INTRACRANIAL ANEURYSMS - EVALUATION BY MR ANGIOGRAPHY

The purpose of this study was to compare the accuracy of a volume gradient-echo MR angiography (MRA) technique with that of intraarterial digital subtraction angiography (IA DSA) in the identification of intracranial aneurysms. The intracranial vasculature was examined in 47 patients by MRA and compared with IA DSA findings in 19 of these patients who had saccular or giant intracranial aneurysms. The remaining 28 patients, in whom no aneurysm was found, served as a control group. MRA was performed with the use of a velocity-compensated gradient-echo sequence (TR = 40-50/TE = 7-15) with a 15° flip angle. The sensitivity and specificity were calculated for the evaluation of the cine 3D reconstructions (cine MRA) only, cine MRA + inspection of the individual partitions, and cine MRA + individual partitions + spin-echo studies. Of 21 aneurysms, of which three were missed in two patients, the sensitivity varied from 67% for cine MRA only to 86% for the cine MRA + partitions + spin-echo studies; of the 19 patients, among whom it was assumed that the diagnosis of any one aneurysm in a patient would lead to angiography and detection of additional aneurysms, the sensitivity varied from 73% for the cine MRA only to 95% for the cine MRA + partitions + spin-echo studies. The results of this study suggest that MRA can define the circle of Willis sufficiently to allow detection of intracranial aneurysms as small as 3-4 mm. MRA holds promise as a truly noninvasive screening examination of intracranial vasculature in patients at risk for aneurysms.