Abstract
Up to now, digital subtraction angiography (DSA) has been considered the gold standard for the detection of cerebrovascular pathology. Two noninvasive angiographic modalities have experienced an impressive recent improvement: magnetic resonance angiography (MRA) and three-dimensional computed tomographic angiography (CTA). With the latest modifications in postprocessing, the resolution of MRA has become similar to that of DSA. MRA can accurately delineate vessels less than 1 mm and aneurysms equal to or greater than 3 mm in diameter. Three-dimensional reconstructionfrom MR images can also be used for planning the surgery of cerebrovascular pathology. Three-dimensional CTA has greater resolution than MRA and has excellent correlation with DSA. CTA is extremely sensitive for the detection of cerebral aneurysms: Compared with DSA its sensitivity is about 97% and its specificity 100%. Although DSA is an invasive procedure, it still possesses greater resolution than MRA and CTA. In the hands of the skilled neuroradiologist, it carries a low risk and is the best method for the evaluation of cross-flow or vascular reserve and for postoperative control. MRA and CTA can replace DSA for the depiction of ruptured or unruptured cerebral aneurysms. As a result of the widespread use of noninvasive angiographic methods, an increasing number of unruptured aneurysms will be diagnosed. It is currently accepted that unruptured aneurysms greater than 5 mm in diameter should be surgically clipped. The wrapping technique is not generally considered to be an effective treatment of cerebral aneurysms.
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