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MR angiography of ruptured aneurysms in acute subarachnoid hemorrhage
1Department of Radiology, Tokyo Metroplitan Ebara Hospital, Oota-ku, Japan.
Purpose:
To determine the efficacy of high-resolution MR angiography for the prospective diagnosis of ruptured aneurysms in acute subarachnoid hemorrhage.
Methods:
We used 3-D time-of-flight MR angiography with a large image matrix (193 x 512 frequency-encoding steps), magnetization transfer saturation, and a variable flip-angle excitation (tilted optimized nonsaturating excitation [TONE]) to study 28 patients with acute subarachnoid hemorrhage. The MR angiograms were compared with intraarterial digital subtraction angiographic (IA-DSA) images.
Results:
Thirty-five (90%) of 39 aneurysms were detected prospectively with MR angiography. At least one aneurysm was identified with MR angiography in 25 (96%) of 26 patients with aneurysms proved by IA-DSA. Although four aneurysms were missed prospectively, three of these were detected retrospectively with MR angiography. Six aneurysms (18%) of those evident on MR angiograms were 3 mm or less in diameter. In one patient, additional targeted maximum intensity projections were greatly helpful for the ensuing IA-DSA by determining the optimial projection angle by which to depict a ruptured aneurysm that neither routine MR angiography nor routine IA-DSA detected.
Conclusion:
High-resolution MR angiography may be a useful diagnostic technique for detecting ruptured aneurysms, even in patients with acute subarachnoid hemorrhage. Initial MR angiography offers valuable and reliable information on ruptured aneurysms in acute subarachnoid hemorrhage, allowing the optimization of projection angles at conventional angiography.
Insights
High-resolution MR angiography effectively detects ruptured aneurysms in patients with acute subarachnoid hemorrhage. This technique provides reliable diagnostic information and aids in optimizing conventional angiography for aneurysm detection.
Area of Science:
- Neuroradiology
- Vascular Imaging
Background:
- Acute subarachnoid hemorrhage (SAH) is a critical condition often caused by ruptured cerebral aneurysms.
- Accurate and timely diagnosis of ruptured aneurysms is crucial for patient management and outcomes.
Purpose of the Study:
- To evaluate the diagnostic efficacy of high-resolution MR angiography (MRA) for detecting ruptured aneurysms in patients presenting with acute SAH.
- To compare the performance of MRA against intraarterial digital subtraction angiography (IA-DSA).
Main Methods:
- Utilized 3-D time-of-flight MRA with advanced techniques including a large image matrix, magnetization transfer saturation, and tilted optimized nonsaturating excitation (TONE).
- Studied a cohort of 28 patients diagnosed with acute SAH.
- Compared MRA findings with IA-DSA results.
Main Results:
- MRA prospectively identified 90% (35/39) of aneurysms.
- MRA detected at least one aneurysm in 96% (25/26) of patients with confirmed aneurysms by IA-DSA.
- Small aneurysms (≤3 mm) were visualized, and retrospective analysis identified additional missed aneurysms.
Conclusions:
- High-resolution MRA is a valuable tool for diagnosing ruptured aneurysms in acute SAH.
- MRA provides reliable initial information, potentially optimizing subsequent conventional angiography procedures.