Diagnosis of Unruptured Intracranial Aneurysms: 3T MR Angiography versus 64-channel Multi-detector Row CT Angiography

Hiratsuka, Yoshiyasu; Miki, Hitoshi; Kiriyama, Ikuko; Kikuchi, Keiichi; Takahashi, Shizue; Matsubara, Ichiro; Sadamoto, Kazuhiko; Mochizuki, Takashi

doi:10.2463/mrms.7.169

Cited by 71 publications

(59 citation statements)

References 31 publications

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“…According to a recent study, 3T TOF MRA demonstrated a screening sensitivity of 67% for aneurysms of Ͻ3 mm, 79% for those of 3-5 mm, and 95% for those of Ͼ5 mm. 36 Because many patients have multiple aneurysms (ϳ30%), 37 a per-patient screening sensitivity is a more accurate metric for assessing the effectiveness of a technique. In this study, the per-patient screening sensitivity and specificity were 96% and 92%, respectively.…”

Section: Efficacy and Safetymentioning

confidence: 99%

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

Rozenfeld

Ansari

Shaibani

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:Autosomal dominant polycystic kidney disease is a genetic disorder affecting 1 in 1000 people worldwide and is associated with an increased risk of intracranial aneurysms. It remains unclear whether there is sufficient net benefit to screening this patient population for IA, considering recent developments in imaging and treatment and our evolving understanding of the natural history of unruptured aneurysms. There is currently no standardized screening protocol for IA in patients with ADPCKD. Our review of the literature focused on the above issues and presents our appraisal of the estimated value of screening for IA in the setting of ADPCKD.ABBREVIATIONS: ADPCKD ϭ autosomal dominant polycystic kidney disease; GFR ϭ glomerular filtration rate; IA ϭ intracranial aneurysm; QALY ϭ quality-

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Section: Efficacy and Safetymentioning

confidence: 99%

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

Rozenfeld

Ansari

Shaibani

et al. 2013

AJNR Am J Neuroradiol

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“…Technical advances in magnetic resonance angiography (MRA) have increased the chances of detecting unruptured intracranial aneurysms (UIAs) [1,2], and the prophylactic treatment of UIAs is now a major focus of efforts to reduce the overall mortality and morbidity of subarachnoid hemorrhage (SAH) by UIA rupture. …”

Section: Introductionmentioning

confidence: 99%

Visit-To-Visit Variability in Systolic Blood Pressure Is a Novel Risk Factor for the Growth of Intracranial Aneurysms

Igase

Kohara

et al. 2013

Cerebrovasc Dis

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Background: Although rupture of unruptured intracranial aneurysms (UIAs) is closely associated with UIA growth during follow-up, few studies have investigated how UIAs grow during observation. Hypertension appears to affect the formation of intracranial aneurysms. However, few studies have investigated the association of blood pressure variability with UIA growth. Visit-to-visit variability (VVV) in systolic blood pressure (SBP) is a newly defined concept which appears to be a good predictor of stroke. With this factor in mind, here we conducted a prospective analysis of the results of 2 years of observation of UIAs by magnetic resonance angiography (MRA) and sought to identify risk factors for UIA growth and rupture. Methods: From December 2006 through June 2010, two hundred patients with 212 UIAs were followed for 2 years. Patient ages ranged from 31 to 91 years. Putative risk factors for the growth of UIAs were evaluated. Subjects were divided into two groups: a UIA growth group consisting of patients whose UIAs increased by 1 mm or more in size or who developed subarachnoid hemorrhage (SAH), and an unchanged group. Brachial blood pressure values were recorded at the time of diagnosis and during follow-up in the outpatient clinic. All blood pressure values were then averaged, and the VVV of SBP was defined as the standard deviation (SD) of a minimum of 5 blood pressure measurements at outpatient visits. Results: UIA growth occurred in 20 patients and SAH occurred in 1 patient. Current smoking tended to be more prevalent in the UIA growth group (p < 0.01). Five of the 12 patients with multiple UIAs showed UIA growth within 2 years and multiplicity was a significant risk factor for UIA growth (p < 0.01). The mean baseline size in the UIA growth group was larger than that in the unchanged group (p = 0.01) and 7 of the 18 patients with large UIAs, categorized as having an initial diameter of 7 mm or more, had an increase in UIA size over the 2 years (p < 0.01). On multivariable logistic regression analysis, current smoking, multiplicity, and UIA size ≥7 mm were significant risk factors for UIA growth. Although no significant difference was seen between the UIA growth and unchanged groups in office SBP during the observation period, VVV in SBP was significantly higher in the UIA growth group than in the unchanged group, and it was significantly and independently associated with UIA growth. Conclusions: VVV in SBP is a novel risk factor for the growth of UIAs and may be a key factor for the prevention of UIA rupture. Future research is needed to confirm that SBP stability prevents UIA rupture.

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“…Three of the included studies 16,24,25 evaluated diagnostic performance of MRA and CTA among their study population, with observers blinded to the results of other imaging examinations. In total, 263 patients with 220 aneurysms underwent both noninvasive imaging tests.…”

Section: Comparison With Ctamentioning

confidence: 99%

“…[26][27][28][29][30][31] In total, 12 articles were included in the meta-analysis. [14][15][16][17][18][19][20][21][22][23][24][25] The study characteristics are shown in Table 1. All included studies had a consecutive design and used DSA as the reference standard.…”

Section: Study Identification and Study Characteristicsmentioning

confidence: 99%

Diagnosing Intracranial Aneurysms With MR Angiography

Sailer

Wagemans

Nelemans

et al. 2014

Stroke

173

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Background and Purpose-The aim of this study was to evaluate the sensitivity and specificity of MR angiography (MRA) in the diagnosis of ruptured and unruptured intracranial aneurysms. Methods-A systematic search was performed on 4 electronic databases on relevant articles that were published from January 1998 to October 2013. Inclusion criteria were met by 12 studies that compared MRA with digital subtraction angiography as reference standard. Two independent reviewers evaluated the methodological quality of the studies. Data from eligible studies were extracted and used to construct 2×2 contingency tables on a per-aneurysm level. Pooled estimates of sensitivity and specificity were calculated for all studies and subgroups of studies. Heterogeneity was tested, and risk for publication bias was assessed. Results-Included studies were of high methodological quality. Studies with larger sample size tended to have higher diagnostic performance. Most studies used time-of-flight MRA technique. Among the 960 patients assessed, 772 aneurysms were present. Heterogeneity with reference to sensitivity and specificity was moderate to high. Pooled sensitivity of MRA was 95% (95% confidence interval, 89%-98%), and pooled specificity was 89% (95% confidence interval, 80%-95%). False-negative and false-positive aneurysms detected on MRA were mainly located at the skull base and middle cerebral artery. Freehand 3-dimensional reconstructions performed by the radiologist significantly increased diagnostic performance. Studies performed on 3 Tesla showed a trend toward higher performance (P=0.054). Conclusions-Studies

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Diagnosis of Unruptured Intracranial Aneurysms: 3T MR Angiography versus 64-channel Multi-detector Row CT Angiography

Abstract: Three-tesla, 3D TOF MRA and 64-MDCTA are excellent modalities with high diagnostic accuracy for evaluating unruptured intracranial aneurysms and no significant difference between them in diagnostic performance.

Cited by 71 publications

References 31 publications

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

Visit-To-Visit Variability in Systolic Blood Pressure Is a Novel Risk Factor for the Growth of Intracranial Aneurysms

Diagnosing Intracranial Aneurysms With MR Angiography

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