Abstract
Neuroimaging is a critical element in evaluating and treating patients with cerebral aneurysms. Each neuroimaging technique has unique strengths, weaknesses, and current developments. In this review, we discuss the utility of two primary noninvasive radiological techniques—computed tomography angiography (CTA) and magnetic resonance angiography (MRA)—as well as of digital subtraction angiography (DSA) for evaluation of cerebral aneurysms. These techniques allow comprehensive evaluation of aneurysm size, location, rupture status, and other imaging characteristics that guide clinicians to make appropriate and timely treatment recommendations.
Highlights
Subarachnoid hemorrhage from rupture of an intracranial aneurysm is a devastating condition associated with approximately 50 % overall mortality and high survivor morbidity despite advances in treatment [1]
Population studies have estimated the overall prevalence of intracranial aneurysms to be 3.2 % [2], the overall incidence of subarachnoid hemorrhage secondary to aneurysmal rupture in a population study spanning 21 countries was relatively low at approximately 9 per 100,000 persons per year, rates differed by country (e.g., Japan and Finland had the highest rates at 22.7 and 19.7, respectively) [3]
The distribution of the hemorrhage can often predict the location of the underlying aneurysm, and CTs can determine the presence of intraventricular hemorrhage and degree of hydrocephalus, which can have significant impact on prognosis and treatment (Fig. 1a)
Summary
Subarachnoid hemorrhage from rupture of an intracranial aneurysm is a devastating condition associated with approximately 50 % overall mortality and high survivor morbidity despite advances in treatment [1]. Population studies have estimated the overall prevalence of intracranial aneurysms to be 3.2 % [2], the overall incidence of subarachnoid hemorrhage secondary to aneurysmal rupture in a population study spanning 21 countries was relatively low at approximately 9 per 100,000 persons per year, rates differed by country (e.g., Japan and Finland had the highest rates at 22.7 and 19.7, respectively) [3]. The angiomorphology of the aneurysm has been posited to influence future hemorrhage risk factors, such as irregular domes [7, 8], daughter sacs [9], and low wall shear stress [10]. It is critically important to accurately characterize aneurysmal morphology to guide treatment, making
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