| 1. Whitehead MT, Cardenas AM, Corey AS, et al. ACR Appropriateness Criteria® Headache. J Am Coll Radiol 2019;16:S364-S77. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for headache. |
No results stated in the abstract. |
4 |
| 2. American College of Radiology. ACR Appropriateness Criteria®: Head Trauma. Available at: https://acsearch.acr.org/docs/69481/Narrative/. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. |
No abstract available. |
4 |
| 3. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 4. Westerlaan HE, van Dijk MJ, Jansen-van der Weide MC, et al. Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis--systematic review and meta-analysis. Radiology. 2011; 258(1):134-145. |
Meta-analysis |
50 studies; 2 independent reviewers |
To calculate the sensitivity and specificity of CTA in the diagnosis of cerebral aneurysms in patients with acute SAH at presentation. |
For sensitivity, the selected studies showed moderate heterogeneity. For specificity, low heterogeneity was observed. The majority of the studies (n = 30) used a four-detector row CT scanner. The studies had good methodologic quality. Pooled sensitivity was 98% (95% CI: 97%, 99%), and pooled specificity was 100% (95% CI: 97%, 100%). Potential sources of variability among the studies were variations in the methodologic features (quality score), CT examination procedure (number of rows on the MDCT scanner), the standard of reference used, and the prevalence of ruptured intracranial aneurysms. There was evidence for publication bias, which may have led to overestimation of the diagnostic accuracy of CTA. |
M |
| 5. Khurram A, Kleinig T, Leyden J. Clinical associations and causes of convexity subarachnoid hemorrhage. Stroke. 45(4):1151-3, 2014 Apr. |
Review/Other-Dx |
742 cases |
To review the Clinical associations and causes of convexity subarachnoid hemorrhage. |
Of 742 cases with SAH, 41 (6%) cases were cSAH, giving a minimum population annual incidence of 5.1 per million (95% confidence interval, 3.7-7.0). Median age was 70 years (interquartile range, 48-79). Commonest causes were cerebral amyloid angiopathy (39%), reversible cerebral vasoconstriction syndrome (17%), cerebral venous sinus thrombosis (10%), large-vessel stenotic atherosclerosis (10%), and posterior reversible encephalopathy syndrome (5%). No cause was identified in 20% (mostly elderly patients with incomplete evaluation). Most (63%) presented with transient neurological symptoms. Many (49%) were misdiagnosed as transient ischemic attacks and treated inappropriately with antithrombotics. |
4 |
| 6. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 43(6):1711-37, 2012 Jun. |
Review/Other-Dx |
N/A |
To present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). |
Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. |
4 |
| 7. Labovitz DL, Halim AX, Brent B, Boden-Albala B, Hauser WA, Sacco RL. Subarachnoid hemorrhage incidence among Whites, Blacks and Caribbean Hispanics: the Northern Manhattan Study. Neuroepidemiology. 26(3):147-50, 2006. |
Review/Other-Dx |
52 patients |
To identify incident (subarachnoid hemorrhage) SAH cases among white, black and Hispanic adults living in Northern Manhattan between July 1993 and June 1997. |
The annual incidence adjusted for age and sex to the 1990 US Census was 9.7 per 100,000 (95% CI 7.5–12.0). Compared with whites (9 cases, age- and sex-adjusted annual incidence 8.2 per 100,000), the rate ratio of SAH was 1.3 (95% CI 0.7–2.4) for Hispanics (34 cases, incidence 10.9), and 1.6 (95% CI 0.8–2.8) for blacks (9 cases, incidence 12.8). The 30-day case fatality rate was 26%. Risk of death increased significantly with age and severity at onset but was not influenced by gender or race-ethnicity. |
4 |
| 8. Schievink WI, Wijdicks EF, Parisi JE, Piepgras DG, Whisnant JP. Sudden death from aneurysmal subarachnoid hemorrhage. Neurology. 45(5):871-4, 1995 May. |
Review/Other-Dx |
113 patients |
To clarify the clinical profile of sudden death from aneurysmal (subarachnoid hemorrhage) SAH. |
No results stated in the abstract. |
4 |
| 9. Shea AM, Reed SD, Curtis LH, Alexander MJ, Villani JJ, Schulman KA. Characteristics of nontraumatic subarachnoid hemorrhage in the United States in 2003. Neurosurgery. 61(6):1131-7; discussion 1137-8, 2007 Dec. |
Review/Other-Dx |
31,476 patients |
To examine the epidemiology and in-hospital outcomes of nontraumatic SAH in the United States. |
In 2003, there were an estimated 31,476 discharges for nontraumatic SAH among patients aged 17 years or older, or 14.5 discharges per 100,000 adults. The in-hospital mortality rate was 25.3%. Microvascular clipping was performed in 7513 discharges, or 23.9% of inpatients with nontraumatic SAH; endovascular coiling was performed in 2849 discharges (9.1%). Adjusted odds of treatment with either procedure were significantly higher in urban teaching hospitals compared with urban nonteaching hospitals (odds ratio, 1.62; 95% confidence interval, 1.00-2.62) or rural hospitals (odds ratio, 3.08; 95% confidence interval, 1.93-4.91). |
4 |
| 10. Wang H, Li W, He H, Luo L, Chen C, Guo Y. 320-detector row CT angiography for detection and evaluation of intracranial aneurysms: comparison with conventional digital subtraction angiography. Clin Radiol. 68(1):e15-20, 2013 Jan. |
Observational-Dx |
52 patients |
To compare the diagnostic performance of 320-detector row computed tomographic angiography (CTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms. |
In 52 patients, 54 aneurysms were detected; 48 patients underwent surgery for 50 aneurysms. The overall sensitivity, specificity, and accuracy of 3D CTA were 96.3, 100, and 94.6%, respectively. Meanwhile, the overall sensitivity, specificity, and accuracy of DSA were 98.1, 98.1, and 95.1%, respectively. For aneurysms less than 3 mm, the sensitivity, specificity, and accuracy of 3D CTA were 81.8, 100, and 93.3%, respectively. The sensitivity, specificity, and accuracy of DSA for small aneurysms were 90.9, 100, and 96.2%, respectively. 3D CTA was superior to DSA in demonstrating aneurysmal calcification, parent artery, and surrounding vascular anatomy. |
2 |
| 11. Heit JJ, Pastena GT, Nogueira RG, et al. Cerebral Angiography for Evaluation of Patients with CT Angiogram-Negative Subarachnoid Hemorrhage: An 11-Year Experience. AJNR Am J Neuroradiol. 37(2):297-304, 2016 Feb. |
Observational-Dx |
230 patients |
To investigate the yield of digital subtraction angiography among patients with SAH or intraventricular hemorrhage and a negative CTA. |
Two hundred thirty patients (mean age, 54 years; 51% male) with CTA-negative SAH were identified. The pattern of SAH was diffuse (40%), perimesencephalic (31%), sulcal (31%), isolated IVH (6%), or identified by xanthochromia (7%). Initial DSA yield was 13%, including vasculitis/vasculopathy (7%), aneurysm (5%), arteriovenous malformation (0.5%), and dural arteriovenous fistula (0.5%). An additional 6 aneurysms/pseudoaneurysms (4%) were identified by follow-up DSA, and a single cavernous malformation (0.4%) was identified by MRI. No cause of hemorrhage was identified in any patient presenting with isolated intraventricular hemorrhage or xanthochromia. Diffuse SAH was due to aneurysm rupture (17%); perimesencephalic SAH was due to aneurysm rupture (3%) or vasculitis/vasculopathy (1.5%); and sulcal SAH was due to vasculitis/vasculopathy (32%), arteriovenous malformation (3%), or dural arteriovenous fistula (3%). |
4 |
| 12. Bechan RS, van Rooij WJ, Peluso JP, Sluzewski M. Yield of Repeat 3D Angiography in Patients with Aneurysmal-Type Subarachnoid Hemorrhage. AJNR Am J Neuroradiol. 37(12):2299-2303, 2016 Dec. |
Observational-Dx |
292 patients |
To evaluate the yield of repeat 3D rotational angiography in patients with aneurysmal-type SAH with negative initial 3D rotational angiography findings and to classify the initial occult aneurysms. |
In 8 of 30 patients (26.7%; 95% CI, 14.0%-44.7%) with initial negative 3D rotational angiography findings, a ruptured aneurysm was found on repeat 3D rotational angiography. Three of 8 initial occult aneurysms were very small (1-2 mm), 2 were supraclinoid carotid artery dissecting aneurysms (2 and 8 mm), 2 were small (1 and 3 mm) basilar perforator aneurysms, and 1 was a 3-mm vertebral artery dissecting aneurysm. |
4 |
| 13. Donmez H, Serifov E, Kahriman G, Mavili E, Durak AC, Menku A. Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms. Eur J Radiol. 80(2):455-61, 2011 Nov. |
Observational-Dx |
112 patients |
To compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH). |
A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively. |
2 |
| 14. Guo W, He XY, Li XF, et al. Meta-analysis of diagnostic significance of sixty-four-row multi-section computed tomography angiography and three-dimensional digital subtraction angiography in patients with cerebral artery aneurysm. J Neurol Sci. 346(1-2):197-203, 2014 Nov 15. |
Meta-analysis |
923 cerebral artery aneurysm cases (8 studies) |
To investigate the potential use and value of 64-MSCT angiography and 3D-DSA in cerebral artery aneurysm. |
Final meta-analysis of 923 cerebral artery aneurysm cases were incorporated from eight cohort studies and selected for statistical analysis. Pooled sensitivity and specificity of 64-MSCT angiography in the diagnosis of cerebral artery aneurysm were 0.97 (95% CI, 0.96–0.98) and 0.91 (0.88–0.94), respectively. The pooled positive LR was 7.68 (95% CI, 3.34–17.67); and the pooled negative LR was 0.04 (95% CI, 0.03–0.05). The pooled diagnostic OR was 263.69 (95% CI, 121.19–573.77). The area under the SROC curve was 0.9934 (standard error [SE] = 0.0031). No significant evidence of publication bias was detected (P > 0.05). |
Good |
| 15. McKinney AM, Palmer CS, Truwit CL, Karagulle A, Teksam M. Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography. AJNR Am J Neuroradiol. 2008;29(3):594-602. |
Observational-Dx |
63 subjects |
To determine the accuracy of 64-section MSCTA (64MSCTA) in aneurysm detection versus combined digital subtraction angiography (DSA) and 3D rotational angiography (3DRA). |
A total of 41 aneurysms were found in 28 patients. The mean size was 6.09 mm on DSA/3DRA and 5.98 mm on 64MSCTA. kappa was excellent (0.97) between the aneurysm size on 64MSCTA and DSA/3DRA. Ultimately, 37 aneurysms were detected by DSA/3DRA in 25 of the 36 patients who underwent conventional angiography. The reviewers noted four 1- to 1.5-mm sessile outpouchings only on 3DRA; none were considered a source of SAH. One 64MSCTA was false positive, whereas one 2-mm aneurysm was missed by CTA. The sensitivity of CTA for aneurysms less than 4 mm was 92.3%, whereas it was 100% for those 4-10 mm and more than 10 mm, excluding the indeterminate, sessile lesions. |
2 |
| 16. Prestigiacomo CJ, Sabit A, He W, Jethwa P, Gandhi C, Russin J. Three dimensional CT angiography versus digital subtraction angiography in the detection of intracranial aneurysms in subarachnoid hemorrhage. J Neurointerv Surg. 2(4):385-9, 2010 Dec. |
Observational-Dx |
179 patients |
To assess the specificity and sensitivity of this non-invasive modality to detect aneurysms. |
Of the 179 patients screened by CTA, 13 (7%) were negative for aneurysms or other vascular lesions (arteriovenous malformation or dural fistula) on CTA and underwent DSA. No new lesions were identified on six vessel angiography, resulting in a 0% false negative rate (sensitivity 100%, predictive value 100%). MRI to rule out thrombosed aneurysms and repeat angiography at the 2 week follow-up were negative. |
2 |
| 17. Xing W, Chen W, Sheng J, et al. Sixty-four-row multislice computed tomographic angiography in the diagnosis and characterization of intracranial aneurysms: comparison with 3D rotational angiography. World Neurosurg. 76(1-2):105-13, 2011 Jul-Aug. |
Observational-Dx |
133 patients |
To compare 64-slice CTA with three-dimensional rotational angiography (3DRA) in the detection and characterization of intracranial aneurysms with special attention to smaller (<3-mm) aneurysms. |
The reference standard revealed 111 aneurysms in 93 patients: 27 aneurysms were read as <3 mm, 66 were read as being between 3 and 8 mm, and 18 were read as >8 mm. The sensitivities of 64-slice CTA for aneurysms<3 mm, between 3 and 8 mm, and >8 mm were 96.3%, 98.5%, and 100%, respectively, on a per-aneurysm basis. The sensitivities of conventional DSA for aneurysms<3 mm, between 3 and 8 mm, and >8 mm were 85.2%, 100%, and 100%, respectively, on a per-aneurysm basis. The 64-slice CT angiographic images could clearly show the aneurysmal characteristics and the relationship between aneurysms and adjacent branch vessels. |
1 |
| 18. Zhao B, Lin F, Wu J, et al. A Multicenter Analysis of Computed Tomography Angiography Alone Versus Digital Subtraction Angiography for the Surgical Treatment of Poor-Grade Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 91:106-11, 2016 Jul. |
Observational-Dx |
144 patients |
To determine the safety and efficacy of CTA alone for surgical treatment of poor-grade aSAH compared with digital subtraction angiography (DSA). |
Of the 116 patients included, 42 (36.2%) patents received CTA alone and 74 patients (63.7%), including 12 patients with CTA and DSA and 62 patients with DSA alone, received DSA before surgical treatment. Patients with larger ruptured aneurysms (P = 0.006), aneurysm sizes of larger than 5 mm (P = 0.025), presence of single aneurysms (P = 0.018), and presence of intraventricular hemorrhage (P = 0.019) more often received CTA alone. All ruptured aneurysms were clipped successfully during surgery. There were no statistically significant differences in postoperative complications and clinical outcomes between the 2 groups. |
2 |
| 19. Philipp LR, McCracken DJ, McCracken CE, et al. Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms. Neurosurgery. 80(5):769-777, 2017 May 01. |
Observational-Dx |
643 patients |
To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH. |
Three hundred and thirty aneurysms were detected by CTA while DSA detected a total of 431 aneurysms. False positive CTA results were seen for 24 aneurysms. DSA identified 125 aneurysms that were missed by CTA and 83.2% of those were <5 mm in diameter. The sensitivity of CTA was 57.6% for aneurysms smaller than 5 mm in size, and 45% for aneurysms originating from the internal carotid artery. The overall sensitivity of CTA in the setting of SAH was 70.7%. |
2 |
| 20. Agid R, Andersson T, Almqvist H, et al. Negative CT angiography findings in patients with spontaneous subarachnoid hemorrhage: When is digital subtraction angiography still needed? AJNR Am J Neuroradiol. 2010;31(4):696-705. |
Observational-Dx |
193 patients |
To evaluate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. |
One hundred ninety-three patients with SAH and negative findings on CTA who underwent subsequent DSA were identified. The distribution of blood on unenhanced CT was the following: PMH in 93 patients, diffuse aneurysmal pattern in 50, no blood on CT (xanthochromic LP) in 32, and peripheral sulcal distribution in 18. All patients with PMH had negative findings on DSA. One patient with no blood on CT had vasculitis on DSA. Six of 18 (33%) patients with peripheral blood had vasculitis on DSA. Three of these were also diagnosed by CTA. All except 1 patient with diffuse aneurysmal blood had negative findings on DSA. One patient was diagnosed with an aneurysm on DSA (1/50, 0.5%). Repeat delayed DSA performed in 28 of these patients revealed a small aneurysm in 4 (14%). Five patients had a complication of DSA (2.6%); 1 was a clinical stroke (0.5%). |
3 |
| 21. Sailer AM, Wagemans BA, Nelemans PJ, de Graaf R, van Zwam WH. Diagnosing intracranial aneurysms with MR angiography: systematic review and meta-analysis. [Review]. Stroke. 45(1):119-26, 2014 Jan.Stroke. 45(1):119-26, 2014 Jan. |
Meta-analysis |
12 studies |
To evaluate the sensitivity and specificity of MR angiography (MRA) in the diagnosis of ruptured and unruptured intracranial aneurysms. |
Included studies were of high methodological quality. Studies with larger sample size tended to have higher diagnostic performance. Most studies used time-of-flight MRA technique. Among the 960 patients assessed, 772 aneurysms were present. Heterogeneity with reference to sensitivity and specificity was moderate to high. Pooled sensitivity of MRA was 95% (95% confidence interval, 89%-98%), and pooled specificity was 89% (95% confidence interval, 80%-95%). False-negative and false-positive aneurysms detected on MRA were mainly located at the skull base and middle cerebral artery. Freehand 3-dimensional reconstructions performed by the radiologist significantly increased diagnostic performance. Studies performed on 3 Tesla showed a trend toward higher performance (P=0.054). |
Good |
| 22. Li MH, Li YD, Gu BX, et al. Accurate diagnosis of small cerebral aneurysms <=5 mm in diameter with 3.0-T MR angiography. Radiology. 271(2):553-60, 2014 May. |
Observational-Dx |
403 patients |
To evaluate the diagnostic accuracy of three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography at 3.0 T in the detection of small cerebral aneurysms. |
Of 403 patients, 273 aneurysms were detected with DSA in 230 patients. Patient-based evaluation with 3D TOF MR angiography at 3.0 T yielded an accuracy of 96%-97%, a sensitivity of 98.2%-98.7%, a specificity of 93.2% -94.8%, a PPV of 94.9%-96.2%, and an NPV of 97.6%-98.2% in the detection of cerebral aneurysms. Aneurysm-based evaluation yielded an accuracy of 96.4%-97.3%, a sensitivity of 98.5%-98.9%, a specificity of 93.2%-94.9%, a PPV of 95.7%-96.8%, and an NPV of 97.6%-98.2%. Aneurysm-location evaluations yielded similar results. |
2 |
| 23. Cho YD, Lee JY, Kwon BJ, Kang HS, Han MH. False-positive diagnosis of cerebral aneurysms using MR angiography: location, anatomic cause, and added value of source image data. Clin Radiol. 66(8):726-31, 2011 Aug. |
Observational-Dx |
172 patients |
To investigate the anatomic causes of false-positive unruptured aneurysms (FPUIAs) and the added value of source images (SIs) in magnetic resonance angiography (MRA)-based UIA diagnosis. |
FPUIAs were most commonly found at the internal carotid artery (ICA)-posterior communicating artery (Pcom) (36%). False-positive results at the ICA-Pcom and ICA-anterior choroidal artery resulted from the presence of infundibuli in 28 (97%) and six (100%), respectively. An arterial loop was the leading cause of FPUIAs throughout all locations of the anterior cerebral artery and middle cerebral artery except the anterior communicating artery, where fenestration was found in six (60%) cases. The areas under the ROC curves of the two image modes were not significantly different (0.887 versus 0.925; p=0.103). Addition of the SIs did not cause a significant change in sensitivity (88.2 versus 83.5%; p=0.21), whereas it led to a significant increase in specificity (74.6 versus 95.2%; p=0.0002). |
2 |
| 24. Sato K, Shimizu H, Fujimura M, Inoue T, Matsumoto Y, Tominaga T. Acute-stage diffusion-weighted magnetic resonance imaging for predicting outcome of poor-grade aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 30(6):1110-20, 2010 Jun. |
Experimental-Dx |
38 patients |
To investigate the role of acute-stage diffusion-weighted images (DWIs) for predicting outcome of poor-grade subarachnoid hemorrhage (SAH). |
We evaluated the correlation between preoperative DWI findings and clinical outcome, and the characteristics of DWI abnormalities. DWI abnormalities were revealed in 81.6% of cases (group S 34.2%; group A 47.3%). All patients in groups N and S and 73.3% of patients in group A were treated radically. For those patients without rerupture, favorable outcomes were achieved in 100% of group N, 53.8% of group S, and 0% of group A. Abnormal lesions on initial DWI, which resulted in permanent lesions, showed a mean apparent diffusion coefficient ratio to the control value of 0.71, which was significantly lower than 0.95 observed in reversible lesions (P<0.01). We recommend radical treatment for even poor-grade SAH as long as the preoperative DWI shows no or only spotty lesions. DWI may provide an objective means to estimate the outcome of poor-grade SAH. |
2 |
| 25. Wartenberg KE, Sheth SJ, Michael Schmidt J, et al. Acute ischemic injury on diffusion-weighted magnetic resonance imaging after poor grade subarachnoid hemorrhage. Neurocrit Care. 14(3):407-15, 2011 Jun. |
Review/Other-Dx |
21 patients |
To determine if rupture of an intracranial aneurysm is associated with acute ischemic brain injury in poor grade patients in autopsy studies and small magnetic resonance imaging series. |
Of the 21 patients 13 were Hunt-Hess grade 5, and eight were grade 4. Eighteen patients (86%) displayed bilateral and symmetric abnormalities on DWI, but not on computed tomography (CT). Involved regions included both anterior cerebral artery territories (16 patients), and less often the thalamus and basal ganglia (4 patients), middle (6 patients) or posterior cerebral artery territories (2 patients), or cerebellum (2 patients). At 1-year, 15 patients were dead (life support had been withdrawn in 6), 2 were moderately to severely disabled (modified Rankin Scale [mRS] = 4-5), and 4 had moderate-to-no disability (mRS = 1-3). |
4 |
| 26. Washington CW, Zipfel GJ, Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage. Detection and monitoring of vasospasm and delayed cerebral ischemia: a review and assessment of the literature. [Review]. Neurocrit Care. 15(2):312-7, 2011 Sep. |
Review/Other-Dx |
N/A |
To evaluate the role of clinical assessment, transcranial Doppler, computed tomographic angiography, and computed tomographic perfusion. |
No results stated in the abstract. |
4 |
| 27. Marshall SA, Kathuria S, Nyquist P, Gandhi D. Noninvasive imaging techniques in the diagnosis and management of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2010;21(2):305-323. |
Review/Other-Dx |
N/A |
A review of the literature regarding the use of noninvasive imaging studies to aid in the diagnosis of ruptured intracerebral arterial aneurysms and VS, along with the current published data comparing the gold standard of DSA to these newer modalities. |
The management of aSAH and VS presents challenges to the neurosurgeon, neurointensivist, and interventional neuroradiologist. Newer and less invasive modalities for the diagnosis of aSAH and detection of VS are being increasingly used. The current data support use of several of these new techniques in a subset of this population of patients, although DSA still retains its place as the gold standard. |
4 |
| 28. Rawal S, Barnett C, John-Baptiste A, Thein HH, Krings T, Rinkel GJ. Effectiveness of diagnostic strategies in suspected delayed cerebral ischemia: a decision analysis. Stroke. 46(1):77-83, 2015 Jan. |
Review/Other-Dx |
I patient |
To identify the best strategy for preventing cerebral infarction in an aneurysmal subarachnoid hemorrhage (ASAH) patient with clinical diagnosis of delayed cerebral ischemia (DCI). |
When treatment was assumed to be ineffective in nonvasospasm patients, Treat All and digital subtraction angiography were equivalent strategies; when a moderate treatment effect was assumed in nonvasospasm patients, Treat All became the superior strategy. Treating all patients was also superior to selecting patients for treatment via computed tomography perfusion. One-way sensitivity analyses demonstrated that the models were robust; 2- and 3-way sensitivity analyses with variation of disease and treatment parameters reinforced dominance of the Treat All strategy. |
4 |
| 29. Westermaier T, Pham M, Stetter C, et al. Value of transcranial Doppler, perfusion-CT and neurological evaluation to forecast secondary ischemia after aneurysmal SAH. Neurocrit Care. 20(3):406-12, 2014 Jun. |
Observational-Dx |
61 patients |
To prospectively evaluate the diagnostic value of detailed neurological evaluation, transcranial Doppler sonography (TCD) and Perfusion-CT (PCT) to predict delayed vasospasm (DV) and delayed cerebral infarction (DCI) within the following 3 days in patients with aneurysmal subarachnoid hemorrhage (SAH). |
The accuracy of TCD and PCT to predict DV or DCI was 0.65 and 0.63, respectively. In comparison, DIND predicted DV or DCI with an accuracy of 0.96. Pathological PCT findings had a higher sensitivity (0.93) and negative predictive value (0.98) than TCD (0.81 and 0.96). |
2 |
| 30. Ibrahim GM, Morgan BR, Macdonald RL. Patient phenotypes associated with outcomes after aneurysmal subarachnoid hemorrhage: a principal component analysis. Stroke. 45(3):670-6, 2014 Mar. |
Experimental-Dx |
120 patients |
To identify baseline patient phenotypes that may predict neurological outcomes. |
Sixteen significant principal components accounting for 74.6% of the variance were identified. A single component dominated by the patients' initial hemodynamic status, World Federation of Neurosurgical Societies score, neurological injury, and initial neutrophil/leukocyte counts was significantly associated with poor outcome. Two additional components were associated with angiographic vasospasm, of which one was also associated with delayed ischemic neurological deficit. The first was dominated by the aneurysm-securing procedure, subarachnoid clot clearance, and intracerebral hemorrhage, whereas the second had high contributions from markers of anemia and albumin levels. |
2 |
| 31. Crowley RW, Medel R, Dumont AS, et al. Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke. 42(4):919-23, 2011 Apr. |
Experimental-Dx |
413 patients |
To determine the relationship between angiographic vasospasm and cerebral infarction after subarachnoid hemorrhage. |
Complete data were available for 381 of 413 patients (92%). Angiographic vasospasm was none/mild in 209 (55%) patients, moderate in 118 (31%), and severe in 54 (14%). Infarcts developed in 6 (3%) of 209 with no/mild, 12 (10%) of 118 patients with moderate, and 25 (46%) of 54 patients with severe vasospasm. Multivariate analysis found a strong association between angiographic vasospasm and cerebral infarction (OR, 9.3; 95% CI, 3.7-23.4). The significant association persisted after adjusting for admission neurological grade and aneurysm size. Method of aneurysm treatment was not associated with a significant difference in frequency of infarction. |
1 |
| 32. Takahashi Y, Sasahara A, Yamazaki K, Inazuka M, Kasuya H. Disturbance of CT perfusion within 24 h after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH. Acta Neurochir (Wien). 159(12):2319-2324, 2017 12. |
Observational-Dx |
86 patients |
To investigate whether data from CT perfusion (CTP) within 24 h after onset are associated with Delayed cerebral ischemia (DCI) and its outcome. |
Delayed cerebral ischemia (DCI) developed in 11 patients and cerebral vasospasm in 28 patients out of a total of 86 aSAH patients scanned within 24 h after onset. The average MTT was correlated with the WFNS grade (p = 0.000), but not mRS (p = 0.128), age (p = 0.759), DCI (p = 0.669), or cerebral vasospasm (p = 0.306). On the other hand, DCI was associated with the Fisher group (p = 0.0056), mRS (p = 0.0052), and cerebral vasospasm (p = 0.000). Moreover, there were no significant differences in the average MTT within 24 h after onset between territories with and without DCI, or between patients with and without DCI. |
2 |
| 33. Greenberg ED, Gold R, Reichman M, et al. Diagnostic accuracy of CT angiography and CT perfusion for cerebral vasospasm: a meta-analysis. AJNR Am J Neuroradiol. 2010;31(10):1853-1860. |
Meta-analysis |
9 studies |
To perform a meta-analysis of the diagnostic performance of CTA and CTP for vasospasm in patients with ASAH by using DSA as the criterion standard. |
CTA and CTP searches yielded 505 and 214 manuscripts, respectively. Ten research studies met inclusion criteria for each CTA and CTP search. Six CTA and 3 CTP studies had sufficient data for statistical analysis. CTA pooled estimates had 79.6% sensitivity (95%CI, 74.9%-83.8%), 93.1%specificity (95%CI, 91.7%-94.3%), 18.1 LR+ (95%CI, 7.3-45.0), and 0.2 LR- (95%CI, 0.1-0.4); and CTP pooled estimates had 74.1% sensitivity (95%CI, 58.7%- 86.2%), 93.0% specificity (95% CI, 79.6%-98.7%), 9.3 LR+ (95%CI, 3.4-25.9), and 0.2 LR- (95%CI, 0.04-1.2). Overall DORs were 124.5 (95%CI, 28.4-546.4) for CTA and 43.0 (95%CI, 6.5-287.1) for CTP. Area under the SROC curve was 98 +/- 2.0%for CTA and 97 +/- 3.0% for CTP. |
M |
| 34. Killeen RP, Gupta A, Delaney H, et al. Appropriate use of CT perfusion following aneurysmal subarachnoid hemorrhage: a Bayesian analysis approach. AJNR Am J Neuroradiol. 35(3):459-65, 2014 Mar. |
Review/Other-Dx |
97 patients |
To determine the test characteristics of ct Perfusion (CTP) for detecting delayed cerebral ischemia and vasospasm in SAH, and then to apply Bayesian analysis to identify subgroups for its appropriate use. |
Ninety-seven patients with SAH were included in the study; 39% (38/97) developed delayed cerebral ischemia. Qualitative CTP deficits were seen in 49% (48/97), occurring in 84% (32/38) with delayed cerebral ischemia and 27% (16/59) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.84 (0.73-0.96), 0.73 (0.62-0.84), 0.67 (0.51-0.79), and 0.88 (0.74-0.94), respectively. A subgroup of 57 patients underwent DSA; 63% (36/57) developed vasospasm. Qualitative CTP deficits were seen in 70% (40/57), occurring in 97% (35/36) with vasospasm and 23% (5/21) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.97 (0.92-1.0), 0.76 (0.58-0.94), 0.88 (0.72-0.95), and 0.94 (0.69-0.99), respectively. Treatment thresholds were determined as 30% for induced hypertension, hypervolemia, and hemodilution and 70% for intra-arterial therapy. |
4 |
| 35. Phan K, Moore JM, Griessenauer CJ, et al. Ultra-Early Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. [Review]. World Neurosurg. 102:632-638.e1, 2017 Jun. |
Meta-analysis |
4 studies |
To discuss the systematic review of Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage. |
Four comparative studies were selected for analysis. Pooled analysis demonstrated that UEAV compared with no-UEAV was associated with greater proportion of rupture aneurysms sized greater than 12 mm (38.3% vs. 24.3%, P < 0.00001). A significantly greater number of patients with UEAV had ruptured MCA aneurysms compared with patients without UEAV (29.7% vs. 19.9%, P = 0.005). Compared with no-UEAV, patients with UEAV were significantly associated with symptomatic cerebral vasospasm (OR 2.07, P = 0.05) and DCI/infarction (OR 2.52, P = 0.02). A significant association also was found between UEAV and an unfavorable outcome at follow-up (OR 1.64, P = 0.03) and greater mortality (OR 2.65, P < 0.00001). |
Good |
| 36. Ionita CC, Graffagnino C, Alexander MJ, Zaidat OO. The value of CT angiography and transcranial doppler sonography in triaging suspected cerebral vasospasm in SAH prior to endovascular therapy. Neurocrit Care. 2008;9(1):8-12. |
Review/Other-Dx |
55 patients |
To evaluate the degree of agreement between TCD and CTA in diagnosing clinical CVS following SAH, and to define the role of CTA in triaging patients prior to digital subtraction angiography (DSA) and endovascular intervention. |
Thirteen patients (24%) had clinical CVS and 42 patients (76%) were asymptomatic. All patients with clinical CVS had also radiological evidence of CVS (agreement 100%). In 35 patients without clinical CVS, both tests agreed for absence of CVS in 28 cases (agreement 83%). The remaining 7 asymptomatic patients had radiological CVS only, in disagreement with clinical absence of CVS (17%). |
4 |
| 37. Hattingen E, Blasel S, Dumesnil R, Vatter H, Zanella FE, Weidauer S. MR angiography in patients with subarachnoid hemorrhage: adequate to evaluate vasospasm-induced vascular narrowing?. Neurosurg Rev. 33(4):431-9, 2010 Oct. |
Observational-Dx |
21 patients |
To evaluate the accuracy of time of flight MR angiography (TOF-MRA) to assess the arterial diameters of the circle of Willis in SAH patients with suspected CVS. |
The diagnosis of CVS was established by comparing the luminal size of baseline and follow-up DSA. The correlation between the arterial ratios measured on MIP angiograms and on follow-up DSA was assessed with Pearson's linear regression analysis. Arterial ratios on MIP angiograms were categorized as correct, overestimated, and underestimated compared to the ratios on follow-up DSA. Pearson's correlation coefficient between the ratios of MIP angiograms and DSA was r?=?0.5799 and the regression coefficient was b?=?0.4775. Highest correlation was found for the category of severe CVS (r?=?0.8201). Of all MIP angiograms, 34.9% showed consistent results compared to the DSA, while 44.2% of MIP images overestimated the vascular narrowing. Standard MIP angiograms from TOF-MRA are not accurate to assess vascular narrowing in patients with suspected CVS after aneurysmal SAH. The multifocal arterial stenoses in CVS may induce severe changes in blood flow dynamics, which compromise the diagnostic accuracy of the TOF-MRA. |
2 |
| 38. Heit JJ, Wintermark M, Martin BW, et al. Reduced Intravoxel Incoherent Motion Microvascular Perfusion Predicts Delayed Cerebral Ischemia and Vasospasm After Aneurysm Rupture. Stroke. 49(3):741-745, 2018 03. |
Review/Other-Dx |
16 patients |
To determine whether decreased IVIM perfusion may identify patients with proximal artery vasospasm and cerebral ischemia (DCI). |
Sixteen patients (11 females, 69%; P=0.9) were included. There were no differences in age, neurological status, or comorbidities between patients who subsequently underwent endovascular treatment of DCI (10 patients; DCI+ group) and those who did not (6 patients; DCI- group). Compared with DCI- patients, DCI+ patients had decreased IVIM perfusion fraction f (0.09±0.03 versus 0.13±0.01; P=0.03), reduced diffusion coefficient D (0.82±0.05 versus 0.92±0.07×10-3 mm2/s; P=0.003), and reduced blood flow-related parameter fD* (1.18±0.40 versus 1.83±0.40×10-3 mm2/s; P=0.009). IVIM pseudodiffusion coefficient D* did not differ between DCI- (0.011±0.002) and DCI+ (0.013±0.005 mm2/s; P=0.4) patients. No differences in mortality or clinical outcome were identified. |
4 |
| 39. Russin JJ, Montagne A, D'Amore F, et al. Permeability imaging as a predictor of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 38(6):973-979, 2018 06. |
Observational-Dx |
20 patients |
To examine whether post-bleed day 4 dynamic contrast-enhanced magnetic resonance (DCE-MR) BBB permeability imaging could predict development of delayed cerebral ischemia (DCI). |
Global MR-derived BBB permeability ( Ktrans) was significantly higher in aSAH patients who subsequently developed DCI (five patients; 2.28?±?0.09?×?10-3 min-1) compared to those who experienced radiographic vasospasm only (three patients; 1.85?±?0.12?×?10-3 min-1; p?<?0.05), or no vasospasm/ischemia (eight patients; 1.74?±?0.07?×?10-3 min-1; p?<?0.01). Ktrans?>?2?×?10-3 min-1 predicted development of DCI (AUC?=?0.98, 95% CI: 0.93-1). Global BBB dysfunction following aSAH is detectable with DCE-MR and predictive of ischemic risk. |
2 |
| 40. Kumar G, Shahripour RB, Harrigan MR. Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. [Review]. J Neurosurg. 124(5):1257-64, 2016 May. |
Meta-analysis |
2870 patients(17 studies) |
To evaluate the predictive value of vasospasm on cerebral ischemia (DCI), as diagnosed on transcranial Doppler (TCD). |
Seventeen studies (n = 2870 patients) met inclusion criteria. The amount of variance attributable to heterogeneity was significant (I(2) > 50%) for all syntheses. No studies reported the impact of TCD evidence of vasospasm on functional outcome or mortality. TCD evidence of vasospasm was found to be highly predictive of DCI. Pooled estimates for TCD diagnosis of vasospasm (for DCI) were sensitivity 90% (95% confidence interval [CI] 77%-96%), specificity 71% (95% CI 51%-84%), positive predictive value 57% (95% CI 38%-71%), and negative predictive value 92% (95% CI 83%-96%). CONCLUSIONS TCD evidence of vasospasm is predictive of DCI with high accuracy. Although high sensitivity and negative predictive value make TCD an ideal monitoring device, it is not a mandated standard of care in aSAH due to the paucity of evidence on clinically relevant outcomes, despite recommendation by national guidelines. High-quality randomized trials evaluating the impact of TCD monitoring on patient-centered and physician-relevant outcomes are needed. |
Good |
| 41. Miller CM, Palestrant D, Schievink WI, Alexander MJ. Prolonged transcranial Doppler monitoring after aneurysmal subarachnoid hemorrhage fails to adequately predict ischemic risk. Neurocrit Care. 15(3):387-92, 2011 Dec. |
Observational-Dx |
107 patients |
To determine if 10 days of Transcranial Doppler ultrasound (TCD) monitoring identifies all patients at risk for infarction. |
107 patients met criteria with 51 (48%) demonstrating vasospasm and 31 (29%) developing stroke. Of those suffering stroke, 22 (71%) demonstrated vasospasm while 9 (22%) did not. Two (2%) patients developed vasospasm only after day 10, neither experiencing stroke. Time to vasospasm onset (5.5 ± 2.5 days) was not impacted by common radiologic or clinical scales. Glasgow Coma Scale (GCS), Hunt and Hess Score (H&H), WFNS, ventriculostomy placement, intubation, and intraventricular hemorrhage were associated with likelihood of stroke (P < 0.05). The negative predictive value of TCD for identifying stroke risk was 84% while the sensitivity was 71%. |
2 |
| 42. Thompson BG, Brown RD, Jr., Amin-Hanjani S, et al. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015;46:2368-400. |
Review/Other-Dx |
68 studies |
To provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. |
Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment. |
4 |
| 43. Malhotra A, Wu X, Forman HP, et al. Management of Unruptured Intracranial Aneurysms in Older Adults: A Cost-effectiveness Analysis. Radiology. 291(2):411-417, 2019 05.Radiology. 291(2):411-417, 2019 05. |
Review/Other-Dx |
N/A |
To evaluate the cost-effectiveness of routine treatment (aneurysm coil placement) versus four different strategies for imaging surveillance of UIAs in adults older than 65 years. |
Imaging follow-up for the first 2 years after detection is the most cost-effective strategy (cost = $24 572, effectiveness = 13.73 QALYs), showing the lowest cost and highest effectiveness. The conclusion remains robust in probabilistic and one-way sensitivity analyses. Time-limited imaging follow-up remains the optimal strategy when the annual growth rate and rupture risk of growing aneurysms are varied. If annual rupture risk of nongrowing aneurysms is greater than 7.1%, coil placement should be performed directly. Conclusion Routine preventive treatment or periodic, indefinite imaging follow-up is not a cost-effective strategy in all adults older than 65 years with unruptured intracranial aneurysms. More aggressive management strategies should be reserved for patients with high risk of rupture, such as those with aneurysms larger than 7 mm and those with aneurysms in the posterior circulation. |
4 |
| 44. Villablanca JP, Duckwiler GR, Jahan R, et al. Natural history of asymptomatic unruptured cerebral aneurysms evaluated at CT angiography: growth and rupture incidence and correlation with epidemiologic risk factors. Radiology. 269(1):258-65, 2013 Oct. |
Observational-Dx |
165 patients |
To characterize the relationship between aneurysm size and epidemiologic risk factors with growth and rupture by using computed tomographic (CT) angiography. |
Patients (n = 165) with aneurysms (n = 258) had a mean follow-up time of 2.24 years from time of diagnosis. Forty-six of 258 (18%) aneurysms in 38 patients grew larger. Spontaneous rupture occurred in four of 228 (1.8%) intradural aneurysms of average size (6.2 mm). Risk of aneurysm rupture per patient-year was 2.4% (95% CI: 0.5%, 7.12%) with growth and 0.2% (95% CI: 0.006%, 1.22%) without growth (P = .034). There was a 12-fold higher risk of rupture for growing aneurysms (P < .002), with high intra- and interobserver correlation coefficients for size, volume, and growth. Tobacco smoking (3.806, one degree of freedom; P < .015,) and initial size (5.895, two degrees of freedom; P < .051) were independent covariates, predicting 78.4% of growing aneurysms. |
4 |
| 45. Li J, Shen B, Ma C, et al. 3D contrast enhancement-MR angiography for imaging of unruptured cerebral aneurysms: a hospital-based prevalence study. PLoS ONE [Electronic Resource]. 9(12):e114157, 2014.PLoS ONE. 9(12):e114157, 2014. |
Observational-Dx |
3993 patients |
To identify the location and size of unruptured cerebral aneurysms (UCAs) and to estimate the overall, age-specific, and sex-specific prevalence. |
Of the 3993 patients (men: women?=?2159:1834), 408 UCAs were found in 350 patients (men: women?=?151:199). The prevalence was 8.8% overall (95% CI, 8.0-10.0%), with 7.0% for men (CI, 6.0-8.0%) and 10.9% for women (CI, 9.0-12.0%). The overall prevalence of UCAs was higher in women than in men (P<0.001) and increased with age both in men and women. Prevalence peaked at age group 75-80 years. Forty-two patients (11.7%) had multiple aneurysms, including 10 (2.9%) male patients and 32 (9.1%) female patients. The most common site of aneurysm was the carotid siphon, and most lesions (71.3%) had a maximum diameter of 3-5 mm. |
1 |
| 46. Golitz P, Struffert T, Ganslandt O, Lang S, Knossalla F, Doerfler A. Contrast-enhanced angiographic computed tomography for detection of aneurysm remnants after clipping: a comparison with digital subtraction angiography in 112 clipped aneurysms. Neurosurgery. 74(6):606-13; discussion 613-4, 2014 Jun. |
Observational-Dx |
84 patients |
To evaluate the reliability of optimized angiographic computed tomography with intravenous contrast agent injection (ivACT) in detecting remnants after aneurysmal clipping compared with digital subtraction angiography (DSA), the gold standard. |
In total, 12 remnants were revealed by DSA, meaning a prevalence of 11%. IvACT demonstrated a sensitivity of 75% to 92% and a specificity of 99% in detecting remnants up to a minimal size of 0.7 × 0.3 mm. Classification of remnants by ivACT was identical to that by DSA, and assessment of size showed a significant correlation with DSA (P < .001). No significant differences between cobalt and titanium alloy were revealed concerning artifacts. |
2 |
| 47. Jamali S, Fahed R, Gentric JC, et al. Inter- and Intrarater Agreement on the Outcome of Endovascular Treatment of Aneurysms Using MRA. AJNR Am J Neuroradiol. 37(5):879-84, 2016 May. |
Observational-Dx |
56 patients |
To assess the inter- and intraobserver agreement in diagnosing aneurysm remnants and recurrences by using multimodality imaging, including TOF MRA. |
The proportion of cases judged to have a major recurrence varied between 16.1% and 71.4% (mean, 35.0% ± 12.7%). There was moderate agreement overall (? = 0.474 ± 0.009), increasing to nearly substantial (? = 0.581 ± 0.014) when the judgment was dichotomized (presence or absence of a major recurrence). Agreement on cases followed-up by MRA-MRA was similarly substantial (? = 0.601 ± 0.018). The intrarater agreement varied between fair (? = 0.257 ± 0.093) and substantial (?= 0.699 ± 0.084), improving with a dichotomized judgment concerning MRA-MRA comparisons. Agreement was no better when raters had access to all images. |
2 |
| 48. Schaafsma JD, Velthuis BK, Majoie CB, et al. Intracranial aneurysms treated with coil placement: test characteristics of follow-up MR angiography--multicenter study. Radiology. 256(1):209-18, 2010 Jul. |
Observational-Dx |
311 patients |
To determine the test characteristics of magnetic resonance (MR) angiography in the assessment of occlusion of aneurysms treated with coil placement. |
Aneurysm assessments (n = 381) at DSA and MR angiography were compared. Incomplete occlusion was seen at DSA in 88 aneurysms (23%). Negative predictive value of MR angiography was 94% (95% confidence interval [CI]: 91%, 97%), positive predictive value was 69% (95% CI: 60%, 78%), sensitivity was 82% (95% CI: 72%, 89%), and specificity was 89% (95% CI: 85%, 93%). AUCs were similar for 3.0- (0.90 [95% CI: 0.86, 0.94]) and 1.5-T MR (0.87 [95% CI: 0.78, 0.95]) and for TOF MR (0.86 [95% CI: 0.81, 0.91]) versus contrast-enhanced MR (0.85 [95% CI: 0.80, 0.91]). A small residual lumen (odds ratio, 2.1 [95% CI: 1.1, 4.3]) and suboptimal projection at DSA (odds ratio, 5.5 [95% CI: 1.5, 21.0]) were independently associated with discordance between intraarterial DSA and MR angiography. |
2 |
| 49. Mortimer AM, Marsh H, Klimczak K, et al. Is long-term follow-up of adequately coil-occluded ruptured cerebral aneurysms always necessary? A single-center study of recurrences after endovascular treatment. J Neurointerv Surg. 7(5):373-9, 2015 May. |
Observational-Dx |
437 patients |
To identify the rate of late reopening and the risk factors for reopening in a large single-center cohort of ruptured aneurysms that appeared adequately occluded at 6 months. To assess whether rates of recurrence have altered over time with improving coil and angiographic technology. |
437 patients with 458 adequately occluded aneurysms at 6 months had mean long-term follow-up of 31 months; 57 (12.4%) were large (= 10 mm) and 104 (22.7%) were wide-necked (>4 mm). Nine aneurysms (2%) showed significant late anatomical deterioration whereby retreatment was considered or undertaken. The risk was greater for large aneurysms (= 10 mm) (OR 15.61, 95% CI 3.79 to 64.33, p=0.0001) or wide-necked aneurysms (>4 mm) (OR 12.70, 95% CI 2.60 to 62.13, p=0.0017). The frequency of significant late anatomical deterioration and retreatment was also less common in those treated in cohort 2 (p<0.05). No completely occluded aneurysm at 6 months demonstrated significant late recurrence. |
2 |
| 50. Vourla E, Filis A, Cornelius JF, et al. Natural History of De Novo Aneurysm Formation in Patients with Treated Aneurysmatic Subarachnoid Hemorrhage: A Ten-Year Follow-Up. World Neurosurg. 122:e291-e295, 2019 Feb. |
Observational-Dx |
130 patients |
To investigate the formation of new aneurysms in patients who had previously undergone treatment of intracranial aneurysms. |
Overall, 130 patients (63% women) who had undergone microsurgical clipping (n = 63; 48.5%) or endovascular coiling (n = 67%; 51.5%) for ruptured aneurysms were included. The average follow-up time for our cohort was 10 ± 2.7 years. De novo aneurysms occurred in 10 of 130 patients (7.7%), with a mean time of 7.9 years for aneurysm detection. No association between the formation of de novo aneurysms and the location of the treated aneurysms, smoking status, hypertension, age, or gender was found. Follow-up imaging studies were performed every 2 years. De novo aneurysms had formed in 2 patients within 2-5 years, 7 patients after 5-10 years, and 1 patient after 10 years of follow-up. In 2 of 10 patients, the de novo aneurysm had ruptured and led to subarachnoid haemorrhage. |
3 |
| 51. Wang JY, Smith R, Ye X, et al. Serial Imaging Surveillance for Patients With a History of Intracranial Aneurysm: Risk of De Novo Aneurysm Formation. Neurosurgery. 77(1):32-42; discussion 42-3, 2015 Jul. |
Observational-Dx |
2153 patients |
To evaluate the benefit of routine radiographic screening for de novo intracranial aneurysms (DNIAs). |
Overall, DNIAs were detected in 26 patients (1.2%). Of the 185 patients with surveillance, DNIAs developed in 9 (4.9%). The risk of DNIA detection was 1.14% per person-year of follow-up (95% confidence interval: 0.6%-2.2%). Patients with imaging follow-up had a significantly higher rate of DNIA detection compared with patients without regular imaging surveillance (4.9% vs 0.86%; P < .001), but surveillance was associated with smaller lesions (with surveillance: 3.8 ± 1.8 mm, without: 7.0 ± 4.4 mm, mean ± standard deviation; P = .026). A unimodal distribution of time to detection was found in those with surveillance, with a peak between 0 and 2 years. There was a trend toward an association of cigarette smoking and DNIA detection within 10 years (P = .06); 6 of the 26 patients (23.1%) with DNIAs had a history of cigarette smoking, with all 6 patients continuing to smoke up to the detection of the DNIAs, which were detected in 2.5 ± 1.8 years. |
2 |
| 52. Zali A, Khoshnood RJ, Zarghi A. De novo aneurysms in long-term follow-up computed tomographic angiography of patients with clipped intracranial aneurysms. World Neurosurg. 82(5):722-5, 2014 Nov. |
Observational-Dx |
459 patients |
To evaluate de novo aneurysm formation in the long-term follow-up of patients with clipped aneurysms. |
The mean ± standard deviation interval from surgery was 7.2 ± 2.3 years for CT angiography controlled patients. De novo aneurysms were detected in 5 of 119 (4.5%) patients and 4 of 8 patients with new subarachnoid hemorrhage. A history of multiple aneurysms was associated with de novo aneurysm formation (P < 0.001). |
3 |
| 53. Bier G, Bongers MN, Hempel JM, et al. Follow-up CT and CT angiography after intracranial aneurysm clipping and coiling-improved image quality by iterative metal artifact reduction. Neuroradiology. 59(7):649-654, 2017 Jul. |
Observational-Dx |
20 patients |
To evaluate a new iterative metal artifact reduction algorithm for post-interventional evaluation of brain tissue and intracranial arteries. |
The qualitative analysis yielded a significant increase in image quality (p = 0.0057) in iteratively processed images with substantial inter-observer agreement (? = 0.72), while the CTA image quality did not differ (p = 0.864) and even showed vessel contrast reduction in six cases (30%). The mean relative attenuation difference was 27% without metal artifact reduction vs. 11% for iterative metal artifact reduction images (p = 0.0003). |
2 |
| 54. Jia Y, Zhang J, Fan J, et al. Gemstone spectral imaging reduced artefacts from metal coils or clips after treatment of cerebral aneurysms: a retrospective study of 35 patients. Br J Radiol. 88(1055):20150222, 2015. |
Observational-Dx |
35 patients |
To evaluate the effect of gemstone spectral imaging (GSI) for metal artefact reduction in cerebral artery CT angiography (CTA) after metal coils or clips treatment. |
CT attenuation value of cerebral artery decreased in Groups B and C as the photon energy increased. The average energy levels of 60.05?±?5.37 and 59.93?±?5.57?keV presented the best CNR in Groups B and C, respectively. CNR values, SNR values and the subjective scores of the image quality of the two sets were higher than those of Group A. |
2 |
| 55. Katsura M, Sato J, Akahane M, et al. Single-energy metal artifact reduction technique for reducing metallic coil artifacts on post-interventional cerebral CT and CT angiography. Neuroradiology. 60(11):1141-1150, 2018 Nov. |
Observational-Dx |
20 patients |
To evaluate the effects of the single-energy metal artifact reduction (SEMAR) algorithm on image quality of cerebral CT and CT angiography (CTA) for patients who underwent intracranial aneurysm coiling. |
The strength of artifacts measured in SEMAR CT images was significantly lower than that in standard CT images (25.7?±?10.2 H.U. vs. 80.4?±?67.2 H.U., p?<?0.01, Student's paired t test). SEMAR CT images were significantly improved compared with standard CT images in the depiction of anatomical structures around the coil (p?<?0.01, the sign test), delineation of the arteries around the coil (p?<?0.01), and the depiction of the status of coiled aneurysms (p?<?0.01). |
1 |
| 56. Lv F, Li Q, Liao J, et al. Detection and Characterization of Intracranial Aneurysms with Dual-Energy Subtraction CTA: Comparison with DSA. Acta Neurochir Suppl. 110(Pt 2):239-45, 2011. |
Observational-Dx |
97 patients |
To investigate the diagnostic performance of dual-energy subtraction CTA in evaluating intracranial aneurysms by comparison with DSA. |
According to the reference standard, 96 aneurysms were present in 81 patients and no aneurysm was found in 16 patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of subtraction CTA on a per-aneurysm basis were 98.9, 100, 100 and 94.1%, respectively. DSA prospectively detected 88 aneurysms in 79 of 81 patients. On a per-aneurysm basis, the sensitivity, specificity, positive predictive value and negative predictive value of DSA were 91.7, 100, 100 and 66.7%, respectively. |
2 |
| 57. Mocanu I, Van Wettere M, Absil J, Bruneau M, Lubicz B, Sadeghi N. Value of dual-energy CT angiography in patients with treated intracranial aneurysms. Neuroradiology. 60(12):1287-1295, 2018 Dec. |
Observational-Dx |
35 patients |
To evaluate the ability of dual-energy CT angiography (DECTA) in metal artifact reduction in patients with treated intracranial aneurysms by comparing DECTA-based virtual monoenergetic extrapolations (VMEs) and mixed images (MI). |
In those aneurysms treated by surgical clipping, quantitative and qualitative analyses showed significant reduction of artifacts on VMEs compared to MI with the best compromise being obtained at 95 keV in order to keep an optimal vessel contrast in the adjacent vessel. In those aneurysms treated by coil embolization, there was no significant reduction of artifacts both on quantitative and qualitative analyses. |
2 |
| 58. van Amerongen MJ, Boogaarts HD, de Vries J, et al. MRA versus DSA for follow-up of coiled intracranial aneurysms: a meta-analysis. [Review]. AJNR Am J Neuroradiol. 35(9):1655-61, 2014 Sep. |
Meta-analysis |
51 articles |
To perform a systematic review and meta-analysis to evaluate the accuracy of TOF-MRA and contrast-enhanced MRA in detecting residual flow in the follow-up of coiled intracranial aneurysms. |
This meta-analysis has revealed that MRA has a high diagnostic performance when it comes to the detection of residual flow in the follow-up of intracranial aneurysms treated with endovascular coil occlusion and therefore should be routinely used for follow-up. CE-MRA did not perform significantly better than TOF-MRA, indicating that follow-up with the latter should be adequate. |
M |
| 59. Schaafsma JD, Velthuis BK, van den Berg R, et al. Coil-treated aneurysms: decision making regarding additional treatment based on findings of MR angiography and intraarterial DSA. Radiology. 265(3):858-63, 2012 Dec. |
Observational-Dx |
417 patients |
To assess whether magnetic resonance (MR) angiography can be used as a noninvasive alternative to intraarterial digital subtraction angiography (DSA) to indicate additional treatment in the follow-up of patients with coil-treated intracranial aneurysms. |
Agreement between intraarterial DSA- and MR angiography-based treatment recommendations was substantial (? = 0.73; 95% confidence interval [CI]: 0.66, 0.80). In 34 of the 310 patients (11%), the advice was additional treatment based on findings of both modalities. In six patients (2%), the advice based on intraarterial DSA findings was additional treatment, while that based on MR angiographic findings was extended follow-up imaging; therefore, none of these patients were discharged from follow-up on the basis of MR angiographic findings. In six other patients (2%), the advice based on MR angiographic findings was additional treatment, while that based on intraarterial DSA findings was extended follow-up imaging (four patients), discharge from follow-up (one patient), and noninterpretable DSA (one patient). Extended follow-up imaging was suggested for 37 patients (12%) after intraarterial DSA and for 49 patients (16%) after MR angiography (difference: 4%; 95% CI: -0.6%, 8.4%). Interobserver agreement was substantial for intraarterial DSA (? = 0.73; 95% CI: 0.64, 0.82) and moderate for MR angiography (? = 0.53; 95% CI: 0.36, 0.70). |
2 |
| 60. Attali J, Benaissa A, Soize S, Kadziolka K, Portefaix C, Pierot L. Follow-up of intracranial aneurysms treated by flow diverter: comparison of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MR angiography (CE-MRA) sequences with digital subtraction angiography as the gold standard. J Neurointerv Surg. 8(1):81-6, 2016 Jan. |
Observational-Dx |
22 patients |
To compare the diagnostic accuracy of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3 T for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment, with digital subtraction angiography (DSA) as the gold standard. |
Twenty-two patients harboring 23 treated aneurysms were included. Interobserver agreement using simplified scales for occlusion (Montreal) and parent artery patency were higher for DSA (0.88 and 0.61) and CE-MRA (0.74 and 0.55) than for 3D-TOF-MRA (0.51 and 0.02). Intermodality agreement was higher for CE-MRA (0.88 and 0.32) than for 3D-TOF-MRA (0.59 and 0.11). CE-MRA yielded better accuracy than 3D-TOF-MRA for aneurysm remnant detection (sensitivity 83% vs 50%; specificity 100% vs 100%) and for the status of the parent artery (specificity 63% vs 32%; sensitivity 100% vs 100%). |
3 |
| 61. Mine B, Tancredi I, Aljishi A, et al. Follow-up of intracranial aneurysms treated by a WEB flow disrupter: a comparative study of DSA and contrast-enhanced MR angiography. J Neurointerv Surg. 8(6):615-20, 2016 Jun. |
Observational-Dx |
15 patients |
To compare contrast-enhanced MR angiography (CE-MRA) and DSA for the follow-up of intracranial aneurysms (IAs) treated with the Woven EndoBridge embolization system DL (WEB DL; Sequent Medical, Aliso Viejo, California, USA). |
Fifteen patients with 16 IAs were included. Mean delay between MRA and DSA was 2 months (range 0-16 months). Interobserver agreement for MRA was substantial to almost perfect (?=0.686-0.921; mean ?=0.809). Intertechnique agreement was moderate to substantial (?=0.579-0.724; mean ?=0.669). Only three out of five inadequately occluded IAs were detected by MRA. |
2 |
| 62. Nawka MT, Sedlacik J, Frolich A, Bester M, Fiehler J, Buhk JH. Multiparametric MRI of intracranial aneurysms treated with the Woven EndoBridge (WEB): a case of Faraday's cage?. J Neurointerv Surg. 10(10):988-994, 2018 Oct. |
Observational-Dx |
25 patients |
To evaluate multiparametric MRI including non-contrast and contrast-enhanced morphological and angiographic techniques for intracranial aneurysms treated with the single-layer Woven EndoBridge (WEB) embolization system applying simultaneous digital subtraction angiography (DSA) as the reference of standard. |
Twenty-five patients fulfilled the inclusion criteria. Rates of complete/adequate occlusion at mid-term follow-up were 84% with both MRA and DSA. A strong signal loss within the WEB was observed in all MR sequences at initial and follow-up examinations. ROI analysis did not reveal significant differences in non-contrast (P=0.946) and contrast-enhanced imaging (P=0.377). A T1-hyperintense thrombus in the non-WEB-carrying dome was a frequent observation. |
3 |
| 63. Timsit C, Soize S, Benaissa A, Portefaix C, Gauvrit JY, Pierot L. Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated with the WEB Device. AJNR Am J Neuroradiol. 37(9):1684-9, 2016 Sep. |
Observational-Dx |
26 patients |
To assess the diagnostic accuracy of 3D-time-of-flight MRA and contrast-enhanced MRA at 3T against DSA, as the criterion standard, for the follow-up of aneurysms treated with the Woven EndoBridge (WEB) system. |
Twenty-six patients with 26 WEB-treated aneurysms were included. The interobserver reproducibility was good with DSA (? = 0.71) and contrast-enhanced-MRA (? = 0.65) compared with moderate with 3D-TOF-MRA (? = 0.47). Intermodality agreement with DSA was fair with both contrast-enhanced MRA (? = 0.36) and 3D-TOF-MRA (? = 0.36) for the evaluation of total occlusion. For aneurysm remnant detection, the prevalence was low (15%), on the basis of DSA, and both MRA techniques showed low sensitivity (25%), high specificity (100%), very good positive predictive value (100%), and very good negative predictive value (88%). |
1 |
| 64. Agarwal N, Gala NB, Choudhry OJ, et al. Prevalence of asymptomatic incidental aneurysms: a review of 2,685 computed tomographic angiograms. World Neurosurg. 82(6):1086-90, 2014 Dec. |
Review/Other-Dx |
N/A |
To present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). |
Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. |
4 |
| 65. Malhotra A, Wu X, Matouk CC, Forman HP, Gandhi D, Sanelli P. MR Angiography Screening and Surveillance for Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Cost-effectiveness Analysis. Radiology. 291(2):400-408, 2019 05.Radiology. 291(2):400-408, 2019 05. |
Review/Other-Dx |
N/A |
To evaluate different MR angiography screening and surveillance strategies for unruptured intracranial aneurysms in patients with Autosomal dominant polycystic kidney disease (ADPKD). |
Base case calculation shows that MR angiography screening of patients with ADPKD every 5 years and annual follow-up in patients with detected intracranial aneurysm is the optimal strategy (cost, $19 839; utility, 25.86 quality-adjusted life years), which becomes more favorable as the life expectancy increases beyond 6 years. The conclusion remains robust in probabilistic and one-way sensitivity analyses. When the prevalence of intracranial aneurysms is greater than 10%, annual rupture risk is 0.35%-2.5%, and the rate of de novo aneurysm detection is lower than 1.8%, MR angiography screening every 5 years with annual MR angiography follow-up is the favorable strategy. |
4 |
| 66. Bor AS, Rinkel GJ, van Norden J, Wermer MJ. Long-term, serial screening for intracranial aneurysms in individuals with a family history of aneurysmal subarachnoid haemorrhage: a cohort study. Lancet neurol.. 13(4):385-92, 2014 Apr. |
Observational-Dx |
458 |
To investigate the yield of long-term serial screening for intracranial aneurysms in these individuals. |
We identified aneurysms in 51 (11%, 95% CI 9-14) of 458 individuals at first screening, in 21 (8%, 5-12) of 261 at second screening, in seven (5%, 2-11) of 128 at third screening, and three (5%, 1-14) of 63 at fourth screening. Five (3%, 95% CI 1-6) of 188 individuals without a history of aneurysms and with two negative screens had a de-novo aneurysm in a follow-up screen. Smoking (odds ratio 2·7, 95% CI 1·2-5·9), history of previous aneurysms (3·9, 1·2-12·7), and familial history of aneurysms (3·5, 1·6-8·1) were significant risk factors for aneurysms at first screening in the multivariable analysis. History of previous aneurysms was the only significant risk factor for aneurysms at follow-up screening (hazard ratio 4·5, 1·1-18·7). Aneurysms were identified in six (5%, 95% CI 2-10) of 129 individuals who were screened before age 30 years. One patient developed a de-novo aneurysm that ruptured 3 years after the last negative screen. |
2 |
| 67. Nurmonen HJ, Huttunen T, Huttunen J, et al. Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population. Neurology. 89(18):1852-1859, 2017 Oct 31. |
Review/Other-Dx |
33 patients |
To define the association of autosomal dominant polycystic kidney disease (ADPKD) with the characteristics of aneurysmal subarachnoid hemorrhage (aSAH) and unruptured intracranial aneurysm (IA) disease. |
In total, there were 33 patients with ADPKD with aSAH and 20 patients with ADPKD with unruptured IAs. The median size of ruptured IAs in ADPKD was significantly smaller than in the general population (6.00 vs 8.00 mm) and the proportion of small ruptured IAs was significantly higher (31% vs 18%). Median age at aSAH was 42.8 years, 10 years younger than in the general IA population. Multiple IAs were present in 45% of patients with ADPKD compared to 28% in the general IA population. Cumulative risk of de novo IA formation was 1.3% per patient-year (vs 0.2% in the general IA population). Hazard for de novo aneurysm formation was significantly elevated in patients with ADPKD (Cox regression hazard ratio 7.7, 95% confidence interval 2.8-20; p < 0.0005). |
4 |
| 68. Flahault A, Trystram D, Nataf F, et al. Screening for intracranial aneurysms in autosomal dominant polycystic kidney disease is cost-effective. Kidney International. 93(3):716-726, 2018 03.Kidney Int. 93(3):716-726, 2018 03. |
Review/Other-Dx |
495 patients |
To evaluate this in a single-center cohort of 495 consecutive patients with autosomal dominant polycystic kidney disease (ADPKD) submitted to targeted intracranial aneurysm screening. |
No results stated in the abstract. |
4 |
| 69. Kim JH, Kwon TH, Kim JH, Chong K, Yoon W. Intracranial Aneurysms in Adult Moyamoya Disease. World Neurosurg. 109:e175-e182, 2018 Jan. |
Review/Other-Dx |
211 patients |
To study the characteristics of intracranial aneurysms occurring in patients with MMD. We retrospectively reviewed our 10-year experience of patients with intracranial aneurysms and a diagnosis of MMD at our hospital. |
There were significant differences between the 2 groups, including age and clinical presentation. Among all enrolled patients (N = 132), 11 aneurysms were discovered in 11 patients. Prevalence of intracranial aneurysms in patients with MMD was 8.3%, and the rupture rate of these aneurysms was 63.6%. We classified the 10 MMD-associated aneurysms (excluding 1 incidentally found paraclinoid aneurysm) as follows: 4 dissecting aneurysms or pseudoaneurysms and 6 hemodynamic true aneurysms. |
4 |
| 70. Jung WS, Kim JH, Ahn SJ, et al. Prevalence of Intracranial Aneurysms in Patients with Aortic Dissection. AJNR Am J Neuroradiol. 38(11):2089-2093, 2017 Nov. |
Observational-Dx |
71 patients |
To determine the prevalence of intracranial aneurysms in patients with aortic dissection and evaluate the independent risk factors for the presence of intracranial aneurysms in these patients. |
The prevalence of intracranial aneurysms was 12.96% in the aortic dissection group and 1.85% in controls (P = .022). The mean diameter of intracranial aneurysms was significantly larger in the aortic dissection group (5.79 ± 3.26 mm in aortic dissection versus 3.04 ± 1.57 mm in controls; P = .008), and intracranial aneurysms of >7 mm were also more common in the aortic dissection group (28.6% in aortic dissection versus 5.3% in controls, P = .003). On multivariate analysis, arch vessel involvement of aortic dissection was an independent risk factor for the presence of intracranial aneurysms (odds ratio, 6.246; 95% confidence interval, 1.472-26.50; P = .013). |
2 |
| 71. Egbe AC, Padang R, Brown RD, et al. Prevalence and predictors of intracranial aneurysms in patients with bicuspid aortic valve. Heart. 103(19):1508-1514, 2017 10. |
Observational-Dx |
678 patients |
To determine the prevalence and outcomes of intracranial aneurysm (IA) in patients with bicuspid aortic valve (BAV). |
There were 678 patients included in this study-mean age 57±13 years, men 480 (71%), mean follow-up 10±3 years (5913 patient-years). Coarctation of aorta (COA) was present in 154 (23%) patients.There were 59 IAs identified in 52 of 678 patients (7.7%). IA was present in 20/154 patients (12.9%) with COA and 32/524 patients (5.7%) without COA (p<0.001). For the patients without COA, female gender and right-left cusp fusion were risks factors for IA in women after adjustment for all potential variables (HR 1.76, CI 1.31 to 2.68, p=0.03). There was no significant trend in the risk for IA across age tertiles: age =40 years versus 41-60 years (HR 1.19, p=0.34), and age 41-60?years versus 61-80 years (HR 1.06, p=0.56).Among the 52 patients with IA, enlargement occurred in three patients (6%), rupture in two patients (4%) and four patients (8%) underwent coil embolisation. For the 626 patients without IA at baseline, no patient developed IA over 7±2 years of imaging follow-up. |
2 |
| 72. Rouchaud A, Brandt MD, Rydberg AM, et al. Prevalence of Intracranial Aneurysms in Patients with Aortic Aneurysms. AJNR Am J Neuroradiol. 37(9):1664-8, 2016 Sep. |
Observational-Dx |
1081 patients |
To evaluate the incidence of intracranial aneurysms in a large cohort of patients with aortic aneurysms and to identify potential risk factors for intracranial aneurysms in this population. |
A total of 1081 patients with aortic aneurysms were included. Of them, 440 (40.7%) had abdominal aortic aneurysms, 446 (41.3%) had thoracic aortic aneurysms, and 195 (18.0%) had both abdominal aortic and thoracic aortic aneurysms. The overall prevalence of associated intracranial aneurysms in patients with aortic aneurysms was 11.8% (128/1081), with 12.7% (56/440), 10.8% (48/446), and 12.3% (24/195), respectively, in patients with abdominal aortic aneurysms, thoracic aortic aneurysms, and both thoracic aortic aneurysms and abdominal aortic aneurysms. Female patients had a higher risk of associated intracranial aneurysms (OR = 2.08; 95% CI, 1.49-3.03; P = .0002). There was a slight association between abdominal aortic aneurysm size and the prevalence of intracranial aneurysms (OR = 1.02; 95% CI, 1.01-1.03; P = .045). There was no significant association between the locations of the aortic and intracranial aneurysms (P = .93). |
2 |
| 73. Curtis SL, Bradley M, Wilde P, et al. Results of screening for intracranial aneurysms in patients with coarctation of the aorta. AJNR Am J Neuroradiol. 33(6):1182-6, 2012 Jun. |
Observational-Dx |
117 patients |
To examine the prevalence of intracranial aneurysms (IAs) through screening with MRA. |
One hundred seventeen MRAs were double-reported. The median age was 29 ± 11 years (range, 16-59 years). IAs were found in 12 patients (10.3%). The mean diameter of IAs was 3.9 mm (range, 2.0-8.0 mm). Patients with aneurysms were older (median, 37 years; range, 16-50 years) than those without (median, 23 years; range, 16-59 years; Z = -2.01, P = .04). Hypertension was more common in those with IAs (IA 83% versus no IA 43%, P = .01). There was no association between ascending aortopathy, bicuspid aortic valves, and IAs. |
2 |
| 74. Derdeyn CP, Zipfel GJ, Albuquerque FC, et al. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. [Review]. Stroke. 48(8):e200-e224, 2017 08. |
Review/Other-Dx |
8 studies |
To review the current data and to make suggestions for the diagnosis and management of both ruptured and unruptured brain arteriovenous malformations. |
The focus of the scientific statement was subdivided into epidemiology; diagnosis; natural history; treatment, including the roles of surgery, stereotactic radiosurgery, and embolization; and management of ruptured and unruptured brain arteriovenous malformations. Areas requiring more evidence were identified. |
4 |
| 75. Morris Z, Whiteley WN, Longstreth WT Jr, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. [Review] [30 refs]. BMJ. 339:b3016, 2009 Aug 17.BMJ. 339:b3016, 2009 Aug 17. |
Meta-analysis |
16 studies |
To quantify the prevalence of incidental findings on magnetic resonance imaging (MRI) of the brain. |
In 16 studies, 135 of 19 559 people had neoplastic incidental brain findings (prevalence 0.70%, 95% confidence interval 0.47% to 0.98%), and prevalence increased with age (chi(2) for linear trend, P=0.003). In 15 studies, 375 of 15 559 people had non-neoplastic incidental brain findings (prevalence 2.0%, 1.1% to 3.1%, excluding white matter hyperintensities, silent infarcts, and microbleeds). The number of asymptomatic people needed to scan to detect any incidental brain finding was 37. The prevalence of incidental brain findings was higher in studies using high resolution MRI sequences than in those using standard resolution sequences (4.3% v 1.7%, P<0.001). The prevalence of neoplastic incidental brain findings increased with age. |
Good |
| 76. Nishida T, Faughnan ME, Krings T, et al. Brain arteriovenous malformations associated with hereditary hemorrhagic telangiectasia: gene-phenotype correlations. Am J Med Genet A. 158A(11):2829-34, 2012 Nov. |
Observational-Dx |
171 patients |
To study clinical manifestations of brain arteriovenous malformations (AVMs) in patients with Hereditary hemorrhagic telangiectasia (HHT) and correlate these with the specific gene mutated. |
We reviewed records of 171 patients with HHT and brain AVMs. A history of ICH was found in 27% (41/152) patients, with a mean age of 26 ± 18 range, (0-68) years. All of patients with ICH were neurologically asymptomatic prior to ICH. Multiple brain AVMs were found in 23% (170/39) of patients on initial examination. Genetic test results were available in 109 (64%) patients. Mutations in ENG, ACVRL1, and SMAD4 were present in 75 (69%), 18 (17%), and 2 (2%), respectively. A history of ICH was reported in 24% of patients with an ENG mutation and 27% of patients with an ACVRL1 mutation, with a mean age of 26 ± 16 (range, 2-50) and 18 ± 21 (0-48) years, respectively. No statistically significant differences in age at first brain AVM diagnosis, prevalence of ICH history, age at ICH, or other manifestations of brain AVMs were observed among gene groups. In conclusion, no evidence for differences in brain AVM characteristics was observed among HHT gene groups, although we cannot exclude clinically important differences. Larger studies are needed to further guide brain AVM screening decisions in patients with HHT. |
2 |
| 77. Kim H, Al-Shahi Salman R, McCulloch CE, Stapf C, Young WL, MARS Coinvestigators. Untreated brain arteriovenous malformation: patient-level meta-analysis of hemorrhage predictors. Neurology. 83(7):590-7, 2014 Aug 12. |
Observational-Dx |
6,074 patients |
To identify risk factors for intracranial hemorrhage in the natural history course of brain arteriovenous malformations (AVMs) using individual patient data meta-analysis of 4 existing cohorts. |
A total of 141 hemorrhage events occurred during 6,074 patient-years of follow-up (annual rate of 2.3%, 95% confidence interval [CI] 2.0%-2.7%), higher for ruptured (4.8%, 3.9%-5.9%) than unruptured (1.3%, 1.0%-1.7%) AVMs at presentation. Hemorrhagic presentation (hazard ratio 3.86, 95% CI 2.42-6.14) and increasing age (1.34 per decade, 1.17-1.53) independently predicted hemorrhage and remained significant predictors in the imputed dataset. Female sex (1.49, 95% CI 0.96-2.30) and exclusively deep venous drainage (1.60, 0.95-2.68, p = 0.02 in imputed dataset) may be additional predictors. AVM size was not associated with intracerebral hemorrhage in multivariable models (p > 0.5). |
1 |
| 78. Gross BA, Du R. Natural history of cerebral arteriovenous malformations: a meta-analysis. [Review]. J Neurosurg. 118(2):437-43, 2013 Feb. |
Meta-analysis |
9 studies (3923 patients) |
To provide overall arteriovenous malformation (AVM) hemorrhage rates and, with enhanced statistical power, to elucidate significant risk factors for hemorrhage. |
Nine natural history studies with 3923 patients and 18,423 patient-years of follow-up were identified for analysis. The overall annual hemorrhage rate was 3.0% (95% CI 2.7%-3.4%). The rate of hemorrhage was 2.2% (95% CI 1.7%-2.7%) for unruptured AVMs and 4.5% (95% CI 3.7%-5.5%) for ruptured AVMs. Prior hemorrhage (HR 3.2, 95% CI 2.1-4.3), deep AVM location (HR 2.4, 95% CI 1.4-3.4), exclusively deep venous drainage (HR 2.4, 95% CI 1.1-3.8), and associated aneurysms (HR 1.8, 95% CI 1.6-2.0) were statistically significant risk factors for hemorrhage. Any deep venous drainage (HR 1.3, 95% CI 0.9-1.75) and female sex (HR 1.4, 95% CI 0.6-2.1) demonstrated a trend toward an increased risk of hemorrhage that was not statistically significant. Small AVM size and older patient age were not significant risk factors for hemorrhage. |
Good |
| 79. Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 383(9917):614-21, 2014 Feb 15. |
Experimental-Dx |
223 patients |
To compare the risk of death and symptomatic stroke in patients with an unruptured brain arteriovenous malformation who are allocated to either medical management alone or medical management with interventional therapy. |
Randomisation was started on April 4, 2007, and was stopped on April 15, 2013, when a data and safety monitoring board appointed by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health recommended halting randomisation because of superiority of the medical management group (log-rank Z statistic of 4·10, exceeding the prespecified stopping boundary value of 2·87). At this point, outcome data were available for 223 patients (mean follow-up 33·3 months [SD 19·7]), 114 assigned to interventional therapy and 109 to medical management. The primary endpoint had been reached by 11 (10·1%) patients in the medical management group compared with 35 (30·7%) in the interventional therapy group. The risk of death or stroke was significantly lower in the medical management group than in the interventional therapy group (hazard ratio 0·27, 95% CI 0·14-0·54). No harms were identified, other than a higher number of strokes (45 vs 12, p<0·0001) and neurological deficits unrelated to stroke (14 vs 1, p=0·0008) in patients allocated to interventional therapy compared with medical management. |
2 |
| 80. Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. [Review]. AJNR Am J Neuroradiol. 33(6):1007-13, 2012 Jun. |
Review/Other-Dx |
N/A |
To review intracranial dural areteriovenous fistulas. |
Intracranial DAVFs are pathologic dural-based shunts and account for 10%-15% of all intracranial arteriovenous malformations. These malformations derive their arterial supply primarily from meningeal vessels, and the venous drainage is either via dural venous sinuses or through the cortical veins. DAVFs have a reported association with dural sinus thrombosis, venous hypertension, previous craniotomy, and trauma, though many lesions are idiopathic. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging. Cross-sectional imaging techniques by using CT and MR imaging aid in the diagnosis, but conventional angiography remains the most accurate method for complete characterization and classification of DAVFs. The pattern of venous drainage observed on dynamic vascular imaging determines the type of DAVF and correlates with the severity of symptoms and the risk of hemorrhage. |
4 |
| 81. Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. Neurosurg. 82(2):166-79, 1995 Feb. |
Review/Other-Dx |
N/A |
To discuss the proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. |
No results stated in the abstract. |
4 |
| 82. Cognard C, Gobin YP, Pierot L, et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 194(3):671-80, 1995 Mar. |
Review/Other-Dx |
N/A |
To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. |
Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. |
4 |
| 83. Mossa-Basha M, Chen J, Gandhi D. Imaging of cerebral arteriovenous malformations and dural arteriovenous fistulas. [Review]. Neurosurg Clin N Am. 23(1):27-42, 2012 Jan. |
Review/Other-Dx |
N/A |
To discuss the role of conventional as well as advanced imaging modalities that are providing novel ways to characterize these vascular malformations. |
Imaging of cerebral AVMs and DAVFs is central to the diagnosis, proper characterization, and evaluation of these lesions. Imaging is helpful in pretreatment planning as well as posttreatment evaluation for residual arteriovenous shunting. DSA remains the gold standard for evaluation of AVM and DAVF, and CBCT is providing improved 3D evaluation. CT and MRI applications are complementary, and provide useful information relating to the association of the vascular lesions to the surrounding intracranial structures as well as physiologic information, which cannot always be adequately evaluated with DSA. Significant improvement in imaging techniques has allowed progressive improvement in temporal and spatial resolution for MRA and CTA techniques, thereby allowing for improved noninvasive evaluation of time-dependent characteristics. |
4 |
| 84. Huang YJ, Hsu SW, Lee TF, Ho JT, Chen WF. Consistency between Targets Delineated by Angiography, Computed Tomography, and Magnetic Resonance Imaging in Stereotactic Radiosurgery for Arteriovenous Malformation. Stereotact Funct Neurosurg. 95(4):236-242, 2017. |
Review/Other-Dx |
23 patients |
To review and analyze the consistency between targets defined by different imaging modalities in radiosurgery for AVMs. |
Twenty-three patients were enrolled. The mean DSCs were between 0.37 and 0.51 for targets by different modalities. There was no significant difference in DSCs regarding Spetzler-Martin grades and hemorrhage history. For CT-delineated target volumes <3 cm3, MRI-delineated target volumes <5 cm3, and angiography-delineated target volumes <2 cm3, the DSCs between the different image modalities were significantly decreased. |
4 |
| 85. Veeravagu A, Hansasuta A, Jiang B, Karim AS, Gibbs IC, Chang SD. Volumetric analysis of intracranial arteriovenous malformations contoured for CyberKnife radiosurgery with 3-dimensional rotational angiography vs computed tomography/magnetic resonance imaging. Neurosurgery. 73(2):262-70, 2013 Aug. |
Observational-Dx |
30 patients |
To compare the nidal contouring of AVMs using fused images of contrasted computed tomography (CT) and magnetic resonance imaging (MRI) with matched images of 3-dimensional (3-D) cerebral angiography for CyberKnife radiosurgery (CKRS) treatment planning. |
The mean volume of the AVM nidus contoured with the addition of 3-D cerebral angiography to the CT/MRI fusion (9.09 cm(3), 95% confidence interval: 5.39 cm(3)-12.8 cm(3)) was statistically smaller than the mean volume contoured with CT/MRI fused scans alone (14.1 cm(3), 95% confidence interval: 9.16 cm(3)-19.1 cm(3)), with a mean volume difference of d = 5.01 cm(3) (P = .001). Diffuse AVM nidus was associated with larger mean volume differences compared with a compact nidus (d = 6.51 vs 2.11 cm(3), P = .02). The mean volume difference was not statistically associated with the patient's sex (male d = 5.61, female d = 5.06, P = .84), previous hemorrhage status (yes d = 5.69, no d = 5.23, P = .86), or previous embolization status (yes d = 6.80, no d = 5.95, P = .11). |
2 |
| 86. Gross BA, Frerichs KU, Du R. Sensitivity of CT angiography, T2-weighted MRI, and magnetic resonance angiography in detecting cerebral arteriovenous malformations and associated aneurysms. J Clin Neurosci. 19(8):1093-5, 2012 Aug. |
Review/Other-Dx |
125 patients |
To we review 125 patients with AVMs, demonstrating overall sensitivities of 90% for computed tomography angiography (CTA), 89% for T2-weighted MRI, and 74% for magnetic resonance angiography (MRA). |
The greater sensitivity of CTA in detecting AVMs compared to MRA did meet statistical significance (p(CTA, MRA)=0.036). For unruptured AVMs, the sensitivities were 96%, 97% and 71% (p(CTA, MRA)=0.043) and for ruptured AVMs, they were 87%, 83% and 77%, respectively. The sensitivity was 100% for both CTA and T2-weighted MRI for AVMs larger than 3 cm. Importantly, associated aneurysms were best detected via CTA, with a sensitivity of 88%, as compared to 29% for MRI and 27% for MRA (p(CTA, MRA)=1.2×10(-6)), with the greatest distinction occurring within the subgroup of intranidal aneurysms with a sensitivity of 83% for CTA compared to 0% for both MRI and MRA (p(CTA, MRA)=0.005). |
4 |
| 87. Narvid J, Do HM, Blevins NH, Fischbein NJ. CT angiography as a screening tool for dural arteriovenous fistula in patients with pulsatile tinnitus: feasibility and test characteristics. AJNR Am J Neuroradiol. 2011;32(3):446-453. |
Observational-Dx |
7 patients |
To determine the sensitivity and specificity of CTA compared with cerebral angiography for DAVF in patients presenting with PT. |
The presence of arterial feeders showed good test characteristics for screening, with a sensitivity of 86% (95% CI, 42-99) and a specificity of 100% (95% CI, 52-100). A shaggy sinus or tentorium was highly specific: sensitivity of 42% (95% CI, 11-79) and specificity of 100% (95% CI, 56-100). The presence of transcalvarial venous channels demonstrated a poor sensitivity of 29% (95% CI, 5-70) but a high specificity 86% (95% CI, 42-99). CT attenuation of the jugular veins showed statistically significant asymmetry in the DAVF group versus the control group (P < .05). |
2 |
| 88. Soize S, Bouquigny F, Kadziolka K, Portefaix C, Pierot L. Value of 4D MR angiography at 3T compared with DSA for the follow-up of treated brain arteriovenous malformation. AJNR Am J Neuroradiol. 2014;35(10):1903-1909. |
Observational-Dx |
37 patients |
To evaluate its usefulness in the follow-up of treated brain AVM. |
Between May 2008 and February 2013, 37 patients with a median age of 45 years (interquartile range = 26-55) were prospectively included. Examinations were acquired 36 months (IQR = 10-45.5) after the last treatment. Interobserver agreement for brain AVM patency was very good for both 4D MRA (kappa 0.82, 95% CI .67-.98) and DSA (kappa 0.84, 95% CI .69-.98). After consensus reading, intermodality agreement for the evaluation of brain AVM patency was good (kappa 0.73, 95% CI .55-.90). Diagnostic accuracy of 4D MRA for residual brain AVM compared with DSA, reached a sensitivity of 73.7%, specificity 100%, positive predictive value 100%, and negative predictive value 78.3%. Agreements by technique of treatment are also detailed. |
3 |
| 89. Hadizadeh DR, Kukuk GM, Steck DT, et al. Noninvasive evaluation of cerebral arteriovenous malformations by 4D-MRA for preoperative planning and postoperative follow-up in 56 patients: comparison with DSA and intraoperative findings. AJNR Am J Neuroradiol. 33(6):1095-101, 2012 Jun. |
Observational-Dx |
56 patients |
To compare 4D-MRA in the pre- and postoperative evaluation of cAVMs with DSA or intraoperative findings as the standards of reference regarding qualitative and quantitative parameters. |
Preoperative Spetzler-Martin classification 4D-MRA and DSA ratings matched in 55/55 patients (Spetzler-Martin grades: I, 12; II, 22; III, 15; IV, 5; V, 1), and 93/100 arterial feeders were correctly identified by preoperative 4D-MRA (7 additional arterial feeders identified by DSA only: group 1, 3/19; group 2, 4/36). Postoperative 4D-MRA and DSA matched in 25/25 patients (residual filling, 1/25). Vessel sharpness and diameters did not differ substantially between the 2 groups. VBC was significantly higher in group 2 (P < .005). |
2 |
| 90. Oleaga L, Dalal SS, Weigele JB, et al. The role of time-resolved 3D contrast-enhanced MR angiography in the assessment and grading of cerebral arteriovenous malformations. Eur J Radiol. 74(3):e117-21, 2010 Jun. |
Observational-Dx |
12 patient |
To assess the role of three-dimensional (3D) contrast-enhanced, time-resolved MR angiography (CE TR MRA) in patients with intracranial arteriovenous malformations (AVMs). |
contrast-enhanced, time-resolved MR angiography (CE TR MRA) provided good quality images in the 3 standard orthogonal planes, and good arterial-venous separation in all cases. All AVMs were correctly graded by CE TR MRA when compared with digital subtraction angiography (DSA). 3D CE TR MRA provides a non-invasive alternative to DSA for the evaluation of cerebral AVMs. |
3 |
| 91. Raoult H, Bannier E, Robert B, Barillot C, Schmitt P, Gauvrit JY. Time-resolved spin-labeled MR angiography for the depiction of cerebral arteriovenous malformations: a comparison of techniques. Radiology. 271(2):524-33, 2014 May. |
Observational-Dx |
16 patients |
To assess time-resolved spin-labeled (SL) magnetic resonance (MR) angiographic imaging with a large acquisition time window over two cardiac cycles for characterization of cerebral arteriovenous malformations (AVMs). |
Time-resolved SL MR angiographic imaging over two cardiac cycles provided a median diagnostic confidence index of 2.5 for arterial feeders, 3.0 for nidus, and 3.0 for venous drainage. Venous drainage depiction quality was higher with time-resolved SL MR angiography over two cardiac cycles than with time-resolved SL MR angiography over one cardiac cycle (P < .001) and TOF MR angiography (P < .001). For AVM characterization, interobserver agreement was very good to excellent, and agreement with DSA showed ? of 0.85 for arterial feeders, ? of 1.00 for nidus size, and ? of 0.82 for venous drainage. |
1 |
| 92. Buis DR, Bot JC, Barkhof F, et al. The predictive value of 3D time-of-flight MR angiography in assessment of brain arteriovenous malformation obliteration after radiosurgery. AJNR Am J Neuroradiol. 33(2):232-8, 2012 Feb. |
Observational-Dx |
120 patients |
To complete angiographic obliteration of its nidus. |
Mean bAVM volume during radiosurgery was 3.4 mL (95% CI, 2.6-4.3 mL). Sixty-six patients (55%) had undergone previous endovascular embolization. The mean intervals between radiosurgery and follow-up MR imaging and for DSA, respectively, were 35.6 months (95% CI, 32.3-38.9 months) and 42.1 months (95% CI, 40.3-44.0 months). With ROC, an area under curve of 0.81-0.83 was found. PPVs of final follow-up MR-imaging for definitive obliteration varied between 0.89 [corrected] and 0.95. NPV was 0.52 [corrected] . An average false-positive rate, meaning overestimation of nidus obliteration of 0.10 [corrected] and an average false-negative rate, meaning underestimation of nidus obliteration of 0.42 [corrected] were found. |
1 |
| 93. Azuma M, Hirai T, Shigematsu Y, et al. Evaluation of Intracranial Dural Arteriovenous Fistulas: Comparison of Unenhanced 3T 3D Time-of-flight MR Angiography with Digital Subtraction Angiography. Magn. reson. med. sci.. 14(4):285-93, 2015. |
Observational-Dx |
26 patients |
To compare the gross characterization of intracranial dural arteriovenous fistulas (DAVFs) between unenhanced 3-tesla 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). |
Interobserver agreement was excellent for fistula site (? = 0.919; 95% confidence interval [CI], 0.805 to 1.000), good for main arterial feeders (? = 0.711; 95% CI, 0.483 to 0.984), and very good for venous drainage (? = 0.900; 95% CI, 0.766 to 1.000). Intermodality agreement was excellent for fistula site (? = 0.968; 95% CI, 0.906 to 1.000) and good for main arterial feeder (? = 0.809; 95% CI, 0.598 to 1.000) and venous drainage (? = 0.837; 95% CI, 0.660 to 1.000). |
2 |
| 94. Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ. Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF. Neuroradiology. 60(1):7-15, 2018 Jan. |
Review/Other-Dx |
108 patients |
To compare the diagnostic accuracy of Computed tomography angiography (CTA) and magnetic resonance imaging/angiography (MRI/MRA) for detection of cortical venous reflux (CVR) in intracranial dural arteriovenous fistulas (DAVFs). |
A total 108 patients were included in this study. CTA signs of CVR included abnormal dilatation, early enhancement, and the presence of a medullary or pial vein. MRI/MRA signs of CVR included abnormal dilatation, early enhancement, flow-related enhancement, flow void, and medullary or pial venous collaterals. The sensitivity of individual CTA signs ranged from 62 to 96%, and specificities from 79 to 94%. The sensitivities of individual MRI/MRA signs ranged from 58 to 83%, and specificities from 77 to 93%. The area under ROC curve (AUC) of CTA and MRI/MRA were 0.91 and 0.87, respectively (P?=?0.04 in direct comparison). In subgroup analysis, CTA had better diagnostic accuracy for higher grade disease (P?=?0.05) and non-aggressive manifestation (P?=?0.04). |
4 |
| 95. Edjlali M, Roca P, Rabrait C, et al. MR selective flow-tracking cartography: a postprocessing procedure applied to four-dimensional flow MR imaging for complete characterization of cranial dural arteriovenous fistulas. Radiology. 270(1):261-8, 2014 Jan. |
Observational-Dx |
8 patients |
To assess the feasibility of a selective flow-tracking cartographic procedure applied to four-dimensional (4D) flow imaging and to demonstrate its usefulness in the characterization of dural arteriovenous fistulas (DAVFs). |
Interreader agreement for shunt location on MR images was perfect (kappa = 1), with good-to-excellent interreader agreement for arterial feeder vessel identification (kappa = 0.97; 95% CI = 0.92, 1.0), and matched in all cases with shunt location defined at DSA. There was good-to-excellent agreement between MR cartography and DSA in the definition of the main feeding arteries (kappa = 0.92; 95% CI = 0.83, 1.0), presence of retrograde flow in dural sinuses (kappa = 1), presence of retrograde cortical venous drainage (kappa = 1), presence of venous ectasia (kappa = 1), and final Cognard classification of DAVFs (kappa = 1, standard error = 0.35). |
1 |
| 96. Iryo Y, Hirai T, Kai Y, et al. Intracranial dural arteriovenous fistulas: evaluation with 3-T four-dimensional MR angiography using arterial spin labeling. Radiology. 2014;271(1):193-199 |
Observational-Dx |
9 patients |
To evaluate whether 3-T four-dimensional (4D) arterial spin-labeling (ASL)-based magnetic resonance (MR) angiography is useful for the evaluation of shunt lesions in patients with intracranial dural arteriovenous fistulas (AVFs). |
On all 4D ASL MR angiographic images, the major intracranial arteries were demonstrated at a temporal resolution of 300 milliseconds. Interobserver agreement was excellent for the fistula site (kappa = 1.00; 95% confidence interval [CI]: 1.00, 1.00), moderate for the main arterial feeders (kappa = 0.53; 95% CI: 0.08, 0.98), and good for venous drainage (kappa = 0.77; 95% CI: 0.35, 1.00). Intermodality agreement was excellent for the fistula site and venous drainage (kappa = 1.00; 95% CI: 1.00, 1.00) and good for the main arterial feeders (kappa = 0.80; 95% CI: 0.58, 1.00). |
2 |
| 97. Nishimura S, Hirai T, Sasao A, et al. Evaluation of dural arteriovenous fistulas with 4D contrast-enhanced MR angiography at 3T. AJNR Am J Neuroradiol. 31(1):80-5, 2010 Jan. |
Observational-Dx |
18 consecutive patients |
To test the hypothesis that 4D-CE-MRA at 3T enables the same characterization of intracranial DAVFs as DSA. |
At DSA, 8 fistulas were located at the transverse sigmoid sinus; 8, at the cavernous sinus; and 2, at the sinus adjacent to the foramen magnum. Interobserver agreement was fair for the main arterial feeders (kappa = 0.59), excellent for the fistula site (kappa = 0.91), and good for venous drainage (kappa = 0.86). Intermodality agreement was moderate for the main arterial feeders (kappa = 0.68) and excellent for the fistula site (kappa = 1.0) and venous drainage (kappa = 1.0). |
2 |
| 98. Amponsah K, Ellis TL, Chan MD, et al. Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation. Neurosurgery. 71(4):893-9, 2012 Oct. |
Observational-Dx |
46 patients |
To evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration. |
The overall obliteration rate for the angiography/MRI group was 88.0% (29 of 33). Patients in the MRI-only group had an obliteration rate of 61.5% (8 of 13), with P=.092 with the Fisher exact test, which is not statistically significant. A Kaplan-Meier analysis was also not statistically significant (log rank test, P=.474). Four of 9 patients with incomplete obliteration on angiography also had shown residual abnormal blood flow on PASL imaging. |
3 |
| 99. Hajj-Ali RA, Calabrese LH. Diagnosis and classification of central nervous system vasculitis. J Autoimmun. 2014;48-49:149-152. |
Review/Other-Dx |
N/A |
To review the diagnosis and classification of central nervous system vasculitis. |
The diagnostic task for CNS vasculitis is challenging and should include a team of expert diagnosticians in many fields. The advancement in diagnostic modalities demystified many of the mimics of CNS vasculitis. Studies on the diagnostic and follow up roles of HR-MRI are such an example. However, a great need exists to expatiate on different aspects of CNS vasculitis such as epidemiologic properties, pathogenesis, diagnostic tools, and management strategies. Substantial work is currently underway, to assess biomarkers to aid in understanding the pathogenesis and to assist in the diagnosis. Multidisciplinary and multicenter collaboration are essential to face these challenges and achieve considerable progress in the coming years. |
4 |
| 100. American College of Radiology. ACR Appropriateness Criteria®: Noncerebral Vasculitis. Available at: https://acsearch.acr.org/docs/3158180/Narrative/. Accessed March 26, 2021. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. |
No abstract available. |
4 |
| 101. Salvarani C, Brown RD, Jr., Calamia KT, et al. Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol. 2007;62(5):442-451. |
Review/Other-Dx |
101 patients |
To analyze the clinical findings, response to therapy, outcome, and incidence of primary central nervous system vasculitis (PCNSV) in a large cohort from a single center. |
Seventy patients were diagnosed by angiography and 31 by central nervous system biopsy. Three histological patterns were observed during biopsy. Although most patients responded to therapy, an increased mortality rate was observed. Relapses occurred in one fourth of patients. Mortality rate and disability at last follow-up were greater in those who presented with a focal neurological deficit, cognitive impairment, cerebral infarctions, and angiographic large-vessel involvement but were lower in those with prominent gadolinium-enhanced lesions when evaluated by magnetic resonance imaging. The annual incidence rate of PCNSV was 2.4 cases per 1,000,000 person-years. |
4 |
| 102. Calabrese LH, Mallek JA. Primary angiitis of the central nervous system. Report of 8 new cases, review of the literature, and proposal for diagnostic criteria. [Review] [121 refs]. Medicine (Baltimore). 67(1):20-39, 1988 Jan. |
Review/Other-Dx |
8 patients |
To establish diagnostic criteria for PACNS which would include 1) the presence of an unexplained neurologic deficit after thorough clinical and laboratory evaluation; 2) documentation by cerebral angiography and/or tissue examination of an arteritic process within the central nervous system; and 3) no evidence of a systemic vasculitide or any other condition to which the angiographic or pathologic features could be secondary. Utilizing these criteria, 8 new cases are reported and are combined with 40 previously diagnosed cases from the literature. |
No results stated in the abstract. |
4 |
| 103. de Boysson H, Boulouis G, Parienti JJ, et al. Concordance of Time-of-Flight MRA and Digital Subtraction Angiography in Adult Primary Central Nervous System Vasculitis. AJNR Am J Neuroradiol. 38(10):1917-1922, 2017 Oct. |
Observational-Dx |
85 patients |
To compare the diagnostic concordance of vessel imaging using 3D-TOF-MRA and DSA in patients with primary central nervous system vasculitis. |
Thirty-one patients met the inclusion criteria, including 20 imaged with a 1.5T MR unit and 11 with a 3T MR unit. Among the 25 patients (81%) with abnormal DSA findings, 24 demonstrated abnormal 3D-TOF-MRA findings, whereas all 6 remaining patients with normal DSA findings had normal 3D-TOF-MRA findings. In the per-segment analysis, concordance between 1.5T 3D-TOF-MRA and DSA was 0.82 (95% CI, 0.75-0.93), and between 3T 3D-TOF-MRA and DSA, it was 0.87 (95% CI, 0.78-0.91). |
2 |
| 104. de Boysson H, Zuber M, Naggara O, et al. Primary angiitis of the central nervous system: description of the first fifty-two adults enrolled in the French cohort of patients with primary vasculitis of the central nervous system. Arthritis Rheumatol 2014;66:1315-26. |
Observational-Dx |
52 patients |
To describe characteristics and outcomes of a multicenter cohort of patients diagnosed as having primary angiitis of the central nervous system (PACNS). |
We included 52 patients (30 males; median age at diagnosis 43.5 years [range 18-79 years]) in whom PACNS was diagnosed between 1996 and 2012. Nineteen (61%) of 31 patients who had undergone brain biopsy had histologic vasculitis (biopsy-proven PACNS), while the other 12 patients had normal or noncontributive biopsy samples. An additional 21 patients had signs suggestive of PACNS on conventional cerebral angiography. All but 1 patient received corticosteroids, and 44 patients received cyclophosphamide (CYC). After a median followup of 35 months (range 2-148 months) postdiagnosis (1 patient with biopsy-proven PACNS died 2 months after diagnosis), 32 patients responded to treatment with improved modified Rankin scale scores, 4 patients (8%) did not respond, 14 patients (27%) had relapse of their disease at least once, and 3 patients (6%) died (1 patient after a relapse). Relapse was more common in patients with than in those without meningeal gadolinium enhancements on magnetic resonance imaging (MRI) (8 of 10 [80%] versus 6 of 32 [19%]; P = 0.001) and more common in patients with than in those without seizures at diagnosis (8 of 17 [47%] versus 6 of 35 [17%]; P = 0.04). |
2 |
| 105. Powers WJ. Primary angiitis of the central nervous system: diagnostic criteria. Neurol Clin 2015;33:515-26. |
Review/Other-Dx |
N/A |
To discuss the diagnostic criteria for primary angiitis of the central nervous system. |
No results stated in the abstract. |
4 |
| 106. Lie JT.. Classification and histopathologic spectrum of central nervous system vasculitis. [Review] [56 refs]. Neurol Clin. 15(4):805-19, 1997 Nov. |
Review/Other-Dx |
N/A |
To discuss the classification and histopathologic spectrum of central nervous system vasculitis. |
No abstract was stated in the abstract. |
4 |
| 107. Mossa-Basha M, Shibata DK, Hallam DK, et al. Added Value of Vessel Wall Magnetic Resonance Imaging for Differentiation of Nonocclusive Intracranial Vasculopathies. Stroke. 48(11):3026-3033, 2017 11.Stroke. 48(11):3026-3033, 2017 11. |
Review/Other-Dx |
54 patients |
To determine the added value of intracranial vessel wall magnetic resonance imaging (IVWI) in differentiating nonocclusive vasculopathies compared with luminal imaging alone. |
Thirty intracranial atherosclerotic disease, 12 inflammatory vasculopathies, and 12 reversible cerebral vasoconstriction syndrome patients with 201 lesions (90 intracranial atherosclerotic disease, 64 reversible cerebral vasoconstriction syndrome, and 47 inflammatory vasculopathy lesions) were included. For both per-lesion and per-patient analyses, there was significant diagnostic accuracy improvement with luminal imaging+IVWI when compared with luminal imaging alone (per-lesion: 88.8% versus 36.1%; P<0.001 and per-patient: 96.3% versus 43.5%; P<0.001, respectively). There was substantial interrater diagnostic agreement for luminal imaging+IVWI (?=0.72) and only slight agreement for luminal imaging (?=0.04). Although there was a significant correlation for both luminal and IVWI pattern of wall involvement with diagnosis, there was a stronger correlation for IVWI finding of lesion eccentricity and intracranial atherosclerotic disease diagnosis than for luminal imaging (?=0.69 versus 0.18; P<0.001). |
4 |
| 108. Obusez EC, Hui F, Hajj-Ali RA, et al. High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis. Ajnr: American Journal of Neuroradiology. 35(8):1527-32, 2014 Aug.AJNR Am J Neuroradiol. 35(8):1527-32, 2014 Aug. |
Review/Other-Dx |
26 patients |
To investigate high-resolution MR imaging arterial wall characteristics of CNS vasculitis and reversible cerebral vasoconstriction syndrome and to determine wall pattern changes during a follow-up period. |
Thirteen patients with CNS vasculitis and 13 patients with reversible cerebral vasoconstriction syndrome were included. In the CNS vasculitis group, 9 patients showed smooth, concentric wall enhancement and thickening; 3 patients had smooth, eccentric wall enhancement and thickening; and 1 patient was without wall enhancement and thickening. Six of 13 patients had follow-up imaging; 4 patients showed stable smooth, concentric enhancement and thickening; and 2 patients had resoluton of initial imaging findings. In the reversible cerebral vasoconstriction syndrome group, 10 patients showed diffuse, uniform wall thickening with negligible-to-mild enhancement. Nine patients had follow-up imaging, with 8 patients showing complete resolution of the initial findings. |
4 |
| 109. Swartz RH, Bhuta SS, Farb RI, et al. Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology. 2009;72(7):627-634. |
Review/Other-Dx |
37 patients |
To review intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. |
Multiplanar T2-weighted fast spin echo and multiplanar T1 fluid-attenuated inversion recovery precontrast and postcontrast images were acquired in 37 patients with focal neurologic deficits. Clinical diagnoses included atherosclerotic disease (13), CNS inflammatory disease (3), dissections (3), aneurysms (3), moyamoya syndrome (2), cavernous angioma (1), extracranial source of stroke (5), and no definitive clinical diagnosis (7). Twelve of 13 with atherosclerotic disease had focal, eccentric vessel wall enhancement, 10 of whom had enhancement only in the vessel supplying the area of ischemic injury. Two of 3 with inflammatory diseases had diffuse, concentric vessel wall enhancement. Three of 3 with dissection showed bright signal on T1, and 2 had irregular wall enhancement with a flap and dual lumen. |
4 |
| 110. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
