contiguous with the outer margin of the basilar artery wall for which we considered a differential of ruptured blood blister aneurysm, thrombosed aneurysm, and loculated extramural blood from elsewhere. Two patients had arterial wall enhancement involving multiple arteries, possibly secondary to SAH. Three patients had arterial wall enhancement at sites of dural penetration, remote from the SAH, likely related to age and atherosclerotic risk factors. Vessel wall-MRI did not alter patient management in this cohort.


Vessel wall-MRI showed abnormalities in seven patients with angiogram-negative SAH. These findings did not alter patient management, but the findings may be useful for other physicians who choose to perform vessel wall-MRI in this patient population.


Subarachnoid Hemorrhage Intracranial aneurysm Magnetic resonance imaging High-resolution vessel wall magnetic resonance imaging 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • J. M. Coutinho
    • 1
  • R. H. Sacho
    • 1
  • J. D. Schaafsma
    • 2
  • R. Agid
    • 1
  • T. Krings
    • 1
  • I. Radovanovic
    • 3
  • C. C. Matouk
    • 4
  • D. J. Mikulis
    • 1
  • D. M. Mandell
    • 1
  1. 1.Division of Neuroradiology, Department of Medical ImagingToronto Western Hospital, University Health Network and the University of TorontoTorontoCanada
  2. 2.Division of Neurology, Department of MedicineUniversity Health Network and the University of TorontoTorontoCanada
  3. 3.Division of Neurosurgery, Department of SurgeryUniversity Health Network and the University of TorontoTorontoCanada
  4. 4.Departments of Diagnostic Radiology and NeurosurgeryYale University School of MedicineNew HavenUSA

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