Comparing magnetic resonance angiography (MRA) and computed tomography angiography (CTA) with conventional angiography in the detection of distal territory cerebral mycotic and oncotic aneurysms.
BACKGROUND
Mycotic and oncotic aneurysms may result in devastating neurologic sequelae if undetected. The objectives of this study were to examine interobserver variability and accuracy of cross-sectional imaging for the detection of distal territory mycotic and oncotic aneurysms.


METHODS
We searched our institutional database for all radiology reports from 2005 to 2015 with an indication or diagnosis of mycotic or oncotic aneurysm. Patients who underwent DSA and either CTA or MRA within 12 weeks of each other were identified. The cross-sectional images from each study were blinded and reviewed by two radiologists. If positive for aneurysm, location and number of aneurysms were reported. Sensitivity, specificity, positive predictive value, negative predictive value, and interobserver variability were determined for MRA and MRA/CTA.


RESULTS
Twenty-five patients were included in this study. Ten (40%) harbored distal aneurysms. Cross-sectional imaging had a sensitivity of 45.5%, specificity of 90.0%, and kappa value of 0.29 (0.00-0.69) for the detection of cerebral mycotic and oncotic aneurysms.


CONCLUSIONS
Because of the low sensitivity and high interobserver variability of cross-sectional imaging, DSA should remain the gold standard for evaluation of suspected oncotic and mycotic aneurysms. In cases in which cross sectional imaging is negative and there is a high clinical suspicion for mycotic aneurysm, DSA should be strongly considered.
Department of Radiology, Mayo Clinic, USA walkoff.lara@mayo.edu.
Lara
L
Walkoff
Department of Radiology, Mayo Clinic, USA.
Waleed
W
Brinjikji
Department of Interventional Neuroradiology, Hôpital Bicêtre, APHP, Paris Sud Université, France.
Aymeric
A
Rouchaud
Department of Interventional Neuroradiology, Hôpital Bicêtre, APHP, Paris Sud Université, France.
Jildaz
J
Caroff
Department of Radiology, Mayo Clinic, USA.
David F
DF
Kallmes
D000328:Adult; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
Aneurysm; angiography; mycotic; oncotic