BACKGROUND AND PURPOSE: Cortical hyperdensity was observed in the immediate postembolization CT scans of some patients with intracranial aneurysms following uneventful endovascular treatments. The clinical significance and possible underlying mechanism were evaluated. MATERIAL AND METHODS: Ninety-three consecutive patients with a total of 100 intracranial aneurysms, treated by endosaccular packing, were studied. Seventy-four aneurysms were treated with balloon assistance, and the remaining aneurysms were treated without balloon assistance. All patients underwent cranial CT just before and immediately after the endovascular treatment. If the post-treatment CT showed any new finding, an immediate MR imaging and a repeat CT 4-6 hours after the initial posttreatment CT were performed. Several parameters were investigated related to the presence of cortical hyperdensity. RESULTS: Cranial CT showed focal cortical hyperdensity following the treatment of 40/74 aneurysms (54%) with balloon remodeling and 9/26 aneurysms (34.6%) without balloon assistance. None of these patients were symptomatic, and cortical hyperdensity resolved in the repeat CT scans. A statistically significant relationship was observed between the presence of this finding and the total amount of contrast material, microcatheter time, number of balloon inflations, and total balloon inflation time. CONCLUSION: Immediate postembolization CT may show focal cortical hyperdensity following uneventful endovascular aneurysm treatment, most likely caused by blood-brain barrier disruption resulting in accumulation of contrast medium. The hyperdensity was more frequent when balloon assistance was used but was also seen in the patients with no balloon use. It is important to differentiate this clinically insignificant finding from possible hemorrhage, which would affect patients' immediate postprocedural medical management.
BACKGROUND AND PURPOSE: Cortical hyperdensity was observed in the immediate postembolization CT scans of some patients with intracranial aneurysms following uneventful endovascular treatments. The clinical significance and possible underlying mechanism were evaluated. MATERIAL AND METHODS: Ninety-three consecutive patients with a total of 100 intracranial aneurysms, treated by endosaccular packing, were studied. Seventy-four aneurysms were treated with balloon assistance, and the remaining aneurysms were treated without balloon assistance. All patients underwent cranial CT just before and immediately after the endovascular treatment. If the post-treatment CT showed any new finding, an immediate MR imaging and a repeat CT 4-6 hours after the initial posttreatment CT were performed. Several parameters were investigated related to the presence of cortical hyperdensity. RESULTS: Cranial CT showed focal cortical hyperdensity following the treatment of 40/74 aneurysms (54%) with balloon remodeling and 9/26 aneurysms (34.6%) without balloon assistance. None of these patients were symptomatic, and cortical hyperdensity resolved in the repeat CT scans. A statistically significant relationship was observed between the presence of this finding and the total amount of contrast material, microcatheter time, number of balloon inflations, and total balloon inflation time. CONCLUSION: Immediate postembolization CT may show focal cortical hyperdensity following uneventful endovascular aneurysm treatment, most likely caused by blood-brain barrier disruption resulting in accumulation of contrast medium. The hyperdensity was more frequent when balloon assistance was used but was also seen in the patients with no balloon use. It is important to differentiate this clinically insignificant finding from possible hemorrhage, which would affect patients' immediate postprocedural medical management.
Authors: H Okazaki; K Tanaka; T Shishido; H Nagase; M Hoshino; S Takebayashi; O Endoh; Y Takamura Journal: J Comput Assist Tomogr Date: 1989 Sep-Oct Impact factor: 1.826
Authors: E Michel; H Liu; K B Remley; A J Martin; M T Madison; J Kucharczyk; C L Truwit Journal: AJNR Am J Neuroradiol Date: 2001-09 Impact factor: 3.825
Authors: Marlise Peruzzo dos Santos Souza; Ronit Agid; Robert A Willinsky; Michael Cusimano; Walter Montanera; M Christopher Wallace; Karel G terBrugge; Thomas R Marotta Journal: Can J Neurol Sci Date: 2005-02 Impact factor: 2.104
Authors: Jeffrey M Katz; Apostolos J Tsiouris; Alessandra Biondi; Kimberly A Salvaggio; Igor Ougorets; Philip E Stieg; Howard A Riina; Y Pierre Gobin Journal: Neuroradiology Date: 2005-07-19 Impact factor: 2.804
Authors: Yuichi Murayama; Yih Lin Nien; Gary Duckwiler; Y Pierre Gobin; Reza Jahan; John Frazee; Neil Martin; Fernando Viñuela Journal: J Neurosurg Date: 2003-05 Impact factor: 5.115
Authors: Isil Saatci; H Saruhan Cekirge; Elisa F M Ciceri; Michel E Mawad; A Gulsun Pamuk; Aytekin Besim Journal: AJNR Am J Neuroradiol Date: 2003-04 Impact factor: 3.825
Authors: Y Shinohara; M Sakamoto; H Takeuchi; T Uno; T Watanabe; T Kaminou; T Ogawa Journal: AJNR Am J Neuroradiol Date: 2012-08-16 Impact factor: 3.825
Authors: T A Tomsick; L D Foster; D S Liebeskind; M D Hill; J Carrozella; M Goyal; R von Kummer; A M Demchuk; I Dzialowski; V Puetz; T Jovin; H Morales; Y Y Palesch; J Broderick; P Khatri; S D Yeatts Journal: AJNR Am J Neuroradiol Date: 2015-07-30 Impact factor: 3.825
Authors: Francesco Diana; Maria Di Gregorio; Giulia Frauenfelder; Renato Saponiero; Daniele Giuseppe Romano Journal: Neuroradiology Date: 2021-03-24 Impact factor: 2.804