[Subarachnoid hemorrhage: assessment in the acute phase with angiography, with high-resolution magnetic resonance (angio-MR)].

Previous reports demonstrated that Magnetic Resonance Angiography (MRA) is a reliable means of diagnosing intracerebral aneurysms. However, in these early studies MRA was performed in patients with cerebral aneurysms already proved by intraarterial angiography. Our study was aimed at investigating the clinical feasibility and the diagnostic accuracy of high-resolution MRA in patients with acute subarachnoid hemorrhage. Twenty-five patients (15 women, 10 men) with CT diagnosis of subarachnoid hemorrhage were prospectively examined with high-resolution MRA within 24 hours of bleeding. All patients underwent intraarterial digital subtraction angiography (IA DSA) immediately after MRA examination. MRA studies were performed with a 1.5-T unit. MRA examinations of the cerebral vessels consisted of axial excitation of two 50-mm volume slabs, with 25% overlap, covering the cerebral circulation from the vertebro-basilar junction to the pericallosal artery. Pulse sequence variables were optimized to reduce voxel size (0.62 x 0.62 x 0.78) and to increase spatial resolution (160-mm FOV, 256 x 256 matrix, 0.78-mm slice thickness) while keeping S/N ratio high. The maximum intensity projection (MIP) reconstruction algorithm was used. The examination lasted nearly 20 minutes. Four MRA examinations (16%) were considered inadequate for diagnosis because of motion artifacts. High-resolution MRA detected 20 of 21 aneurysms in 17 patients, with 1 false positive and 1 false negative. Two patients had multiple aneurysms, 2 and 4 respectively, all of them detected by MRA. No cause of subarachnoid hemorrhage was found by IA DSA in 4 patients, while MRA studies were considered negative in 3 patients. Nineteen aneurysms were surgically clipped, while 2 basilar artery aneurysms were occluded by intravascular treatment. MRA and DSA findings were compared with surgical findings. Relative to IA DSA, MRA exhibited 95% sensitivity and 95% specificity. Aneurysm size ranged 2-10 mm: the smallest aneurysm detected by MRA was 2.5 mm. Anatomical and morphological agreement between MRA and IA DSA was excellent, with only slight MRA underestimation of the aneurysm size in 25% of cases and overestimation in 15% of cases. The aneurysm neck was shown by MRA in 60% and by IA DSA in 81% of cases. High-resolution MRA proved to be especially useful in complex anatomical sites where the direction of the aneurysm could be clearly demonstrated through the accurate selection of the appropriate projection angle and the careful examination of direct axial images.(ABSTRACT TRUNCATED AT 400 WORDS)