title: Long-term MRI findings of muslin-induced foreign body granulomas after aneurysm wrapping. A report of two cases and literature review.
abstract: Muslin-induced foreign body granulomas are rare delayed complications after wrapping of intracranial aneurysms. Few small case series have been reported, with a paucity of documented MRI findings. In addition, there are no reports on long-term radiological appearances or temporal evolution of conservatively managed patients. We thus report on the long-term radiological and clinical follow-up of two patients with asymptomatic muslin-induced foreign body granulomas after wrapping of recurrent middle cerebral arterial aneurysms. Both patients were successfully managed conservatively and remain asymptomatic three and six years after diagnosis of their granulomas. A literature review confirms that MRI features of muslin-induced foreign body granuloma are typical. Features include focal areas of elevated T2 signal with increased diffusion-weighted signal and thin rim enhancement. To the best of our knowledge, this is the first report to confirm that there is a corresponding reduction in apparent diffusion coefficient, as typical in an intracranial abscess. Thus a history of aneurysm wrapping is critical for diagnosis. Accurate clinical recognition of this exuberant inflammatory response will avoid misdiagnosis as pyogenic abscess or tumor and prevent unnecessary or invasive treatment.
authors.affiliation: Interventional Neuroradiology Unit, Department of Diagnostic Imaging, Monash Medical Center; Melbourne, Australia - ronilvchandra@gmail.com.
authors.forename: Lee-Anne
authors.initials: LA
authors.lastname: Slater
authors.affiliation: Interventional Neuroradiology Unit, Department of Diagnostic Imaging, Monash Medical Center; Melbourne, Australia.
authors.forename: Ronil V
authors.initials: RV
authors.lastname: Chandra
authors.affiliation: Interventional Neuroradiology Unit, Department of Diagnostic Imaging, Monash Medical Center; Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Holt
authors.affiliation: Department of Neurosurgery, Monash Medical Centre, Monash University; Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Danks
authors.affiliation: Interventional Neuroradiology Unit, Department of Diagnostic Imaging, Monash Medical Center; Melbourne, Australia.
authors.forename: Winston
authors.initials: W
authors.lastname: Chong
mesh_terms: D000368:Aged; D001458:Bandages / Q000009:adverse effects*; D001930:Brain Injuries / Q000209:etiology* / Q000473:pathology*; D015745:Granuloma, Foreign-Body / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D013784:Textiles / Q000009:adverse effects; D016896:Treatment Outcome
keywords: granuloma; intracranial aneurysm; magnetic resonance imaging; wrapping