Diagnostic accuracy of magnetic resonance angiography for cerebral aneurysms in correlation with 3D-digital subtraction angiographic images: a study of 133 aneurysms.
OBJECTIVE
We investigated the sensitivity of 3D-time-of flight (3D-TOF) magnetic resonance angiography (MRA) in the detection of cerebral aneurysms with the use of 3D digital subtraction angiography as the gold standard. We also evaluated the effects of location and number of aneurysms (and experience of the reader) on the sensitivity.


METHODS
3D-TOF MRA was performed in 82 patients with 133 cerebral aneurysms. Each patient underwent rotational angiography. Three-dimensional reconstructed images were obtained from data of the rotational angiography (as the gold standard). A blind study with 4 readers of different experiences was performed to evaluate the diagnostic accuracy of 3D-TOF MRA for cerebral aneurysms.


RESULTS
One hundred five (79%) of all 133 aneurysms were detected with MRA by a neuroradiologist, 100 (75%) were detected by an experienced neurosurgeon, 84 (63%) were detected by a general radiologist, and 80 (60%) were detected by a resident neuroradiologist. For each reader, the detectability was lower for small aneurysms (<3 mm in maximum diameter) and/or for those located at the internal carotid artery and anterior cerebral artery. False-positive aneurysms were 29 for the neuroradiologist, 19 for the neurosurgeon, 31 for the general radiologist, and 30 for the resident neuroradiologist; most of the aneurysms were at the internal carotid artery. Causes of the false-positive and false-negative results included complex flow in a tortuous artery and susceptibility artifacts.


CONCLUSIONS
Although MRA is useful in the diagnosis of cerebral aneurysms, sufficient experience and careful attention are necessary for accurate diagnosis of aneurysms located at the internal carotid and anterior cerebral arteries.
Okahara
Mika
M
Department of Neuroradiology, Nagatomi Neurosurgical Hospital, Oita, Japan. okaharam@mb.infoweb.ne.jp
Kiyosue
Hiro
H
Yamashita
Masanori
M
Nagatomi
Hirohumi
H
Hata
Hiroyuki
H
Saginoya
Toshiyuki
T
Sagara
Yoshiko
Y
Mori
Hiromu
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity