Background and purpose: The neuroradiologic location of asymptomatic paraclinoid aneurysms is decisive for patient management. In a preliminary study, we designed a paraclinoid MR protocol (PMP) including high-resolution T2-weighted images in 2 orthogonal planes to define the inferior limit of the distal dural ring plane that represents the borderline between the intradural and extradural internal carotid artery. In this clinical study, we compared this protocol with digital subtraction angiography (DSA) for the location of paraclinoid aneurysms.
Materials and methods: During a 3-year period, we performed PMP and conventional angiograms in 14 consecutive patients with 17 asymptomatic paraclinoid aneurysms. Ophthalmic (superior) aneurysms were excluded. Two independent observers reviewed MR imaging data, and a third experienced neuroradiologist analyzed the conventional angiograms. MR imaging and conventional angiograms were independently analyzed, and interpretations obtained with each technique were compared.
Results: PMP allowed correct visualization of the aneurysms in all patients. No significant differences (P >.05) were found between the DSA and PMP for the measurement of the aneurysmal neck or sac. Interobserver agreement was good. MR imaging was discordant with conventional angiography regarding the position around the cavernous sinus of the aneurysmal neck and sac in 5 cases. PMP images were helpful for treatment decisions in 4 cases.
Conclusion: PMP is an interesting tool that might be used in association with conventional angiography for the assessment of paraclinoid aneurysms.