RESUMO
To emphasize the limitations of magnetic resonance angiographic screening for intracranial aneurysms, we present the case of a patient with a false-negative screening result, unfortunately advancing to rupture of the aneurysm. An asymptomatic woman underwent magnetic resonance angiographic screening in an investigational setting. Three years later, she had an onset of sudden headache, after which her condition rapidly deteriorated. Severe subarachnoid hemorrhage and an intracerebral hematoma were diagnosed. Conventional angiography detected a small ruptured middle cerebral artery trifurcation aneurysm and two very small aneurysms. There are still limitations in the ability of magnetic resonance angiography to detect small or very small aneurysms. Even small-probability findings should always be confirmed or excluded by conventional angiography.
Assuntos
Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/genética , Aneurisma Roto/cirurgia , Craniotomia , Reações Falso-Negativas , Feminino , Seguimentos , Testes Genéticos , Humanos , Aneurisma Intracraniano/genética , Aneurisma Intracraniano/cirurgia , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/genética , Hemorragia Subaracnóidea/cirurgiaRESUMO
PURPOSE: To evaluate the accuracy and limitations of magnetic resonance (MR) angiographic screening for incidental intracranial aneurysms (IAs) in healthy individuals with a family history of IA. MATERIALS AND METHODS: Four hundred asymptomatic individuals in 68 families with a history of aneurysmal subarachnoid hemorrhage underwent MR angiography. Six families also had a history of polycystic kidney disease. A multislab, three-dimensional, time-of-flight sequence was used. Conventional angiography was performed to confirm positive MR angiographic findings. RESULTS: IAs were detected with MR angiography in 37 individuals, 32 of whom underwent conventional angiography. Intraobserver consistency was excellent (kappa = 0.96), and interobserver reproducibility was good to excellent (kappa = 0.59-0.82). Both techniques showed similar results in the evaluation of size, localization, and orientation of aneurysms and visibility of the aneurysm neck. CONCLUSION: MR angiography is an accurate and feasible method of noninvasive screening for IAs in individuals at high risk. Conventional angiography is still necessary before operative treatment.