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Reply: REPLY: hancement already visible on conventional sequences (and there- fore potentially related to a “true” enhancement of the wall). e thank our colleagues for their comments about our re- A better understanding of the factors likely to promote slow- Wcent article, “Blood Flow Mimicking Aneurysmal Wall En- flowing blood near the aneurysmal wall (such as the size of the hancement: A Diagnostic Pitfall of Vessel Wall MRI Using the aneurysm?) also appears important. In our opinion, the real abil- Postcontrast 3D Turbo Spin-Echo MR Imaging Sequence.” ity of the 3D-TSE sequence to assess arterial wall inflammation Black-blood techniques such as motion-sensitized driven remains uncertain because we cannot formally exclude residual equilibrium or delay alternating with nutation for tailored excita- slow-flowing blood (even including the additional black-blood tion (DANTE) offer new perspectives for a better understanding technique). Further studies are required to evaluate alternative/ of the nature of intracranial aneurysm enhancement. In our ex- complementary MR sequences less sensitive to flow artifacts and perience, flow-related artifacts are frequently encountered using with a higher spatial resolution. the postcontrast 3D-TSE sequence for a wide range of incidental We hope that this discussion will encourage other teams to aneurysms (at the center of the aneurysmal cavity but also in continue evaluating the circumferential wall enhancement of contact with the wall of the aneurysm). It is now clear that the intracranial aneurysms, which remains a particularly complex slow-flowing blood near the aneurysmal wall may represent all or entity. part of the visible enhancement using conventional 3D-TSE se- quences. Such findings raise the question of the relevance of this parameter for the management of asymptomatic patients. REFERENCE The relationship among contrast enhancement on 3D-TSE, 1. Kalsoum E, Chabernaud Negrier A, Tuilier T, et al. Blood flow mim- slow-flowing blood, low shear stress, and aneurysmal instability is icking aneurysmal wall enhancement: a diagnostic pitfall of vessel poorly reported and is still speculative. In addition, studies with a wall MRI using the postcontrast 3D turbo spin-echo MR imaging long-term follow-up and/or histologic correlation are lacking in sequence. AJNR Am J Neuroradiol 2018;39:1065–67 CrossRef Medline X J. Hodel the literature. Thus, it appears difficult to assume that the en- X E. Kalsoum hancement related to slow-flowing blood and that of the aneurys- X T. Tuilier mal wall itself are both related to inflammation/instability. Quite X A. Benaı¨ssa on the opposite, we think that it would be interesting to indepen- Department of Neuroradiology Centre Hospitalier Universitaire Henri Mondor dently analyze each component of the enhancement visible on Cre´teil, France conventional 3D-TSE, including slow-flowing blood. Such an ap- X R. Blanc proach would allow us to identify patients in whom the slow- Department of Interventional Neuroradiology Rothschild Foundation Hospital flowing blood is predominant versus those in whom the addition Paris, France of a black-blood technique has little or no influence on the en- X P. Brugie`res Department of Neuroradiology Centre Hospitalier Universitaire Henri Mondor http://dx.doi.org/10.3174/ajnr.A5789 Cre´teil, France AJNR Am J Neuroradiol 39:E119 Nov 2018 www.ajnr.org E119 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5789
Publisher site
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Abstract

REPLY: hancement already visible on conventional sequences (and there- fore potentially related to a “true” enhancement of the wall). e thank our colleagues for their comments about our re- A better understanding of the factors likely to promote slow- Wcent article, “Blood Flow Mimicking Aneurysmal Wall En- flowing blood near the aneurysmal wall (such as the size of the hancement: A Diagnostic Pitfall of Vessel Wall MRI Using the aneurysm?) also appears important. In our opinion, the real abil- Postcontrast 3D Turbo Spin-Echo MR Imaging Sequence.” ity of the 3D-TSE sequence to assess arterial wall inflammation Black-blood techniques such as motion-sensitized driven remains uncertain because we cannot formally exclude residual equilibrium or delay alternating with nutation for tailored excita- slow-flowing blood (even including the additional black-blood tion (DANTE) offer new perspectives for a better understanding technique). Further studies are required to evaluate alternative/ of the nature of intracranial aneurysm enhancement. In our ex- complementary MR sequences less sensitive to flow artifacts and perience, flow-related artifacts are frequently encountered using with a higher spatial resolution. the postcontrast 3D-TSE sequence for a wide range of incidental We hope that this discussion will encourage other teams to aneurysms (at the center of the aneurysmal cavity but also in continue evaluating the circumferential wall enhancement of contact with the wall of the aneurysm). It is now clear that the intracranial aneurysms, which remains a particularly complex slow-flowing blood near the aneurysmal wall may represent all or entity. part of the visible enhancement using conventional 3D-TSE se- quences. Such findings raise the question of the relevance of this parameter for the management of asymptomatic patients. REFERENCE The relationship among contrast enhancement on 3D-TSE, 1. Kalsoum E, Chabernaud Negrier A, Tuilier T, et al. Blood flow mim- slow-flowing blood, low shear stress, and aneurysmal instability is icking aneurysmal wall enhancement: a diagnostic pitfall of vessel poorly reported and is still speculative. In addition, studies with a wall MRI using the postcontrast 3D turbo spin-echo MR imaging long-term follow-up and/or histologic correlation are lacking in sequence. AJNR Am J Neuroradiol 2018;39:1065–67 CrossRef Medline X J. Hodel the literature. Thus, it appears difficult to assume that the en- X E. Kalsoum hancement related to slow-flowing blood and that of the aneurys- X T. Tuilier mal wall itself are both related to inflammation/instability. Quite X A. Benaı¨ssa on the opposite, we think that it would be interesting to indepen- Department of Neuroradiology Centre Hospitalier Universitaire Henri Mondor dently analyze each component of the enhancement visible on Cre´teil, France conventional 3D-TSE, including slow-flowing blood. Such an ap- X R. Blanc proach would allow us to identify patients in whom the slow- Department of Interventional Neuroradiology Rothschild Foundation Hospital flowing blood is predominant versus those in whom the addition Paris, France of a black-blood technique has little or no influence on the en- X P. Brugie`res Department of Neuroradiology Centre Hospitalier Universitaire Henri Mondor http://dx.doi.org/10.3174/ajnr.A5789 Cre´teil, France AJNR Am J Neuroradiol 39:E119 Nov 2018 www.ajnr.org E119

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Nov 1, 2018

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