Utility of Susceptibility-Weighted Angiography Sequence in the Diagnosis of Ruptured Infectious Aneurysms.

In a patient with infective endocarditis (IE), susceptibility-weighted angiography (SWAN) sequence revealed 2 intracranial infectious aneurysms (IIAs) as bright signal lesion, related to the high-velocity arterial flow within the IIAs. In addition, SWAN revealed a convexal subarachnoid hemorrhage-related to distal IIA rupture-as a dark signal. The risk of IIA rupture emphasizes the need for serial imaging follow-up in patients with IE receiving antibiotic therapy after endovascular treatment and after valve surgery. Considering its specific risks, particularly in patients with IE who may be on anticoagulation, digital subtraction angiography is not used routinely in this context. Therefore, SWAN might be an alternative method for selecting patients with IE who need conventional angiography and might be useful for serial follow-up and monitoring after treatment. Future studies should investigate the role of SWAN for the detection of IIAs.