Detection of unruptured intracranial aneurysms on noninvasive imaging. Is there still a role for digital subtraction angiography?

Rustemi, Oriela; Alaraj, Ali; Orning, Jennifer; Du, Xinjian; Aletich, Victor; Amin‐Hanjani, Sepideh; Charbel, Fady T.

doi:10.4103/2152-7806.170029

Cited by 27 publications

(12 citation statements)

References 21 publications

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“…As mentioned, the reported sensitivity and specificity of screening tools for detecting UIAs are both approximately 90%. [20][21][22] However, in our cohort, the precision rate of UIA detection was only 57%, and the false-positive rate was 43%. These differences probably occurred due to the focus on small aneurysms in this study.…”

Section: Discussioncontrasting

confidence: 68%

Features of “false positive” unruptured intracranial aneurysms on screening magnetic resonance angiography

et al. 2020

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Background Physicians can find it challenging to decide whether confirmative digital subtraction angiography (DSA) should be performed in patients who present with "suspicious small aneurysmlike structures" on magnetic resonance angiography (MRA). Factors associated with "false positive aneurysms on MRA" (FPAMs)," which are finally confirmed as negative on DSA, have rarely been reported. This study aimed to identify the clinical or radiologic clues indicative of FPAM on DSA. Methods Patients who had undergone DSA between 2016 and 2019 for suspicious aneurysm-like structures < 5 mm in size on MRA were enrolled. Patient demographics and the details regarding the geometry of the structures were retrospectively reviewed. Univariate and multivariate logistic regression analyses were conducted to identify the associated factors. Receiver operating characteristic curve analysis was performed to assess the clinical implications. Results Of the 107 suspicious structures, 46 were indicated as being false positive on DSA (42.96%). Location (positive on C7 and negative on C5-6 ICA) and lower dome to neck ratio were found to be significant parameters in the multivariate analysis. The dome to neck ratio threshold value was 0.99. Conclusion Suspicious aneurysm-like structures located not on C5-6 but on C7 ICA and having wide neck morphologies (dome to neck ratio < 0.99) are highly likely to be negative on DSA.

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Section: Discussioncontrasting

confidence: 68%

Features of “false positive” unruptured intracranial aneurysms on screening magnetic resonance angiography

et al. 2020

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“…For aneurysms smaller than 4 mm, DSA was superior to the other modalities. [ 105 ] This work confirms that CT and MR angiography are not able to detect lesions less than 3–4 mm in size, which is the dimension of vessels found most commonly in the PC.…”

Section: Chronological Review Of Pcd Literaturesupporting

confidence: 73%

“…With the addition of digital subtraction, four-vessel angiography became, and still is, the “gold standard” for evaluating AC and PC disease. [ 23 34 78 105 109 ] At the same time, the development of EC–IC bypass microneurosurgery permitted surgical reconstruction of the PC vessels, which was performed successfully with excellent outcomes in several centers. [ 14 18 74 115 ] Only those patients who had failed maximal medical therapy were referred for PC reconstructive surgery.…”

Section: Introduction - Short Summary Of This Paper For the Reader Wmentioning

confidence: 99%

“…Computed tomography (CT) and magnetic resonance (MR) imaging and angiography was introduced in the 1980s and 1990s and used as a basis of clinical trials of various medcial therapies, even though the imaging studies were not able to demonstrate PC lesions with high accuracy, calling into question the conclusions of these studies. [ 23 34 78 105 109 ]…”

Section: Introduction - Short Summary Of This Paper For the Reader Wmentioning

confidence: 99%

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A review of the diagnosis and management of vertebral basilar (posterior) circulation disease

Ausman¹,

Liebeskind²,

Gonzalez³

et al. 2018

Surg Neurol Int

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We have reviewed the English literature published in the last 70 years on Diseases of the Vertebral Basilar Circulation, or Posterior Circulation Disease (PCD). We have found that errors have been made in the conduct and interpretation of these studies that have led to incorrect approaches to the management of PCD. Because of the difficulty in evaluating the PC, the management of PCD has been incorrectly applied from anterior circulation disease (ACD) experience to PCD. PCD is a common form of stroke affecting 20-40% patients with stroke. Yet, the evidence is strong that the Anterior Circulation (AC) and Posterior Circulations (PC) differ in their pathology, in their clinical presentations, in the rapidity of development of symptoms, in optimal imaging methods, and in available treatments.There appears to be two categories of patients who present with PCD. The first, acute basilar artery occlusion has a more rapid onset. The diagnosis must be made quickly and if imaging proves a diagnosis of Basilar Artery Occlusion (BAO), the treatment of choice is Interventional removal of the basilar artery thrombosis or embolus. The second category of PCD and the most commonly seen PCD disease process presents with non-specific symptoms and early warnings of PCD that now can be related to ischemic events in the entire PC vessels. These warning symptoms and signs occur much earlier than those in the AC.IA angiography is still the gold standard of diagnosis and is superior in definition to MR and CT angiography which are commonly used as a convenient screening imaging tool to evaluate PCD but are both inferior to IA angiography in definition for lesions below 3-4 mm. In at least two reported studies 7T MR angiography appears superior to other imaging modalities and will become the gold standard of imaging of PCD in the future. Medical treatments applied to the ACD have not been proven of value in specific forms of PCD. Interventional therapy was promising but of unproven value in Randomized Controlled Trials (RCT) except for the treatment of Basilar Artery Occlusion (BAO).Surgical revascularization has been proved to be highly successful in patients, who are refractory to medical therapy. These studies have been ignored by the scientific community basically because of an incorrect interpretation of the flawed EC-IC Bypass Trial in 1985 as applying to all stroke patients. Moreover, the EC-IC Bypass Study did not include PCD patients in their study population, but the study results were extrapolated to patients with PCD without any scientific basis. This experience led clinicians to an incorrect bias that surgical treatments are of no value in PCD. Thus, incorrectly, surgical treatments of PCD have not been considered among the therapeutic possibilities for PCD.QMRA is a new quantitative MR technique that measures specific blood flow in extra and intracranial vessels. QMRA has been used to select those patients who may benefit from medical, or interventional, or surgical treatment for PCD based on flow determinations with a high ...

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“…It is used after aneurysm clipping to access whether the aneurysm occlusion is complete. Catheter angiography is the gold standard for cerebral aneurysm diagnosis [2] and for confirming aneurysm occlusion. However, intraoperative catheter angiography requires a programmed setup; is invasive, expensive, and time-consuming, and requires a well-trained staff.…”

Section: Icg-va For Accessing Aneurysm Occlusion After Clippingmentioning

confidence: 99%

Innovations in the Surgery of Cerebral Aneurysms: Enhanced Visualization, Perfusion, and Function Monitoring

Rustemi¹,

Puppa²,

Scerrati³

2020

Neurosurgical Procedures - Innovative Approaches

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Surgery of cerebral aneurysms has evolved over the years. Advances regard enhanced intraoperative visualization and monitoring of both function and perfusion. Technological assistance used in oncological or skull base surgery, such as intraoperative neurophysiological monitoring (IONM) or endoscopy, now adopt to vascular surgery. Intraoperative indocyanine green video angiography (ICG-VA) and techniques for its interpretation (squeezing maneuver; entrapment sign), endoscopes, and exoscopes increase visualization. Flow evaluation by microflow probe permits perfusion monitoring; IONM allows functional monitoring. Bypasses replace flow in complex aneurysm cases. Pre-, intra-, and postoperative imaging and flow measurement techniques help in donor selection and follow-up. Despite some progression in the aneurysm clips, the principle has not changed. Innovation and even change of principle in aneurysm exclusion might be desirable. Basic research in aneurysm wall and flow dynamics might in the future change the paradigms of cerebral aneurysm treatment.

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Detection of unruptured intracranial aneurysms on noninvasive imaging. Is there still a role for digital subtraction angiography?

Cited by 27 publications

References 21 publications

Features of “false positive” unruptured intracranial aneurysms on screening magnetic resonance angiography

Features of “false positive” unruptured intracranial aneurysms on screening magnetic resonance angiography

A review of the diagnosis and management of vertebral basilar (posterior) circulation disease

Innovations in the Surgery of Cerebral Aneurysms: Enhanced Visualization, Perfusion, and Function Monitoring

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