Brown B M, Soldevilla F
Department of Radiology, Kaiser Sunnyside Medical Center, Clackamas, OR 97015, USA.
AJR Am J Roentgenol. 1999 Jul;173(1):133-8. doi: 10.2214/ajr.173.1.10397113.
We used MR angiography to determine prevalence of unruptured familial intracranial aneurysms in a prepaid medical care program. We compared surgical outcomes and the cost of treating unruptured versus ruptured aneurysms. We compared the cost of MR angiography with the cost of screening mammography and with the cost of surgically treating a ruptured aneurysm.
During a 30-month period, we performed MR angiography to show cerebral aneurysms in 63 surgical candidates who had one or more first-degree relatives with an aneurysm. Unruptured aneurysms seen on MR angiography were evaluated by digital subtraction angiography (DSA) and treated surgically.
MR angiography showed nine unruptured aneurysms in six patients. Eight aneurysms were seen on MR angiography and nine were seen on DSA. Seven unruptured aneurysms were treated surgically. The mean treatment cost was 50% lower for an unruptured aneurysm than that for a ruptured aneurysm. No patient surgically treated for an unruptured aneurysm required rehabilitation, unlike 25% of patients with ruptured aneurysms. The annual total cost of MR angiography was equivalent to 2.9% of the annual cost of screening mammography. The annual cost of MR angiography equaled half the cost of treating one patient after aneurysm rupture.
MR angiography showed a 9.5% prevalence of unruptured aneurysms among persons who had one or more first-degree relatives with a cerebral aneurysm. DSA confirmed 88% of aneurysms found on MR angiography. Persons with unruptured aneurysms had better treatment outcomes at lower cost than did patients treated for aneurysm rupture. The annual MR angiography cost was low compared with the cost of screening mammography and with the cost of treating one patient with aneurysm rupture.
我们采用磁共振血管造影术来确定一个预付医疗保健项目中未破裂的家族性颅内动脉瘤的患病率。我们比较了手术结果以及治疗未破裂动脉瘤与破裂动脉瘤的成本。我们还将磁共振血管造影术的成本与乳腺钼靶筛查的成本以及手术治疗破裂动脉瘤的成本进行了比较。
在30个月的时间里，我们对63名有一个或多个患有动脉瘤的一级亲属的手术候选者进行了磁共振血管造影术以显示脑动脉瘤。磁共振血管造影术发现的未破裂动脉瘤通过数字减影血管造影术（DSA）进行评估并接受手术治疗。
磁共振血管造影术在6名患者中显示出9个未破裂动脉瘤。磁共振血管造影术发现了8个动脉瘤，DSA发现了9个。7个未破裂动脉瘤接受了手术治疗。未破裂动脉瘤的平均治疗成本比破裂动脉瘤低50%。与25%的破裂动脉瘤患者不同，接受未破裂动脉瘤手术治疗的患者无需康复治疗。磁共振血管造影术的年度总成本相当于乳腺钼靶筛查年度成本的2.9%。磁共振血管造影术的年度成本等于动脉瘤破裂后治疗一名患者成本的一半。
磁共振血管造影术显示，在有一个或多个患有脑动脉瘤的一级亲属的人群中，未破裂动脉瘤的患病率为9.5%。DSA证实了磁共振血管造影术发现的动脉瘤中的88%。与接受动脉瘤破裂治疗的患者相比，患有未破裂动脉瘤的患者治疗效果更好，成本更低。与乳腺钼靶筛查成本以及治疗一名动脉瘤破裂患者的成本相比，磁共振血管造影术的年度成本较低。
