MR angiography of ruptured aneurysms in acute subarachnoid hemorrhage

• Published in: American journal of neuroradiology Vol. 18; no. 6; pp. 1025 - 1032
• Main Authors: Ida, M, Kurisu, Y, Yamashita, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.06.1997; American Society of Neuroradiology
• Subjects: Adolescent; Adult; Aged; Aneurysm, Ruptured - diagnosis; Angiography, Digital Subtraction - instrumentation; Biological and medical sciences; Comparative Study; Female; Humans; Image Processing, Computer-Assisted - instrumentation; Intracranial Aneurysm - diagnosis; Magnetic Resonance Angiography - instrumentation; Male; Medical sciences; Middle Aged; Neurology; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Subarachnoid Hemorrhage - diagnosis; Vascular diseases and vascular malformations of the nervous system; Human; Image subtraction; Intracranial; Magnetization transfer; Nervous system diseases; Radiodiagnosis; Acute; Cardiovascular disease; Nuclear magnetic resonance imaging; Hemorrhage; Cerebral disorder; Vascular disease; Dissecting aneurysm; Central nervous system disease; Subarachnoid; Medical imagery; Digital angiography; Tridimensional image; Intraarterial administration; Diagnosis; Technique; NMR angiography; Cerebrovascular disease; Comparative study
• ISSN: 0195-6108; 1936-959X

To determine the efficacy of high-resolution MR angiography for the prospective diagnosis of ruptured aneurysms in acute subarachnoid hemorrhage. 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. 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. 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.