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.
Similar content being viewed by others
References
Jennet B, Lindsay KW (1994) An introduction to neurosurgery, 5th edn. Butterworth-Heinemann, Oxford, pp 146–148
Rinkel GJ, Djibuti M, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256
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
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
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
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
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
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
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
Skalpe IO (1983) The toxicity of nonionic watersoluble monomeric and dimeric contrast media in selective vertebral angiography. Neuroradiology 24:219–223
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
Katzen BT (1985) Peripheral, abdominal and interventional applications of DSA. Radiol Clin North Am 23:227–241
Grzyska U, Freitag J, Zeumer H (1990) Selective cerebral intraarterial DSA. Complication rate and control of risk factors. Neuroradiology 32:296–299
Heiserman JE, Dean BL, Hodak JA (1994) Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 15:1401–1407
Waugh JR, Sacharias N (1992) Arteriographic complications in the DSA era. Radiology 182:243–246
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
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
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
Jamieson KG (1954) Rupture of an intracranial aneurysm during cerebral angiography. J Neurosurg 11:625–628
Dublin B, Barry N (1980) Cerebral aneurysmal rupture during angiography with confirmation by computed tomography. Surg Neurol 13:19–26
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
Keogh AJ, Sankhla SK (1996) Magnetic resonance angiography for anterior midline aneurysms. Br J Neurosurg 10(2):143–147
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
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
Keogh, Vhora S (1998) The usefulness of magnetic resonance angiography in surgery for intracranial aneurysms that have bled. Surg Neurol 50:122–129
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
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
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484
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
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
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
Schuierer G, Huk WJ, Laub G (1992) Magnetic resonance angiography of intracranial aneurysms: comparison with intra-arterial digital subtraction angiography. Neuroradiology 35:50–54
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
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
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
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
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
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
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
Ida M, Kurisu T, Yamashita M (1997) MR angiography of ruptured aneurysms in acute subarachnoid hemorrhage. AJNR Am J Neuroradiol 18:1025–1032
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
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
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
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
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
Juvela S, Porras M, Heiskanen O (1993) Natural history of unruptured intracranial aneurysms: a long-term follow-up study. J Neurosurg 79:174–182
McCormick WF, Acosta-Rua GJ (1970) The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 33:427–442
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
Wirth F (1985) Surgical treatment of incidental intracranial aneurysms. Clin Neurosurg, Baltimore
Author information
Authors and Affiliations
Corresponding author
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
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-004-1260-9