title: Serial Imaging Surveillance for Patients With a History of Intracranial Aneurysm: Risk of De Novo Aneurysm Formation.
abstract: BACKGROUND
  Although rare, de novo intracranial aneurysms (DNIAs) may develop in patients with a history of intracranial aneurysms (IAs).
  
  
  OBJECTIVE
  To evaluate the benefit of routine radiographic screening for DNIAs.
  
  
  METHODS
  Data for 2153 patients with IAs were retrospectively analyzed. A total of 185 patients underwent screening for DNIAs at frequent intervals.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The low 1.14% per-person year risk of DNIA detection and small DNIA size at detection cannot justify routine screening for DNIAs in all patients with a personal history of IAs. If imaging follow-up is considered for selected patients, early screening will likely yield the most benefit in patients who continue to smoke cigarettes.
authors: Departments of *Neurosurgery and ‡Radiology, Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Joanna Y
authors: JY
authors: Wang
authors: Ryan
authors: R
authors: Smith
authors: Xiaobu
authors: X
authors: Ye
authors: Wuyang
authors: W
authors: Yang
authors: Justin M
authors: JM
authors: Caplan
authors: Martin G
authors: MG
authors: Radvany
authors: Geoffrey P
authors: GP
authors: Colby
authors: Alexander L
authors: AL
authors: Coon
authors: Rafael J
authors: RJ
authors: Tamargo
authors: Judy
authors: J
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed