Department of Radiology, Maison Blanche Hospital, Université Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims, France.
J Neuroradiol. 2013 Jul;40(3):204-10. doi: 10.1016/j.neurad.2013.03.004. Epub 2013 May 9.
Magnetic resonance angiography (MRA) has been evaluated for the detection of unruptured intracranial aneurysms with favorable results at 3 Tesla (3T) and with similar diagnostic accuracy as both 3D time-of-flight (3D-TOF) and contrast-enhanced (CE-MRA) MRA. However, the diagnostic value and place of MRA in the detection of ruptured aneurysms has been little evaluated. Thus, the goal of this prospective single-center series was to assess the feasibility and diagnostic value of 3T 3D-TOF MRA and CE-MRA for aneurysm detection in acute non-traumatic subarachnoid hemorrhage (SAH).
From March 2006 to December 2007, all consecutive patients admitted to our hospital with acute non-traumatic SAH (≤10 days) were prospectively included in this study evaluating MRA in the diagnostic workup of SAH. Feasibility of MRA and sensitivity/specificity of 3D-TOF and CE-MRA were assessed compared with gold standard DSA.
In all, 84 consecutive patients (45 women, 39 men; age 23-86 years) were included. The feasibility of MRA was low (43/84, 51.2%). The reasons given for patients not undergoing magnetic resonance imaging (MRI) examination were clinical status (27 patients), potential delay in aneurysm treatment (11 patients) and contraindications to MRI (three patients). In patients explored by MRA, the sensitivity of CE-MRA (95%) was higher compared with 3D-TOF (86%) with similar specificity (80%). Also, 3D-TOF missed five aneurysms while CE-MRA missed two.
The value of MRA in the diagnostic workup of ruptured aneurysms is limited due to its low feasibility during the acute phase of bleeding. Sensitivity for aneurysm detection was good for both MRA techniques, but tended to be better with CE-MRA.
磁共振血管造影（MRA）已在 3 特斯拉（3T）下用于检测未破裂颅内动脉瘤，并取得了良好的结果，其诊断准确性与三维时间飞跃（3D-TOF）和对比增强（CE-MRA）MRA 相似。然而，MRA 在检测破裂动脉瘤中的诊断价值和地位尚未得到充分评估。因此，本前瞻性单中心系列研究的目的是评估 3T 三维时间飞跃（3D-TOF）MRA 和 CE-MRA 在急性非创伤性蛛网膜下腔出血（SAH）中检测动脉瘤的可行性和诊断价值。
从 2006 年 3 月至 2007 年 12 月，所有连续因急性非创伤性 SAH（≤10 天）入院的患者均前瞻性纳入本研究，评估 MRA 在 SAH 诊断中的应用。评估 MRA 的可行性，并与金标准 DSA 比较 3D-TOF 和 CE-MRA 的敏感性/特异性。
共纳入 84 例连续患者（45 例女性，39 例男性；年龄 23-86 岁）。MRA 的可行性较低（43/84，51.2%）。未行 MRI 检查的患者原因包括临床状况（27 例）、动脉瘤治疗潜在延迟（11 例）和 MRI 禁忌证（3 例）。在接受 MRA 检查的患者中，CE-MRA 的敏感性（95%）高于 3D-TOF（86%），特异性相似（80%）。此外，3D-TOF 漏诊了 5 个动脉瘤，CE-MRA 漏诊了 2 个。
由于在出血急性期可行性较低，MRA 在破裂动脉瘤的诊断中的价值有限。两种 MRA 技术检测动脉瘤的敏感性均较好，但 CE-MRA 倾向于更好。
