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Intraplaque haemorrhage mimicking carotid pseudoaneurysm on magnetic resonance angiography

¹ Department of Academic Radiology, University of Nottingham and ² Department of Vascular Surgery, Queen's Medical Centre, Nottingham NG7 2UH, UK

Correspondence: Mr Stephen Goode, Department of Academic Radiology, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK. E-mail: msxsg{at}nottingham.ac.uk

Contrast-enhanced magnetic resonance angiography (CE-MRA) is a commonly used technique to assess the extracranial carotid arteries. We describe two patients (investigated for carotid artery atherosclerotic disease) who underwent CE-MRA. Results suggested pseudoaneurysms of the extracranial carotid arteries. Magnetic resonance direct thrombus imaging (MRDTI) showed that the appearances were due to intraplaque haemorrhage adjacent to the vessel, with the T₁-shortening effect of methaemoglobin within the intraplaque haemorrhage mimicking blood flow on the CE-MRA sequence. The cases presented demonstrate this diagnostic pitfall and illustrate the contribution of simple magnetic resonance plaque imaging to establishing the correct diagnosis.