title: Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms:  proof of principle.
abstract: BACKGROUND
  High-resolution magnetic resonance vessel wall imaging (MR-VWI) is increasingly used to study steno-occlusive cerebrovascular disease, but has not yet been applied to patients with aneurysmal subarachnoid hemorrhage (SAH).
  
  
  OBJECTIVE
  To study the ability of high-resolution MR-VWI to determine the site of rupture in patients with aneurysmal SAH.
  
  
  METHODS
  Medical records of patients admitted with aneurysmal SAH between December 2011 and May 2012 were reviewed. MR-VWI was routinely performed for patients treated in the IMRIS Neurovascular Suite immediately before definitive treatment of the ruptured aneurysm.
  
  
  RESULTS
  We report for the first time high-resolution MR-VWI in 5 patients with aneurysmal SAH. Three patients harbored multiple intracranial aneurysms. The ruptured aneurysms demonstrated thick vessel wall enhancement in all cases. None of the associated unruptured aneurysms demonstrated this MR imaging finding.
  
  
  CONCLUSIONS
  High-resolution MR-VWI identified the site of rupture in patients with aneurysmal SAH, including those patients harboring multiple intracranial aneurysms. It may represent a useful tool in the investigation of aneurysmal SAH.
authors.affiliation: Department of Neurosurgery, Neurovascular & Stroke Programs, Yale University School of Medicine, New Haven, Connecticut, USA. charles.matouk@yale.edu
authors.forename: Charles C
authors.initials: CC
authors.lastname: Matouk
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Mandell
authors.forename: Murat
authors.initials: M
authors.lastname: Günel
authors.forename: Ketan R
authors.initials: KR
authors.lastname: Bulsara
authors.forename: Ajay
authors.initials: A
authors.lastname: Malhotra
authors.forename: Ryan
authors.initials: R
authors.lastname: Hebert
authors.forename: Michele H
authors.initials: MH
authors.lastname: Johnson
authors.forename: David J
authors.initials: DJ
authors.lastname: Mikulis
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Minja
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D001808:Blood Vessels / Q000473:pathology*; D002533:Cerebral Angiography; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D019635:Neurosurgical Procedures; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed