Clinical utility of magnetic resonance angiography in the evaluation of aneurysms from a neurosurgical point of view.

The possibilities and limitations of MRA in the evaluation of intracranial aneurysms were investigated in this study. 54 patients, 30 with acute SAH were diagnosed using the three dimensional time-of-flight MRA in comparison with a conventional four vessel digital subtraction angiography prior to surgery. Furthermore, postoperative MRA was performed to assess clip placement and vessel patency and to search for innocent additional aneurysms in patients with emergency surgery due to intracerebral hemorrhage causing mass effect in whom preoperatively only the side of the lesion was investigated in DSA. 64 aneurysms in all vessel territories were detected. Three aneurysms were missed in MRA and there were three false positive results. Four baby-aneurysms were missed by both imaging modalities and were found during surgery. In all patients with CT scans suspicious of aneurysms MRA was able to detect or rule out the aneurysm. Postoperative MRA to demonstrate clip placement and vessel patency was not possible due to susceptibility artefacts. MRA should be the diagnostic procedure of first choice in CT findings suspicious of aneurysms. The follow-up of confirmed aneurysms is safely possible. MRA is very well applicable in the acute setting after SAH. The axial acquisition films and the rotatable maximum intensity projection reconstructions provide useful insights into the location of the aneurysm and its neighboring structures thus influencing the preoperative planning of surgical strategies. Keeping the limitations in mind it is a safe tool in the evaluation of aneurysms, especially with the rapidly improving postoprocessing possibilities.