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

Neuroradiology volume 46, pages 867–875 (2004)Cite this article

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.

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Author information

Affiliations

  1. Department of Radiology, University Hospital, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    Henriëtte E. Westerlaan, A. M. van der Vliet & M. Oudkerk

  2. Department of Radiology, Langeland Hospital, Zoetermeer, The Netherlands

    J. M. Hew

  3. Department of Neurosurgery, University Hospital Groningen, Groningen, The Netherlands

    J. D. M. Metzemaekers & J. J. A. Mooij

Authors
  1. Henriëtte E. Westerlaan
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  2. A. M. van der Vliet
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  3. J. M. Hew
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  4. J. D. M. Metzemaekers
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  5. J. J. A. Mooij
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  6. M. Oudkerk
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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

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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

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

Keywords

  • Three dimensional time-of-flight MRA
  • Subarachnoid hemorrhage
  • Intracranial aneurysms