ABSTRACT
Magnetic resonance angiography is now commercially available for a variety of scanners and is being increasingly applied in the diagnosis of cerebrovascular disorders. Considering the clinical consequences, especially in intracranial aneurysms, studies to determine the sensitivity and specificity of the method are essential. Here we report our experience with a 3D-FISH time-of-flight magnetic resonance angiography protocol in 52 patients who have suffered an acute subarachnoid hemorrhage. In 26 of the 52 patients, conventional angiography identified 31 aneurysms (3-20 mm) that were confirmed during surgery or autopsy. Magnetic resonance angiography correctly identified 28 of the 31 aneurysms (sensitivity 90.3%) and missed one ruptured (3 mm) and two incidental aneurysms (3 mm) in patients with multiple aneurysms. The sensitivity for a ruptured aneurysm was 96%. The 26 patients who suffered subarachnoid hemorrhage without evidence of an intracranial aneurysm on repeated angiography served as a control group. Magnetic resonance angiography revealed no false-positive findings, resulting in a specificity of 100%. In correlation with the literature, we conclude that magnetic resonance angiography is not sensitive enough for the management of acute subarachnoid hemorrhage. However, the method provides important complementary information for definition of the bleeding site in patients with multiple aneurysms. In addition, the calculation of projections not possible with conventional angiography can aid surgical planning. Since only very small aneurysms were missed by magnetic resonance angiography, the sensitivity seems appropriate to screen asymptomatic patients who are at risk for intracranial aneurysms.
