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Harrar DB, Sun LR, Goss M, Pearl MS. Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children. J Child Neurol 2022; 37:693-701. [PMID: 35673704 DOI: 10.1177/08830738221106818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cerebrovascular disorders are an important cause of morbidity and mortality in children. Although minimally invasive, cerebral digital subtraction angiography (DSA) has been shown to be safe in children and is a valuable, and perhaps underutilized, technique for the diagnosis and management of pediatric cerebrovascular disorders in the critical care setting. Through a case-based approach, we explore the utility of DSA in critically ill children with acute intracranial hemorrhage (ICH). We discuss the use of DSA in the acute management of aneurysm and arteriovenous malformation rupture as well as cerebral vasospasm. Those caring for critically ill children with acute ICH should consider cerebral DSA as part of a comprehensive approach to the diagnosis and management of these conditions.
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Affiliation(s)
- D B Harrar
- Division of Neurology, 8404Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - L R Sun
- Division of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - M Goss
- Division of Neurology, 72462Dell Children's Hospital, Austin, TX, USA
| | - M S Pearl
- Department of Radiology, 8404Children's National Hospital, Washington, DC, USA
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HaiFeng L, YongSheng X, YangQin X, Yu D, ShuaiWen W, XingRu L, JunQiang L. Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis. Neuroradiology 2017; 59:1083-1092. [DOI: 10.1007/s00234-017-1905-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022]
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Bourcier R, Chatel S, Bourcereau E, Jouan S, Marec HL, Daumas-Duport B, Sevin-Allouet M, Guillon B, Roualdes V, Riem T, Isidor B, Lebranchu P, Connault J, Tourneau TL, Gaignard A, Loirand G, Redon R, Desal H. Understanding the Pathophysiology of Intracranial Aneurysm: The ICAN Project. Neurosurgery 2017; 80:621-626. [DOI: 10.1093/neuros/nyw135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/22/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND: Understanding the pathophysiologic mechanism of intracranial aneurysm (IA) formation is a prerequisite to assess the potential risk of rupture. Nowadays, there are neither reliable biomarkers nor diagnostic tools to predict the formation or the evolution of IA. Increasing evidence suggests a genetic component of IA but genetics studies have failed to identify genetic variation causally related to IA.
OBJECTIVE: To develop diagnostic and predictive tools for the risk of IA formation and rupture.
METHODS: The French ICAN project is a noninterventional nationwide and multicentric research program. Each typical IA of bifurcation will be included. For familial forms, further IA screening will be applied among first-degree relatives. By accurate phenotype description with high-throughput genetic screening, we aim to identify new genes involved in IA. These potential genetic markers will be tested in large groups of patients. Any relevant pathway identified will be further explored in a large cohort of sporadic carriers of IA, which will be well documented with clinical, biological, and imaging data.
EXPECTED OUTCOMES: Discovering genetic risk factors, better understanding the pathophysiology, and identifying molecular mechanisms responsible for IA formation will be essential bases for the development of biomarkers and identification of therapeutic targets.
DISCUSSION: Our protocol has many assets. A nationwide recruitment allows for the inclusion of large pedigrees with familial forms of IA. It will combine accurate phenotyping and comprehensive imaging with high-throughput genetic screening. Last, it will enable exploiting metadata to explore new pathophysiological pathways of interest by crossing clinical, genetic, biological, and imaging information.
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Affiliation(s)
- Romain Bourcier
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Stéphanie Chatel
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Emmanuelle Bourcereau
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Solène Jouan
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Hervé Le Marec
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
- Cardiology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Benjamin Daumas-Duport
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | | | - Benoit Guillon
- Neurology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Vincent Roualdes
- Neurosurgery Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Tanguy Riem
- Neurosurgery Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Bertrand Isidor
- Clinical genetics Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Pierre Lebranchu
- Ophtalmologic Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Jérôme Connault
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Thierry Le Tourneau
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
- Cardiology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Alban Gaignard
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Gervaise Loirand
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Richard Redon
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Hubert Desal
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
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Cotroneo E, Dazzi M, Gigli R, Guidetti G, Cantore G, Chiappetta F. Magnetic Resonance Angiography for Evaluation of Intracranial Aneurysms Treated with Guglielmi Detachable Coils. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099801100102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thirteen cases of cerebral aneurysms submitted to endovascular treatment using Guglielmi detachable coils (GDC) are described. Control MRI-angiography 3D TOF was performed three and six months later. In order to spare patients the discomfort and risks related to repeated trauma and iodate contrast injection, we examined the possibility of an alternative non-invasive diagnostic method. For this purpose, the digital subtraction angiograms performed three and six months after embolisation were compared with the MR-angiograms obtained in the same period, all using the same tomograph at middle field intensity (0.5T). We discuss the outcome of this comparison and the limits of the MR-angiography method in the follow-up of aneurysms submitted to endovascular treatment.
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Affiliation(s)
| | - M. Dazzi
- 2nd Div. of Neuroradiology, “La Sapienza” University Hospital
| | | | - G. Guidetti
- 2nd Div. of Neuroradiology, “La Sapienza” University Hospital
| | - G.P. Cantore
- 1st Chair of Neurosurgery, “La Sapienza” University Hospital
| | - F. Chiappetta
- Division of Neurosurgery, S. Camillo-Forlanini Hospital; Rome
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Bourcier R, Lenoble C, Guyomarch-Delasalle B, Daumas-Duport B, Papagiannaki C, Redon R, Desal H. Is there an inherited anatomical conformation favoring aneurysmal formation of the anterior communicating artery? J Neurosurg 2016; 126:1598-1605. [PMID: 27315030 DOI: 10.3171/2016.4.jns153032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated with the presence of anterior communicating artery (ACoA) aneurysms in the familial forms of IAs. METHODS This multicenter study investigated bifurcation IAs in patients who had a sporadic ACoA IA without a family history of IA (SACAA group), in patients who had an ACoA IA with a family history of IA (FACAA group), and in their healthy first-degree relatives (HFDRs). Through the use of MR angiography (MRA) reconstructions, the symmetry of the A1 segments and the angle between the A1 and A2 segments were analyzed on 3D models for each group. These measurements were then compared among the 3 groups. RESULTS Twenty-four patients with SACAA, 24 patients with FACAA, and 20 HFDRs were included in the study. Asymmetrical configuration of the A1 segments was more frequent in the FACAA group than in the HFDR group (p = 0.002). The aneurysm-side A1-A2 angle was lower in the FACAA group (p = 0.003) and SACAA group (p = 0.007) than in the HFDR group. On the contralateral side, there was no difference in A1-A2 angles between groups. CONCLUSIONS The anatomical shape of the ACoA complex seems to be similarly associated with the presence of ACoA IAs in both the FACAA and SACAA groups. This highlights the role played by hemodynamic constraints in aneurysm formation and questions the hypothesis of the hereditary character of these anatomical shapes.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.,CNRS, UMR 6291, Université de Nantes, Nantes; and
| | - Cédric Lenoble
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec
| | | | - Benjamin Daumas-Duport
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec
| | | | - Richard Redon
- INSERM, UMR1087, l'institut du thorax, CHU de Nantes.,CNRS, UMR 6291, Université de Nantes, Nantes; and
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.,CNRS, UMR 6291, Université de Nantes, Nantes; and
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6
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Aneurismi arteriosi intracranici. Neurologia 2016. [DOI: 10.1016/s1634-7072(15)76145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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7
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Detection and characterization of unruptured intracranial aneurysms: Comparison of 3T MRA and DSA. J Neuroradiol 2014; 42:162-8. [PMID: 25454398 DOI: 10.1016/j.neurad.2014.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/18/2014] [Accepted: 08/30/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare magnetic resonance angiography (MRA) at 3 Tesla (3T) and digital subtraction angiography (DSA) for the detection and characterization of unruptured intracranial aneurysms (UIA). MATERIALS AND METHODS This study has been approved by our local ethical committee. From February to August 2010, 40 consecutive patients with UIA contemporarily underwent MRA at 3T including time-of-flight (TOF-MRA) and contrast enhanced (CE-MRA) techniques and DSA. MR images were independently reviewed by 3 radiologists and DSA images were reviewed by 2 radiologists together. Interobserver and intertechnique agreements were assessed for aneurysm detection and characterization including maximal diameter, neck width and the presence of a bleb or a branch arising from the sac. RESULTS DS angiography revealed 56 aneurysms. Mean sensitivity and positive predictive value of MRA were 91.4% and 93.4% respectively. For UIA < 3 mm and those ≥ 3 mm, MRA had a mean sensitivity of 74.1% and 100% respectively. Intertechnique and interobserver agreements were substantial for the measurement of UIA maximal diameter (mean κ, 0.607 and 0.601 respectively) and were moderate and fair for neck width measurement respectively (mean κ, 0.456 and 0.285 respectively). For bleb detection, intertechnique and interobserver agreements were fair and slight respectively (mean κ, 0.312 and 0.116 respectively) whereas both were slight for detection of branches arising from the sac (mean κ, 0.151 and 0.070 respectively). CONCLUSION MR angiography at 3T has a high sensitivity for the detection of UIA. However, it remains significantly inferior to DSA for morphological characterization of UIA.
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8
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Schlimper C, Nemitz O, Dorenbeck U, Scorzin J, Whitaker R, Tasdizen T, Rumpf M, Schaller K. Restoring three-dimensional magnetic resonance angiography images with mean curvature motion. Neurol Res 2013; 32:87-93. [DOI: 10.1179/016164110x12556180206077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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9
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Evaluation of intracranial aneurysms with high-resolution MR angiography using single-artery highlighting technique: correlation with digital subtraction angiography. Radiol Med 2012; 118:1379-87. [DOI: 10.1007/s11547-012-0871-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 12/22/2011] [Indexed: 11/26/2022]
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10
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The clinical value of MRA at 3.0 T for the diagnosis and therapeutic planning of patients with subarachnoid haemorrhage. Eur Radiol 2012; 22:1404-12. [DOI: 10.1007/s00330-012-2390-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 11/30/2011] [Accepted: 01/12/2012] [Indexed: 11/25/2022]
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11
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False-positive diagnosis of cerebral aneurysms using MR angiography: Location, anatomic cause, and added value of source image data. Clin Radiol 2011; 66:726-31. [PMID: 21529794 DOI: 10.1016/j.crad.2011.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 01/21/2011] [Accepted: 01/31/2011] [Indexed: 11/24/2022]
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12
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Zacharia BE, Hickman ZL, Grobelny BT, DeRosa P, Kotchetkov I, Ducruet AF, Connolly ES. Epidemiology of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 2010; 21:221-33. [PMID: 20380965 DOI: 10.1016/j.nec.2009.10.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a form of hemorrhagic stroke that affects up to 30,000 individuals per year in the United States. The incidence of aSAH has been shown to be associated with numerous nonmodifiable (age, gender, ethnicity, family history, aneurysm location, size) and modifiable (hypertension, body mass index, tobacco and illicit drug use) risk factors. Although early repair of ruptured aneurysms and aggressive postoperative management has improved overall outcomes, it remains a devastating disease, with mortality approaching 50% and less than 60% of survivors returning to functional independence. As treatment modalities change and the percentage of minority and elderly populations increase, it is critical to maintain an up-to-date understanding of the epidemiology of SAH.
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Affiliation(s)
- Brad E Zacharia
- Department of Neurological Surgery, Columbia University Medical Center, 630 West 168th Street, P&S Building 5-454, New York, NY 10032, USA
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Bederson JB, Connolly ES, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE, Harbaugh RE, Patel AB, Rosenwasser RH. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40:994-1025. [PMID: 19164800 DOI: 10.1161/strokeaha.108.191395] [Citation(s) in RCA: 911] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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14
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Schwab KE, Gailloud P, Wyse G, Tamargo RJ. LIMITATIONS OF MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY IN THE DIAGNOSIS OF INTRACRANIAL ANEURYSMS. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000316416.63323.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Schwab KE, Gailloud P, Wyse G, Tamargo RJ. LIMITATIONS OF MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY IN THE DIAGNOSIS OF INTRACRANIAL ANEURYSMS. Neurosurgery 2008; 63:29-34; discussion 34-5. [DOI: 10.1227/01.neu.0000335068.53190.46] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kristin E. Schwab
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Philippe Gailloud
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerald Wyse
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rafael J. Tamargo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kupersmith MJ, Heller G, Cox TA. Magnetic resonance angiography and clinical evaluation of third nerve palsies and posterior communicating artery aneurysms. J Neurosurg 2006; 105:228-34. [PMID: 17219827 DOI: 10.3171/jns.2006.105.2.228] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Object
The authors conducted a study to determine the utility of the clinical profile and magnetic resonance (MR) angiography in evaluating patients with isolated third cranial nerve palsies or posterior communicating artery (PCoA) aneurysms.
Methods
Three-dimensional time-of-flight MR angiography was performed in a consecutive series of patients with isolated acute third cranial nerve palsy not due to a ruptured aneurysm and in patients with unruptured PCoA aneurysms. A neuroradiologist, masked to the identities of the patients, interpreted reformatted maximum intensity projection (MIP) and source images of the PCoAs and aneurysms. The investigators assessed clinical features of oculomotor nerve dysfunction and focal head pain. Cases involving cranial third nerve palsy without aneurysms were classified as Group 1 (no case entailed catheter-based angiography), and cases involving PCoA aneurysms seen on MR angiography (42 cases confirmed by catheter-based angiography) were classified as Group 2.
The mean age of the 73 patients in Group 1 was 60.1 years and that of the 45 patients in Group 2 was 59.1 years (p = 0.37). The pattern and severity of oculomotor (p = 0.61) and lid (p = 0.83) dysfunction and pain frequency (p = 0.2) were similar for the 73 patients with vasculopathy in Group 1 and the 15 symptomatic patients in Group 2. Abnormal pupils were observed in 38% of the patients in Group 1 and 80% of those in Group 2 (p = 0.016). In cases of complete external third nerve palsy, nine of 22 in Group 1 and none of four in Group 2 had normal pupil function. For all patients, source imaging showed 206 PCoAs (85%) and MIP imaging demonstrated 120 PCoAs (49%). Of 48 aneurysms (three bilateral), MIP imaging showed 44 (92%) and source imaging showed 47 (98%). Only a 2-mm aneurysm seen on catheter-based angiography was missed by MR angiography. Symptomatic aneurysms were equal or greater than 4 mm in size.
Conclusions
Only the presence of complete external third nerve palsy and normal pupil function allowed ischemia to be clinically distinguished from a PCoA aneurysm in a patient with isolated third nerve palsy and no subarachnoid hemorrhage. When source image MR angiography demonstrates normal findings, catheter-based angiography need not be performed in these patients, even if pupil function is abnormal.
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Affiliation(s)
- Mark J Kupersmith
- Institute of Neurology and Neurosurgery at Roosevelt Hospital, New York Eye and Ear Infirmary, Albert Einstein School of Medicine, New York, New York 10019, USA.
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Broderick JP, Sauerbeck LR, Foroud T, Huston J, Pankratz N, Meissner I, Brown RD. The Familial Intracranial Aneurysm (FIA) study protocol. BMC MEDICAL GENETICS 2005; 6:17. [PMID: 15854227 PMCID: PMC1097731 DOI: 10.1186/1471-2350-6-17] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 04/26/2005] [Indexed: 12/21/2022]
Abstract
Background Subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms (IAs) occurs in about 20,000 people per year in the U.S. annually and nearly half of the affected persons are dead within the first 30 days. Survivors of ruptured IAs are often left with substantial disability. Thus, primary prevention of aneurysm formation and rupture is of paramount importance. Prior studies indicate that genetic factors are important in the formation and rupture of IAs. The long-term goal of the Familial Intracranial Aneurysm (FIA) Study is to identify genes that underlie the development and rupture of intracranial aneurysms (IA). Methods/Design The FIA Study includes 26 clinical centers which have extensive experience in the clinical management and imaging of intracerebral aneurysms. 475 families with affected sib pairs or with multiple affected relatives will be enrolled through retrospective and prospective screening of potential subjects with an IA. After giving informed consent, the proband or their spokesperson invites other family members to participate. Each participant is interviewed using a standardized questionnaire which covers medical history, social history and demographic information. In addition blood is drawn from each participant for DNA isolation and immortalization of lymphocytes. High- risk family members without a previously diagnosed IA undergo magnetic resonance angiography (MRA) to identify asymptomatic unruptured aneurysms. A 10 cM genome screen will be performed to identify FIA susceptibility loci. Due to the significant mortality of affected individuals, novel approaches are employed to reconstruct the genotype of critical deceased individuals. These include the intensive recruitment of the spouse and children of deceased, affected individuals. Discussion A successful, adequately-powered genetic linkage study of IA is challenging given the very high, early mortality of ruptured IA. Design features in the FIA Study that address this challenge include recruitment at a large number of highly active clinical centers, comprehensive screening and recruitment techniques, non-invasive vascular imaging of high-risk subjects, genome reconstruction of dead affected individuals using marker data from closely related family members, and inclusion of environmental covariates in the statistical analysis.
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Affiliation(s)
- Joseph P Broderick
- Department of Neurology, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0525, USA
| | - Laura R Sauerbeck
- Department of Neurology, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0525, USA
| | - Tatiana Foroud
- Medical & Molecular Genetics, Indiana University, 975 West Walnut St., IB 130, Indianapolis, IN 46202-5251, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Nathan Pankratz
- Medical & Molecular Genetics, Indiana University, 975 West Walnut St., IB 130, Indianapolis, IN 46202-5251, USA
| | - Irene Meissner
- Division of Cerebrovascular Disease and Department of Neurology, Mayo Clinic, 200, First Street SW, Rochester, MN 55905, USA
| | - Robert D Brown
- Division of Cerebrovascular Disease and Department of Neurology, Mayo Clinic, 200, First Street SW, Rochester, MN 55905, USA
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Westerlaan HE, van der Vliet AM, Hew JM, Metzemaekers JDM, Mooij JJA, Oudkerk M. Magnetic resonance angiography in the selection of patients suitable for neurosurgical intervention of ruptured intracranial aneurysms. Neuroradiology 2004; 46:867-75. [PMID: 15502999 DOI: 10.1007/s00234-004-1260-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Accepted: 07/06/2004] [Indexed: 10/26/2022]
Abstract
This study was aimed at establishing whether magnetic resonance angiography (MRA) can be applied to planning and performing surgery on ruptured intracranial aneurysms, especially in the early phase, without recourse to intra-arterial digital subtraction angiography (IA-DSA). From February 1998 to August 2001, in all patients presenting with a subarachnoid hemorrhage, MRA was performed first. A three-dimensional time-of-flight MRA protocol with T2-weighted coronal and axial images was used. If MRA demonstrated an aneurysm, surgery was undertaken. IA-DSA was limited to patients with negative or inconclusive MRA findings. We compared MRA images with operative findings in positive patients and with IA-DSA in negatives. IA-DSA was considered the gold standard when MRA findings were inconclusive. In this study, 205 consecutive patients (mean age 52.7 years, 69% women) were included. In 133 patients (64.9%) MRA demonstrated an aneurysm, directly followed by neurosurgical intervention. In 33 patients (16.1%) MRA findings were categorized as inconclusive. In 39 patients (19.0%) MRA results were negative. No false-negative ruptured aneurysms were selected by MRA. In only one patient surgical intervention was performed based on false-positive MRA findings. MRA can replace IA-DSA as a first diagnostic modality in the selection of patients suitable for surgical treatment of ruptured intracranial aneurysms.
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Affiliation(s)
- Henriëtte E Westerlaan
- Department of Radiology, University Hospital, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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Affiliation(s)
- Katie Oyama
- Katie Oyama is a staff nurse in the neuro/trauma intensive care unit at Oregon Health & Science University, Portland, Ore
| | - Laura Criddle
- Laura Criddle is the clinical nurse specialist for the emergency department and the neuro/trauma intensive care unit at Oregon Health & Science University, Portland, Ore
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Kouskouras C, Charitanti A, Giavroglou C, Foroglou N, Selviaridis P, Kontopoulos V, Dimitriadis AS. Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings. Neuroradiology 2004; 46:842-50. [PMID: 15448952 DOI: 10.1007/s00234-004-1259-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Computed tomographic angiography (CTA) and magnetic resonance angiography (MSA) have been used recently for evaluation of intracranial aneurysms. If they are to replace conventional digital subtraction angiography (DSA), their sensitivity and specificity should be equal to the latter. In order to determine whether computed tomographic angiography and magnetic resonance angiography can provide the necessary information for presurgical evaluation we compared blindly the results of helical CT angiography and MR angiography with the results of digital subtraction angiography and the intraoperative findings. We evaluated 35 patients with the possible clinical diagnosis of intracranial aneurysm. Our data suggest that both CTA and MRA can provide valuable preoperative information concerning the location, the characteristics and the relationships of most intracranial aneurysms. Both original and reconstructed images should be evaluated together for higher accuracy. In addition helical CT, being a fast, inexpensive and noninvasive method, can be used as a reliable alternative to DSA in emergency situations demanding immediate operation.
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Affiliation(s)
- C Kouskouras
- Department of Radiology, AHEPA University Hospital, Aristotle's University of Thessaloniki, S. Kiriakidi 1, 54636 Thessaloniki, Greece
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21
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Abstract
Intracranial pathologies involving the visual pathway are manifold. Aligning to anatomy, the most frequent and/or most important extrinsic and intrinsic intracranial lesions are presented. Clinical symptoms and imaging characteristics of lesions of the sellar region are demonstrated in different imaging modalities. The extrinsic lesions mainly consist of pituitary adenomas, meningeomas, craniopharyngeomas and chordomas. In (asymptomatic and symptomatic) aneurysms, different neurological symptoms depend on the location of aneurysms of the circle of Willis. Intrinsic tumors as astrocytoma of any grade, ependymoma and primary CNS-lymphoma require the main pathology in the course of the visual pathway. Vascular and demyelinating diseases complete this overview of intracranial lesions.
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Affiliation(s)
- W Müller-Forell
- Institute of Neuroradiology, Medical School University of Mainz, Langenbeckstrasse 1, D-55101, Mainz, Germany.
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22
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Kuhn J, Vehlen C, Mennel HD, Mahkorn D, Bewermeyer H. Rupture of an internal carotid artery aneurysm during angiography with leakage of contrast medium via an external ventricular drain. Neuroradiology 2003; 45:905-7. [PMID: 14534767 DOI: 10.1007/s00234-003-1079-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2002] [Accepted: 06/30/2003] [Indexed: 11/27/2022]
Abstract
With a ruptured intracranial aneurysm producing subarachnoid haemorrhage (SAH) cerebral angiography is currently used for identification of the affected vessel. Aneurysm rerupturing is one of the more serious complications of cerebral angiography and has been frequently described. We report a 61-year-old man who presented with SAH who had rerupture of a large aneurysm of the internal carotid artery during angiography. A substantial amount of contrast medium escaped via a ventricular drain. The three main risk factors for rerupture of an aneurysm are: angiography performed within 6 h of the primary SAH, an aneurysm on the internal carotid artery and an unfavourable Glasgow coma score.
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Affiliation(s)
- J Kuhn
- Neurologische Klinik, Kliniken der Stadt Köln, Krankenhaus Merheim, Ostmerheimerstr 200, 51109 Köln, Germany.
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23
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Kawashima M, Matsushima T, Miyazono M, Hirokawa E, Baba H. Two surgical cases of internal carotid-ophthalmic artery aneurysms: special reference to the usefulness of three-dimensional CT angiography. Neurol Res 2002; 24:825-8. [PMID: 12500708 DOI: 10.1179/016164102101200807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Three-dimensional computerized tomography angiography (3D-CTA) is a noninvasive tool for the diagnosis of cerebral aneurysms. 3D-CTA is helpful in the evaluation of the configuration of aneurysms and their surrounding vessels and anatomical structures. The aim of this study is to assess the usefulness of 3D-CTA for patients with unruptured internal carotid-ophthalmic artery aneurysms. We pre-operatively obtained surgical simulation images using 3D-CTA and 3D reconstruction and then compared them with magnetic resonance angiography (MRA), conventional cerebral angiography and operative findings in the patients. Two patients with unruptured internal carotid-ophthalmic artery aneurysm were selected. These patients underwent direct neck clipping after the optic canal was unroofed through a combined epidural-subdural approach. The cerebral aneurysm was detected by 3D-CTA, MRA and conventional cerebral angiography in each case. Only by 3D-CTA, however, could we easily detect the relationships among the aneurysm neck, ophthalmic artery and optic canal. Based on this information, direct clipping operations were performed safely without any complications. 3D-CTA is an excellent noninvasive diagnostic method not only for detecting cerebral aneurysms, but also for evaluating the relationships between the aneurysms and surrounding structures.
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MESH Headings
- Aged
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/pathology
- Carotid Artery, Internal/surgery
- Carotid Artery, Internal, Dissection/diagnostic imaging
- Carotid Artery, Internal, Dissection/pathology
- Carotid Artery, Internal, Dissection/surgery
- Cerebral Angiography
- Cranial Fossa, Anterior/anatomy & histology
- Cranial Fossa, Anterior/diagnostic imaging
- Cranial Fossa, Anterior/surgery
- Female
- Humans
- Imaging, Three-Dimensional
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/pathology
- Intracranial Aneurysm/surgery
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Neurosurgical Procedures
- Ophthalmic Artery/diagnostic imaging
- Ophthalmic Artery/pathology
- Ophthalmic Artery/surgery
- Orbit/anatomy & histology
- Orbit/diagnostic imaging
- Orbit/surgery
- Predictive Value of Tests
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures
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Affiliation(s)
- Masatou Kawashima
- Department of Neurosurgery, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 60 Fukuoka, 812-8582, Japan
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24
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Wang MC, Rubinstein D, Kindt GW, Breeze RE. Prevalence of intracranial aneurysms in first-degree relatives of patients with aneurysms. Neurosurg Focus 2002; 13:e2. [PMID: 15844874 DOI: 10.3171/foc.2002.13.3.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
A familial predisposition toward cerebral aneurysms has been previously described in patients with two or more affected family members. In the present study the familial incidence of unruptured intracranial aneurysms was studied in 96 patients with at least one first-degree relative (parent, sibling, or child) in whom a cerebral aneurysm was diagnosed.
Methods
All patients were between 20 and 70 years of age and underwent three-dimensional fast–spin echo magnetic resonance imaging. Sixty-one patients (63.5%) were women. The majority of patients (84%) were caucasian and the remainder were Hispanic (13%) or African-American (3%). No patient suffered a medical condition (excluding hypertension and smoking) known to be associated with cerebral aneurysm formation.
In four patients at least one aneurysm was found (two harbored multiple aneurysms). Three of the four patients were women. Two of the patients were siblings. The estimated prevalence in first-degree relatives was 4.2% (95% confidence interval 1.2–10.1). Of note, the mean age in the current study population was 39 years. The authors of recent metaanalyses have suggested that the prevalence of nonfamilial aneurysms is approximately 2%, despite earlier reports in which higher figures were cited.
Conclusions
The authors conclude that first-degree relatives of patients with aneurysms are at higher risk for harboring an intracranial aneurysm.
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Affiliation(s)
- Marjorie C Wang
- Department of Neurosurgery, University of Colorado Health Sciences Center, Denver 80262, USA
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25
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Okahara M, Kiyosue H, Yamashita M, Nagatomi H, Hata H, Saginoya T, Sagara Y, Mori H. Diagnostic accuracy of magnetic resonance angiography for cerebral aneurysms in correlation with 3D-digital subtraction angiographic images: a study of 133 aneurysms. Stroke 2002; 33:1803-8. [PMID: 12105357 DOI: 10.1161/01.str.0000019510.32145.a9] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the sensitivity of 3D-time-of flight (3D-TOF) magnetic resonance angiography (MRA) in the detection of cerebral aneurysms with the use of 3D digital subtraction angiography as the gold standard. We also evaluated the effects of location and number of aneurysms (and experience of the reader) on the sensitivity. METHODS 3D-TOF MRA was performed in 82 patients with 133 cerebral aneurysms. Each patient underwent rotational angiography. Three-dimensional reconstructed images were obtained from data of the rotational angiography (as the gold standard). A blind study with 4 readers of different experiences was performed to evaluate the diagnostic accuracy of 3D-TOF MRA for cerebral aneurysms. RESULTS One hundred five (79%) of all 133 aneurysms were detected with MRA by a neuroradiologist, 100 (75%) were detected by an experienced neurosurgeon, 84 (63%) were detected by a general radiologist, and 80 (60%) were detected by a resident neuroradiologist. For each reader, the detectability was lower for small aneurysms (<3 mm in maximum diameter) and/or for those located at the internal carotid artery and anterior cerebral artery. False-positive aneurysms were 29 for the neuroradiologist, 19 for the neurosurgeon, 31 for the general radiologist, and 30 for the resident neuroradiologist; most of the aneurysms were at the internal carotid artery. Causes of the false-positive and false-negative results included complex flow in a tortuous artery and susceptibility artifacts. CONCLUSIONS Although MRA is useful in the diagnosis of cerebral aneurysms, sufficient experience and careful attention are necessary for accurate diagnosis of aneurysms located at the internal carotid and anterior cerebral arteries.
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Affiliation(s)
- Mika Okahara
- Department of Neuroradiology, Nagatomi Neurosurgical Hospital, Oita, Japan.
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26
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Lee AG, Hayman LA, Brazis PW. The evaluation of isolated third nerve palsy revisited: an update on the evolving role of magnetic resonance, computed tomography, and catheter angiography. Surv Ophthalmol 2002; 47:137-57. [PMID: 11918895 DOI: 10.1016/s0039-6257(01)00303-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The evaluation and management of the neurologically isolated third nerve palsy continues to evolve. The major concern for the clinician confronted with a patient with a third nerve palsy has been the exclusion of an intracranial aneurysm. The evolution of new imaging techniques, such as computed tomography angiography and magnetic resonance angiography, have provided new imaging options for clinicians. This article reviews the pertinent recent literature on the use of these imaging studies in evaluating the patient with a third nerve palsy.
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Affiliation(s)
- Andrew G Lee
- Department of Ophthalmology, The University of Iowa Hospital, Iowa City, IA 52242, USA
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27
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Johnson MR, Good CD, Penny WD, Barnes PR, Scadding JW. Lesson of the week: Playing the odds in clinical decision making: lessons from berry aneurysms undetected by magnetic resonance angiography. BMJ (CLINICAL RESEARCH ED.) 2001; 322:1347-9. [PMID: 11387186 PMCID: PMC1120432 DOI: 10.1136/bmj.322.7298.1347] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M R Johnson
- Division of Neuroscience and Psychological Medicine, Charing Cross Hospital, London W6 8RF.
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28
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Watanabe Z, Kikuchi Y, Izaki K, Hanyu N, Lim FS, Gotou H, Koizumi J, Gotou T, Kowada M, Watanabe K. The usefulness of 3D MR angiography in surgery for ruptured cerebral aneurysms. SURGICAL NEUROLOGY 2001; 55:359-64. [PMID: 11483196 DOI: 10.1016/s0090-3019(01)00452-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND We have used magnetic resonance angiography (MRA) in screening for unruptured cerebral aneurysms since 1993. The development of high-resolution magnetic resonance (MR) imaging has led to a remarkable improvement in image quality. Three-dimensional (3D) MRA can be used for surgical simulation. Here, we report on the usefulness of and problems associated with 3D MRA for the surgery of ruptured cerebral aneurysms. METHODS Between June 1998 and June 2000, 106 patients with SAH diagnosed by 3D MRA underwent surgery. We compared 3D MRA images with operative findings and investigated the usefulness of this assessment tool. RESULTS In 48 of 106 cases (45.3%), we were able to perform surgery based on 3D MRA alone. By using the 3D images, we could easily detect the relative location of the aneurysm, its neck and the surrounding arteries. The remaining cases required further examinations because of uncertainty of diagnosis or insufficient information. CONCLUSION 3D MRA is a safe and useful procedure for the diagnosis and surgery of ruptured cerebral aneurysms. However, in approximately half of all cases, 3D computed tomographic angiography (CTA) or digital subtraction angiography (DSA) is required in addition for the planning of surgery. It is important to use 3D MRA for surgery only after taking sufficient consideration of certain limitations peculiar to MRA.
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Affiliation(s)
- Z Watanabe
- Department of Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Japan
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29
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White PM, Teasdale EM, Wardlaw JM, Easton V. Intracranial aneurysms: CT angiography and MR angiography for detection prospective blinded comparison in a large patient cohort. Radiology 2001; 219:739-49. [PMID: 11376263 DOI: 10.1148/radiology.219.3.r01ma16739] [Citation(s) in RCA: 233] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare computed tomographic (CT) angiography and magnetic resonance (MR) angiography with intraarterial digital subtraction angiography (DSA) in the detection of intracranial aneurysms. MATERIALS AND METHODS One hundred forty-two patients underwent intraarterial DSA to detect aneurysms. CT angiography, three-dimensional time-of-flight MR angiography, and intraarterial DSA were performed contemporaneously. Film hard-copy images and maximum intensity projection reconstructions of the CT angiograms and MR angiograms were reviewed at different times. RESULTS The accuracy per patient for the best observer was 0.87 at CT angiography and 0.85 at MR angiography. The accuracy per aneurysm for the best observer was 0.73 at CT angiography and 0.67 at MR angiography. Differences between readers and modalities were not significant. Interobserver agreement was good: kappa value of 0.73 for CT angiography and of 0.74 for MR angiography. The sensitivity for detection of aneurysms smaller than 5 mm was 0.57 for CT angiography and 0.35 for MR angiography compared with 0.94 and 0.86, respectively, for detection of aneurysms 5 mm or larger. The accuracy of both CT angiography and MR angiography was lower for detection of internal carotid artery aneurysms compared with that at other sites. With low observer confidence, the likelihood of correct interpretation was significantly poorer. CONCLUSION CT angiography and MR angiography have limited sensitivity in the detection of small aneurysms but good interobserver agreement. There is no significant difference in diagnostic performance between the noninvasive modalities.
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Affiliation(s)
- P M White
- University Department of Neurosurgery and Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland.
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30
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Adams WM, Laitt RD, Jackson A. Time of Flight 3D Magnetic Resonance Angiography in the Follow-up of Coiled Cerebral Aneurysms. Interv Neuroradiol 2001; 5:127-37. [PMID: 20670501 DOI: 10.1177/159101999900500203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/1999] [Accepted: 04/03/1999] [Indexed: 11/15/2022] Open
Abstract
SUMMARY The use of Guglielmi Detachable Coil (GDC) for the en do vascular treatment of intracerebral aneurysms is increasing, particularly in those aneurysms for which there is a high surgical morbidity and mortality. However, the long-term efficacy of GDC is not known. Until the natural history of GDC treatment is established longterm follow-up in this cohort of patients is required, of necessity involving repeated intraarterial angiography (IA DSA) with its known attendant risks and exposure to ionising radiation. Three dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is now readily accepted as a non-invasive screening tool for familial aneurysmal disease and has been used as an alternative to IA DSA in the surgical management of aneurysmal subarachnoid haemorrhage. MRA in patients treated with GDC is safe, imparts no radiation dose and provides acceptable image quality. The aim of this study was to assess 3D TOP MRA source data, maximum intensity projection (MIP) and 3D isosurface reconstruction in comparison to IA DSA in the follow-up of 25 patients treated with GDC. Images were assessed for parent and branch artery flow, the presence of neck recurrence and aneurysm regrowth. There was good correlation for all these features when 3D isosurface MRA and source data were compared with IA DSA. The correlation between MIP MRA and IA DSA was less robust. Additional confidence can be obtained by performing plain films of the skull to demonstrate change in coil ball configuration. MRA has the potential to replace IA DSA in the follow- up of GDC treated cerebral aneurysms.
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Affiliation(s)
- W M Adams
- Department of Neuroradiology, Central Manchester Healthcare Trust Oxford Road; Manchester, UK -
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31
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White PM, Wardlaw JM, Easton V. Can noninvasive imaging accurately depict intracranial aneurysms? A systematic review. Radiology 2000; 217:361-70. [PMID: 11058629 DOI: 10.1148/radiology.217.2.r00nv06361] [Citation(s) in RCA: 205] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To perform a systematic review to determine the accuracy of computed tomographic (CT) angiography, magnetic resonance (MR) angiography, and transcranial Doppler ultrasonography (US) in depicting intracranial aneurysms. MATERIALS AND METHODS A 1988-1998 literature search for studies with 10 or more subjects in which noninvasive imaging was compared with angiography was undertaken. Studies meeting initial criteria were evaluated by using intrinsically weighted standardized assessment to determine suitability for inclusion. Studies scoring greater than 50% were included. RESULTS Of 103 studies that met initial criteria, 38 scored greater than 50%. CT angiography and MR angiography had accuracies per aneurysm of 89% (95% CI: 87%, 91%) and 90% (95% CI: 87%, 92%), respectively. For US, data were scanty and accuracy was lower, although the CIs overlapped those of CT angiography and MR angiography. Sensitivity was greater for detection of aneurysms larger than 3 mm than for detection of aneurysms 3 mm or smaller-for CT angiography, 96% (95% CI: 94%, 98%) versus 61% (95% CI: 51%, 70%), and for MR angiography, 94% (95% CI: 90%, 97%) versus 38% (95% CI: 25%, 53%). Diagnostic accuracy was similar for anterior and posterior circulation aneurysms. CONCLUSION CT angiography and MR angiography depicted aneurysms with an accuracy of about 90%. Most studies were performed in populations with high aneurysm prevalence, which may have introduced bias toward noninvasive examinations.
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Affiliation(s)
- P M White
- Depts of Neurosurgery and Neuroradiology, Institute of Neurological Sciences, Southern General Hosp, Glasgow, Scotland.
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32
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Foot C, Merfield E. Suspected subarachnoid haemorrhage with a negative CT head scan: What next? Emerg Med Australas 2000. [DOI: 10.1046/j.1442-2026.2000.00126.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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33
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Abstract
The incidence of subarachnoid haemorrhage (SAH) is 6-8 per 100 000 person years, peaking in the sixth decade. SAH, mostly due to rupture of an intracranial aneurysm, accounts for a quarter of cerebrovascular deaths. Aneurysms increase in frequency with age beyond the third decade, are 1.6 times more common in women and are associated with a number of genetic conditions. Prospective autopsy and angiographic studies indicate that between 3.6 and 6% of the population harbour an intracranial aneurysm. Studies have found an increased rate of SAH in first degree relatives of SAH patients (relative risk 3.7-6.6). In affected families, the most frequent relationship between sufferers is sibling to sibling. The rupture rate of asymptomatic aneurysms was thought to be 1-2% per annum, but the recent International Study of Unruptured Intracranial Aneurysms found that the rupture rate of small aneurysms was only 0.05% per annum in patients with no prior SAH, and 0.5% per annum for large (>10 mm diameter) aneurysms and for all aneurysms in patients with previous SAH. Non-invasive tests such as magnetic resonance angiography (MRA), computed tomographic angiography (CTA) and transcranial Doppler (TCD) have been advocated as alternatives to intra-arterial digital subtraction angiography to screen for aneurysms. Although all are promising techniques, the quality of data testing their accuracy is limited. Overall reported sensitivity for CTA and MRA (TCD is poorer) was 76-98% and specificity was 85-100%, but many subjects had an aneurysm or recent SAH, which could overestimate accuracy. CTA and MRA are much poorer methods for the detection of aneurysms <5 mm diameter, which account for up to one-third of unruptured aneurysms. Elective surgical clipping of asymptomatic aneurysms has a morbidity of 10.9% and mortality of 3. 8%. Treatment of aneurysms by Guglielmi coils, for which there is less long-term follow-up available, has a 4% morbidity and 1% mortality, but only achieves complete aneurysm occlusion in 52-78% of cases. There has been interest in screening for aneurysms, but the indication for, and cost effectiveness of screening are unclear because aneurysm prevalence varies, rupture rate is low, non-invasive imaging tests are not yet accurate enough to exclude small aneurysms and the morbidity and mortality for elective surgical treatment of unruptured aneurysms is high. There may be a limited role for investigation of high risk subgroups. Ideally, screening in such subgroups should be tested in a randomized trial. The avoidance of risk factors for aneurysms such as smoking, hypertension and hypercholesterolaemia should be part of the management of at-risk subjects.
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Affiliation(s)
- J M Wardlaw
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.
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34
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Klötzsch C, Bozzato A, Lammers G, Mull M, Lennartz B, Noth J. Three-dimensional transcranial color-coded sonography of cerebral aneurysms. Stroke 1999; 30:2285-90. [PMID: 10548659 DOI: 10.1161/01.str.30.11.2285] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The role of 2-dimensional transcranial color-coded sonography (2D-TCCS) as a diagnostic tool in cases of vascular alteration is unquestioned. The skill of the operator, however, may be responsible for some intertrial variability. The clinical value of a new, workstation-based, 3D reconstruction system for TCCS was evaluated in patients with intracranial aneurysms. METHODS Thirty patients with 30 intracranial aneurysms were investigated (8 men, 22 women; mean+/-SD age 54+/-17 years). The TCCS examinations were performed with a 2-MHz probe using the power mode. The 3D system (3D-Echotech, Germany) consisted of an electromagnet, which induced a low-intensity magnetic field near the head of the patient. A magnetic position sensor was attached to the ultrasound probe and transmitted the spatial orientation of the probe to a workstation, which also received the corresponding 2D-images from the video-port of the duplex machine. The echo contrast enhancer D-galactose (Levovist, Schering, Germany) was used in all patients to improve the signal-to-noise ratio. All patients underwent presurgical digital subtraction angiography (DSA) to demonstrate the aneurysm. RESULTS Twenty-nine of 30 angiographically proven intracranial aneurysms (97%) were detected by 3D-TCCS. The aneurysmal diameter estimated by DSA ranged from 3 to 16 mm (mean 7. 2+/-3.6 mm). A comparison of the 3 main diameters of each aneurysm revealed a correlation coefficient of 0.95 between DSA and 3D-TCCS. The 3D determination of the aneurysmal size by 2 experienced sonographers correlated with 0.96. CONCLUSIONS 3D-TCCS is a new, noninvasive method to investigate intracranial aneurysms. The differentiation between artifacts and true changes of the vessel anatomy is much easier in 3D-TCCS than in conventional 2D-TCCS. The new method yields an excellent correlation with the gold standard, DSA. Because the same 3D-TCCS data can be postprocessed by different investigators, it may be possible to improve reproducibility and increase the objectivity of transcranial color-coded duplex sonography.
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MESH Headings
- Angiography, Digital Subtraction
- Artifacts
- Computer Systems
- Contrast Media
- Electromagnetic Phenomena/instrumentation
- Female
- Galactose
- Humans
- Image Processing, Computer-Assisted/instrumentation
- Image Processing, Computer-Assisted/methods
- Intracranial Aneurysm/diagnostic imaging
- Male
- Middle Aged
- Observer Variation
- Polysaccharides
- Reproducibility of Results
- Signal Processing, Computer-Assisted
- Ultrasonography, Doppler, Color/instrumentation
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Doppler, Transcranial/instrumentation
- Ultrasonography, Doppler, Transcranial/methods
- Video Recording
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Affiliation(s)
- C Klötzsch
- Department of Neurology, Universitätsklinikum der Rheinisch-Westfälischen Technischen Hochschule, Aachen, Germany.
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35
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Jacobson DM, Trobe JD. The emerging role of magnetic resonance angiography in the management of patients with third cranial nerve palsy. Am J Ophthalmol 1999; 128:94-6. [PMID: 10482100 DOI: 10.1016/s0002-9394(99)00107-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To discuss the sensitivity of three-dimensional time-of-flight (3D TOF) magnetic resonance angiography (MRA) for detecting aneurysms causing third cranial nerve palsy and to propose guidelines for the use of MRA in the evaluation of patients with different clinical presentations of oculomotor nerve palsy. METHODS From a review of the scientific literature, we determined the proportion of aneurysms of various size that cause third nerve palsy, the sensitivity of MRA in detecting aneurysms of these size classes, and the relationship of aneurysmal size to rupture. RESULTS The data disclose that properly performed and interpreted 3D TOF MRA will overlook only 1.5% of aneurysms producing third cranial nerve palsy that will, if untreated, rupture during the subsequent 8 years. CONCLUSIONS Magnetic resonance angiography plays an important diagnostic role in the evaluation of patients with isolated third cranial nerve palsy. However, because of the potentially drastic consequences of overlooking an aneurysm, MRA should be the definitive screening test only among patients with a relatively low likelihood of harboring an aneurysm or a relatively high likelihood of suffering a complication from catheter angiography.
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Affiliation(s)
- D M Jacobson
- Department of Neurology, Marshfield Clinic, Wisconsin 54449, USA.
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36
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Velthuis BK, Rinkel GJ, Ramos LM, Witkamp TD, van Leeuwen MS. Perimesencephalic hemorrhage. Exclusion of vertebrobasilar aneurysms with CT angiography. Stroke 1999; 30:1103-9. [PMID: 10229751 DOI: 10.1161/01.str.30.5.1103] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE It is important to recognize a perimesencephalic pattern of hemorrhage in patients with subarachnoid hemorrhage (SAH), because in 95% of these patients the cause is nonaneurysmal and the prognosis is excellent. The purpose of this study was to investigate whether CT angiography can accurately exclude vertebrobasilar aneurysms in patients with perimesencephalic patterns of hemorrhage and therefore replace digital subtraction angiography (DSA) in this setting. METHODS In 40 patients with posterior fossa SAH as shown on unenhanced CT, 2 radiologists independently evaluated unenhanced CT for distinguishing between perimesencephalic and nonperimesencephalic pattern of hemorrhage and assessed CT angiography for detection of aneurysms. All patients subsequently underwent DSA or autopsy. RESULTS Observers agreed in 38 of 40 patients (95%) in differentiating perimesencephalic and nonperimesencephalic patterns of hemorrhage on unenhanced CT. On the CT angiograms, both observers detected a vertebrobasilar aneurysm in 16 patients and no aneurysm in 24 patients. These findings were confirmed by DSA or autopsy. No patients with a perimesencephalic pattern of hemorrhage were found to have an aneurysm on either CT angiography or DSA. CONCLUSIONS Good recognition of a perimesencephalic pattern of hemorrhage is possible on unenhanced CT, and CT angiography accurately excludes and detects vertebrobasilar aneurysms. DSA can be withheld in patients with a perimesencephalic pattern of hemorrhage and negative CT angiography.
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Affiliation(s)
- B K Velthuis
- Departments of Radiology, Utrecht University Hospital, Utrecht, The Netherlands
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Baxter AB, Cohen WA, Maravilla KR. Imaging of Intracranial Aneurysms and Subarachnoid Hemorrhage. Neurosurg Clin N Am 1998. [DOI: 10.1016/s1042-3680(18)30243-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Alterman RL, Drucker E. Cost-Effective Screening for Cerebral Aneurysms. Neurosurg Clin N Am 1998. [DOI: 10.1016/s1042-3680(18)30246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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39
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Le Roux PD, Winn HR. Management of Cerebral Aneurysms: How Can Current Management Be Improved? Neurosurg Clin N Am 1998. [DOI: 10.1016/s1042-3680(18)30241-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Affiliation(s)
- S Gilman
- Department of Neurology, University of Michigan, Ann Arbor 48109-0316, USA
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