Skip to main content
Log in

Magnetic resonance angiography in the selection of patients suitable for neurosurgical intervention of ruptured intracranial aneurysms

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jennet B, Lindsay KW (1994) An introduction to neurosurgery, 5th edn. Butterworth-Heinemann, Oxford, pp 146–148

  2. Rinkel GJ, Djibuti M, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256

    CAS  PubMed  Google Scholar 

  3. Linn FH, Rinkel GJ, Algra A, van Gijn J (1996) Incidence of subarachnoid haemorrhage. Role of region, year, and rate of computed tomography: a meta-analysis. Stroke 27:625–629

    CAS  PubMed  Google Scholar 

  4. Hop JW, Rinkel GJ, Algra A, van Gijn J (1997) Case-fatality rates and functional outcome after subarachnoid haemorrhage: a systematic review. Stroke 28:660–664

    CAS  PubMed  Google Scholar 

  5. Hijdra A, Braakman R, van Gijn J, Vermeulen M, van Crevel H (1987) Aneurysmal subarachnoid haemorrhage: complications and outcome in a hospital population. Stroke 18:1061–1067

    CAS  PubMed  Google Scholar 

  6. Thomeer RTWM, Taal JCW, Voormolen JHC, Wintzen AR (1994) Aneurysmal bleeding. A plea for early surgery in good-risk patients. Acta Neurochir (Wien) 128:126–131

    Google Scholar 

  7. ISAT (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  8. Gross-Fengels W, Mödder U, Beyer D, Neufang KF, Godehardt E (1987) Komplikationen brachiocephaler Katheterangiographien bei Verwendung eines nicht-ionischen Kontrastmittels. Radiologe 27:83–88

    CAS  PubMed  Google Scholar 

  9. Mützel W, Speck U (1983) Effects of ionic and non-ionic contrast media after selective peripheral and cerebral arterial injections in rats. Fortschr Röntgenstr 118:62–66

    Google Scholar 

  10. Skalpe IO (1983) The toxicity of nonionic watersoluble monomeric and dimeric contrast media in selective vertebral angiography. Neuroradiology 24:219–223

    CAS  PubMed  Google Scholar 

  11. Skalpe IO, Aulie A (1985) The toxicity of non-ionic watersoluble media in selective vertebral angiography. An experimental study in rabbits with special reference to the difference between monomeric and dimeric compounds. Neuroradiology 27:77–79

    CAS  PubMed  Google Scholar 

  12. Katzen BT (1985) Peripheral, abdominal and interventional applications of DSA. Radiol Clin North Am 23:227–241

    CAS  PubMed  Google Scholar 

  13. Grzyska U, Freitag J, Zeumer H (1990) Selective cerebral intraarterial DSA. Complication rate and control of risk factors. Neuroradiology 32:296–299

    CAS  PubMed  Google Scholar 

  14. Heiserman JE, Dean BL, Hodak JA (1994) Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 15:1401–1407

    CAS  PubMed  Google Scholar 

  15. Waugh JR, Sacharias N (1992) Arteriographic complications in the DSA era. Radiology 182:243–246

    Google Scholar 

  16. Leffers AM, Wagner A (2000) Neurologic complications of cerebral angiography. A retrospective study of complication rate and patient risk factors. Acta Radiol 41:204–210

    CAS  PubMed  Google Scholar 

  17. Warnock NG, Gandhi MR, Bergvall U, Powell T (1993) Complications of intra-arterial digital subtraction angiography in patients investigated for cerebral vascular disease. Br J Radiol 66:855–858

    CAS  PubMed  Google Scholar 

  18. Cloft HJ, GJ Joseph, JE Dion (1999) Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation. A meta-analysis. Stroke 30:317–320

    CAS  PubMed  Google Scholar 

  19. Jamieson KG (1954) Rupture of an intracranial aneurysm during cerebral angiography. J Neurosurg 11:625–628

    CAS  PubMed  Google Scholar 

  20. Dublin B, Barry N (1980) Cerebral aneurysmal rupture during angiography with confirmation by computed tomography. Surg Neurol 13:19–26

    CAS  PubMed  Google Scholar 

  21. Koenig GH, Marshall WH, Poole GJ, Kramer RA (1979) Rupture of intracranial aneurysms during cerebral angiography: report of ten cases and review of the literature. Neurosurgery 5:314–324

    CAS  PubMed  Google Scholar 

  22. Keogh AJ, Sankhla SK (1996) Magnetic resonance angiography for anterior midline aneurysms. Br J Neurosurg 10(2):143–147

    Article  CAS  PubMed  Google Scholar 

  23. Sankhla SK, Gunawardena WJ, Coutinho CMA, Jones AP, Keogh AJ (1996) Magnetic resonance angiography in the management of aneurysmal subarachnoid haemorrhage: a study of 51 cases. Neuroradiology 38:724–729

    Article  CAS  PubMed  Google Scholar 

  24. Watanabe Z, Kikuchi Y, Izaki K, Hanyu N, Lim FS, Gotou H, Koizumi J, Gotou T, Kowada M, Watanabe K (2001) The usefulness of 3D MR angiography in surgery for ruptured cerebral aneurysms. Surg Neurol 55:359–364

    Article  CAS  PubMed  Google Scholar 

  25. Keogh, Vhora S (1998) The usefulness of magnetic resonance angiography in surgery for intracranial aneurysms that have bled. Surg Neurol 50:122–129

    Article  CAS  PubMed  Google Scholar 

  26. Matsumoto M, Sato M, Nakano M, Endo Y, Watanabe Y, Sasaki T, Suzuki K, Kodama N (2000) Three-dimensional computerized tomography angiography-guided surgery for acutely ruptured cerebral aneurysms. J Neurosurg 94:718–727

    Google Scholar 

  27. Hunt WE, Hess RM (1968) Surgical risk as related to the time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–19

    CAS  PubMed  Google Scholar 

  28. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484

    Article  CAS  PubMed  Google Scholar 

  29. Anderson GB, Steinke DE, Petruk KC (1999) Computed tomographic angiography versus digital subtraction angiography for the diagnosis and early treatment of ruptured intracranial aneurysms. Neurosurgery 45:1315–1322

    Article  CAS  PubMed  Google Scholar 

  30. Velthuis BK, Rinkel GJE, Ramos LMP, Witkamp TD, van der Sprenkel JW, Vandertop WP, van Leeuwen MS (1998) Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography. Radiology 208:423–430

    CAS  PubMed  Google Scholar 

  31. Velthuis BK, van Leeuwen MS, Witkamp TE, Ramos LM, van der Sprenkel JW, Rinkel GJ (1999) Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography. J Neurosurg 91:761–767

    Google Scholar 

  32. Schuierer G, Huk WJ, Laub G (1992) Magnetic resonance angiography of intracranial aneurysms: comparison with intra-arterial digital subtraction angiography. Neuroradiology 35:50–54

    CAS  PubMed  Google Scholar 

  33. Stock KW, Radue EW, Jacob AL, Bao XS, Steinbrich W (1995) Intracranial arteries: prospective blinded comparative study of MR angiography and DSA in 50 patients. Radiology 195:451–456

    CAS  PubMed  Google Scholar 

  34. Korogi Y, Takahashi M, Mabuchi N, Nakagawa T, Fujiwara S, Horikawa Y, Miki H, O’Uchi T, Shiga H, Shiokawa Y (1996) Intracranial aneurysms: diagnostic accuracy of MR Angiography with evaluation of maximum intensity projection and source images. Radiology 199:199–207

    Google Scholar 

  35. Korogi Y, Takahashi M, Mabuchi N, Miki H, Fujiwara S, Horikawa Y, Nakagawa T, O’Uchi T, Watabe T, Shiga H (1994) Intracranial aneurysms: diagnostic accuracy of three-dimensional, Fourier transform, time-of-flight MR angiography. Radiology 193:181–186

    CAS  PubMed  Google Scholar 

  36. Horikoshi T, Fukamachi A, Nishi H, Fukasawa I (1994) Detection of intracranial aneurysms by three-dimensional time-of-flight magnetic resonance angiography. Neuroradiology 36:203–207

    CAS  PubMed  Google Scholar 

  37. Ross JS, Masaryk TJ, Modic MT, Ruggieri PM, Haacke EM, Selman WR (1990) Intracranial aneurysms: evaluation by MR angiography. AJNR Am J Neuroradiol 155:159–165

    CAS  Google Scholar 

  38. Adams WM, Laitt RD, Jackson A (2000) The role of MR angiography in the pretreatment assessment of intracranial aneurysms: a comparative study. AJNR Am J Neuroradiol 21:1618–1628

    CAS  PubMed  Google Scholar 

  39. Huston III J, Nichols DA, Luetmer PH, Goodwin JT, Meyer FB, Wiebers DO, Weaver AL (1994) Blinded prospective evaluation of sensitivity of MR angiography to known intracranial aneurysms: importance of aneurysm size. AJNR Am J Neuroradiol 15:1607–1614

    PubMed  Google Scholar 

  40. Ida M, Kurisu T, Yamashita M (1997) MR angiography of ruptured aneurysms in acute subarachnoid hemorrhage. AJNR Am J Neuroradiol 18:1025–1032

    CAS  PubMed  Google Scholar 

  41. Gouliamos A, Gotsis E, Vlahos L, Samara C, Kapsalaki E, Rologis D, Kapsalakis Z, Papavasiliou C (1992) Magnetic resonance angiography compared to intra-arterial digital subtraction angiography in patients with subarachnoid haemorrhage. Neuroradiology 35:46–49

    CAS  PubMed  Google Scholar 

  42. Anzalone N, Triulzi F, Scotti G (1995) Acute subarachnoid haemorrhage: 3D time-of-flight MR angiography versus intra-arterial digital angiography. Neuroradiology 37:257–261

    Article  CAS  PubMed  Google Scholar 

  43. Wilcock D, Jaspan T, Holland I, Cherryman G, Worthington B (1996) Comparison of magnetic resonance angiography with conventional angiography in the detection of intracranial aneurysms in patients presenting with subarachnoid haemorrhage. Clin Radiol 51:330–334

    CAS  PubMed  Google Scholar 

  44. Jäger HR, Mansmann U, Hausmann O, Partzsch U, Moseley IF, Taylor WJ (2000) MRA versus digital subtraction angiography in acute subarachnoid haemorrhage: a blinded multireader study of prospectively recruited patients. Neuroradiology 42:313–326

    Article  PubMed  Google Scholar 

  45. Curnes JT, Shogry MEC, Clark DC, Elsner HJ (1993) MR angiographic demonstration of an intracranial aneurysm not seen on conventional angiography. AJNR Am J Neuroradiol 14:971–973

    CAS  PubMed  Google Scholar 

  46. Juvela S, Porras M, Heiskanen O (1993) Natural history of unruptured intracranial aneurysms: a long-term follow-up study. J Neurosurg 79:174–182

    CAS  PubMed  Google Scholar 

  47. McCormick WF, Acosta-Rua GJ (1970) The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 33:427–442

    Google Scholar 

  48. Edner G, Kagström E, Wallstedt L (1992) Total overall management and surgical outcome after aneurysmal subarachnoid haemorrhage in a defined population. Br J Neurosurg 6:409–420

    CAS  PubMed  Google Scholar 

  49. Wirth F (1985) Surgical treatment of incidental intracranial aneurysms. Clin Neurosurg, Baltimore

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Henriëtte E. Westerlaan.

Additional information

This paper was presented in whole at the following meetings: ECR Vienna March 2003; RSNA Chicago December 2002; and CIRSE Lucerne October 2002

Rights and permissions

Reprints and permissions

About this article

Cite this article

Westerlaan, H.E., van der Vliet, A.M., Hew, J.M. et al. Magnetic resonance angiography in the selection of patients suitable for neurosurgical intervention of ruptured intracranial aneurysms. Neuroradiology 46, 867–875 (2004). https://doi.org/10.1007/s00234-004-1260-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-004-1260-9

Keywords

Navigation