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Monitoring of infectious intracranial aneurysms by sequential computed tomographic/magnetic resonance imaging studies
J Ahmadi1, H Tung, S L Giannotta
1Department of Radiology, University of Southern California School of Medicine, Los Angeles.
Abstract:
To monitor the course of infectious intracranial aneurysms, repeated cerebral angiography has been recommended every 2 weeks during intravenous antibiotic therapy until the aneurysm has resolved or an operation has been performed. However, serial cerebral angiograms are not without some risk to the patient. We have prospectively studied five patients harboring a total of six infectious intracranial aneurysms by sequential computed tomography (CT) and/or magnetic resonance imaging (MRI) studies. All infectious aneurysms were initially identified by cerebral angiography and were treated with 6 to 8 weeks of intravenous antibiotics. The aneurysm size ranged from 4 to 10 mm. Sequential CT scans and/or MRI studies were obtained at 2- to 3-week intervals to monitor the course of the aneurysms. Three aneurysms enlarged during antibiotic therapy, and one remained unchanged in size. These four aneurysms were treated surgically. The two remaining aneurysms resolved with intravenous antibiotic therapy. Cerebral angiograms were obtained routinely preoperatively and were used to verify the resolution of the infectious aneurysms when they were no longer visible on CT or MRI. On the basis of this prospective study, we conclude that sequential thin-slice CT and/or MRI can effectively and safely monitor the course of infectious intracranial aneurysms once identified by cerebral angiography. This may reduce the need for serial angiography and reduce the ultimate risk in the management of infectious intracranial aneurysms.
Insights
Sequential computed tomography (CT) and magnetic resonance imaging (MRI) can safely monitor infectious intracranial aneurysms. This imaging approach may reduce the need for repeated, risky cerebral angiograms during treatment.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Infectious Diseases
Background:
- Infectious intracranial aneurysms require monitoring during antibiotic therapy.
- Serial cerebral angiography is the standard but carries patient risks.
- Alternative imaging modalities are needed to assess aneurysm progression.
Purpose of the Study:
- To evaluate the efficacy and safety of sequential CT and/or MRI for monitoring infectious intracranial aneurysms.
- To compare CT/MRI monitoring with traditional serial angiography.
- To assess the impact on patient risk during aneurysm management.
Main Methods:
- Prospective study of five patients with six infectious intracranial aneurysms.
- Initial identification via cerebral angiography.
- Treatment with 6-8 weeks of intravenous antibiotics.
- Monitoring with sequential CT and/or MRI at 2-3 week intervals.
Main Results:
- Three aneurysms enlarged, one remained unchanged; these four required surgical intervention.
- Two aneurysms resolved completely with antibiotic therapy alone.
- CT/MRI effectively visualized aneurysm changes, guiding treatment decisions.
- Cerebral angiography confirmed resolution when aneurysms were no longer visible on CT/MRI.
Conclusions:
- Sequential thin-slice CT and/or MRI provide effective and safe monitoring for infectious intracranial aneurysms.
- This imaging strategy can potentially reduce the reliance on serial cerebral angiography.
- Utilizing CT/MRI may decrease the overall risks associated with managing these aneurysms.