From the Department of Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, New Haven, Connecticut
Yale School of Medicine (X.W., B.G.), New Haven, Connecticut.
AJNR Am J Neuroradiol. 2018 May;39(5):875-880. doi: 10.3174/ajnr.A5631. Epub 2018 Apr 12.
The long-term history and management of unruptured intracranial aneurysms is not well understood. Our aim was to determine current practice patterns in the management of unruptured intracranial aneurysms, especially regarding imaging surveillance for conservatively managed aneurysms of this type.
An on-line survey was designed to examine physician practice and preference regarding the management of small unruptured intracranial aneurysms (≤7 mm in diameter). The survey was circulated to members of the American Society of Neuroradiology. Participation was voluntary, and all responses were anonymous.
A total of 227 individual survey responses were obtained and included in the analysis with 54.6% (124/227) from diagnostic neuroradiologists (practicing >50% neuroradiology) and one-third (29%) from neurointerventional radiologists. One hundred seventy-three of 227 responded that routine, periodic imaging surveillance would be appropriate for conservatively managed unruptured intracranial aneurysms, and 84% of respondents recommended surveillance frequency of at least once a year. Fifty-nine percent favored indefinite, life-long follow-up for small unruptured intracranial aneurysms, and a similar number of respondents favored noncontrast MR angiography for aneurysm follow-up. Significant heterogeneity was found in size measurements used to assess aneurysms and criteria used to define growth on surveillance imaging.
The natural history of intracranial aneurysms is not well-understood. A large proportion of incidentally detected, unruptured aneurysms are small (<7 mm). The survey results show significant heterogeneity in practice even among neuroradiologists and underlies the need to standardize imaging practice. Further studies are needed to assess the optimal frequency and duration of surveillance imaging for unruptured intracranial aneurysms. The criteria used to measure aneurysms and define growth on imaging also need to be standardized.
颅内未破裂动脉瘤的长期病史和管理情况尚不清楚。我们的目的是确定颅内未破裂动脉瘤管理的当前实践模式，特别是针对这种类型的保守治疗动脉瘤的影像学监测。
设计了一项在线调查，以检查医生在管理小的颅内未破裂动脉瘤（直径≤7mm）方面的实践和偏好。该调查分发给美国神经放射学会的成员。参与是自愿的，所有的回答都是匿名的。
共获得 227 份单独的调查回复，并纳入分析，其中 54.6%（124/227）来自诊断神经放射学家（从事神经放射学工作>50%），三分之一（29%）来自神经介入放射学家。227 名受访者中有 173 名表示，对于保守治疗的颅内未破裂动脉瘤，常规定期影像学监测是合适的，84%的受访者建议每年至少进行一次监测。59%的人赞成对小的颅内未破裂动脉瘤进行无限期的终身随访，同样数量的受访者赞成对动脉瘤进行非对比磁共振血管造影（MRA）随访。在用于评估动脉瘤的大小测量和用于定义监测影像上生长的标准方面，发现了显著的异质性。
颅内动脉瘤的自然史尚不清楚。很大一部分偶然发现的未破裂动脉瘤较小（<7mm）。调查结果显示，即使在神经放射学家之间，实践也存在显著的异质性，这突显了标准化成像实践的必要性。需要进一步的研究来评估颅内未破裂动脉瘤监测影像学的最佳频率和持续时间。用于测量动脉瘤和定义影像学上生长的标准也需要标准化。
