title: Role of MRA in the detection of intracranial aneurysm in the acute phase of subarachnoid hemorrhage.
abstract: BACKGROUND
  Magnetic resonance angiography (MRA) has been evaluated for the detection of unruptured intracranial aneurysms with favorable results at 3 Tesla (3T) and with similar diagnostic accuracy as both 3D time-of-flight (3D-TOF) and contrast-enhanced (CE-MRA) MRA. However, the diagnostic value and place of MRA in the detection of ruptured aneurysms has been little evaluated. Thus, the goal of this prospective single-center series was to assess the feasibility and diagnostic value of 3T 3D-TOF MRA and CE-MRA for aneurysm detection in acute non-traumatic subarachnoid hemorrhage (SAH).
  
  
  METHODS
  From March 2006 to December 2007, all consecutive patients admitted to our hospital with acute non-traumatic SAH (≤10 days) were prospectively included in this study evaluating MRA in the diagnostic workup of SAH. Feasibility of MRA and sensitivity/specificity of 3D-TOF and CE-MRA were assessed compared with gold standard DSA.
  
  
  RESULTS
  In all, 84 consecutive patients (45 women, 39 men; age 23-86 years) were included. The feasibility of MRA was low (43/84, 51.2%). The reasons given for patients not undergoing magnetic resonance imaging (MRI) examination were clinical status (27 patients), potential delay in aneurysm treatment (11 patients) and contraindications to MRI (three patients). In patients explored by MRA, the sensitivity of CE-MRA (95%) was higher compared with 3D-TOF (86%) with similar specificity (80%). Also, 3D-TOF missed five aneurysms while CE-MRA missed two.
  
  
  CONCLUSIONS
  The value of MRA in the diagnostic workup of ruptured aneurysms is limited due to its low feasibility during the acute phase of bleeding. Sensitivity for aneurysm detection was good for both MRA techniques, but tended to be better with CE-MRA.
authors.affiliation: Department of Radiology, Maison Blanche Hospital, Université Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims, France. lpierot@gmail.com
authors.forename: Laurent
authors.initials: L
authors.lastname: Pierot
authors.forename: Christophe
authors.initials: C
authors.lastname: Portefaix
authors.forename: Christine
authors.initials: C
authors.lastname: Rodriguez-Régent
authors.forename: Sophie
authors.initials: S
authors.lastname: Gallas
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Meder
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis*
keywords: MRA; Ruptured aneurysms; Subarachnoid hemorrhage