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Johnsen LH, Herder M, Vangberg T, Kloster R, Ingebrigtsen T, Isaksen JG, Mathiesen EB. Prevalence of unruptured intracranial aneurysms: impact of different definitions - the Tromsø Study. J Neurol Neurosurg Psychiatry 2022; 93:902-907. [PMID: 35688631 DOI: 10.1136/jnnp-2022-329270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Management of incidental unruptured intracranial aneurysms (UIAs) remains challenging and depends on their risk of rupture, estimated from the assumed prevalence of aneurysms and the incidence of aneurysmal subarachnoid haemorrhage. Reported prevalence varies, and consistent criteria for definition of UIAs are lacking. We aimed to study the prevalence of UIAs in a general population according to different definitions of aneurysm. METHODS Cross-sectional population-based study using 3-dimensional time-of-flight 3 Tesla MR angiography to identify size, type and location of UIAs in 1862 adults aged 40-84 years. Size was measured as the maximal distance between any two points in the aneurysm sac. Prevalence was estimated for different diameter cutoffs (≥1, 2 and 3 mm) with and without inclusion of extradural aneurysms. RESULTS The overall prevalence of intradural saccular aneurysms ≥2 mm was 6.6% (95% CI 5.4% to 7.6%), 7.5% (95% CI 5.9% to 9.2%) in women and 5.5% (95% CI 4.1% to 7.2%) in men. Depending on the definition of an aneurysm, the overall prevalence ranged from 3.8% (95% CI 3.0% to 4.8%) for intradural aneurysms ≥3 mm to 8.3% (95% CI 7.1% to 9.7%) when both intradural and extradural aneurysms ≥1 mm were included. CONCLUSION Prevalence in this study was higher than previously observed in other Western populations and was substantially influenced by definitions according to size and extradural or intradural location. The high prevalence of UIAs sized <5 mm may suggest lower rupture risk than previously estimated. Consensus on more robust and consistent radiological definitions of UIAs is warranted.
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Affiliation(s)
- Liv-Hege Johnsen
- Department of Radiology, University Hospital of North Norway, Tromso, Norway .,Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway
| | - Marit Herder
- Department of Radiology, University Hospital of North Norway, Tromso, Norway.,Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway
| | - Torgil Vangberg
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,PET Imaging Center, University Hospital of North Norway, Tromso, Norway
| | - Roar Kloster
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Jørgen Gjernes Isaksen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurology, University Hospital of North Norway, Tromso, Norway
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Ahmed SU, Mocco J, Zhang X, Kelly M, Doshi A, Nael K, De Leacy R. MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis. J Neurointerv Surg 2019; 11:1009-1014. [PMID: 31048457 DOI: 10.1136/neurintsurg-2019-014936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. METHODS Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. RESULTS The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. CONCLUSION MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.
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Affiliation(s)
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Xiangnan Zhang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Kelly
- Royal University Hospital, University of Saskatchewan, Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Amish Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kambiz Nael
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Edjlali M, Rodriguez-Régent C, Hodel J, Aboukais R, Trystram D, Pruvo JP, Meder JF, Oppenheim C, Lejeune JP, Leclerc X, Naggara O. Subarachnoid hemorrhage in ten questions. Diagn Interv Imaging 2015; 96:657-66. [PMID: 26141485 DOI: 10.1016/j.diii.2015.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/10/2015] [Indexed: 11/16/2022]
Abstract
Traumatic subarachnoid hemorrhage (SAH) has an annual incidence of 9 per 100 000 people. It is a rare but serious event, with an estimated mortality rate of 40% within the first 48hours. In 85% of cases, it is due to rupture of an intracranial aneurysm. In the early phase, during the first 24hours, cerebral CT, combined with intracranial CT angiography is recommended to make a positive diagnosis of SAH, to identify the cause and to investigate for an intracranial aneurysm. Cerebral MRI may be proposed if the patient's clinical condition allows it. FLAIR imaging is more sensitive than CT to demonstrate a subarachnoid hemorrhage and offers greater degrees of sensitivity for the diagnosis of restricted subarachnoid hemorrhage in cortical sulcus. A lumbar puncture should be performed if these investigations are normal while clinical suspicion is high.
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Affiliation(s)
- M Edjlali
- Inserm UMR 894, Department of Neuroradiolgy, Faculty of Medicine Paris Descartes University, Pyschiatry and Neurosciences Centers, Sainte-Anne Hospital, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France; Department of Neuroradiology, Lille Nord de France University, Roger Salengro Hospital, Lille University Hospitals, avenue Émile-Laine, 59037 Lille cedex, France.
| | - C Rodriguez-Régent
- Inserm UMR 894, Department of Neuroradiolgy, Faculty of Medicine Paris Descartes University, Pyschiatry and Neurosciences Centers, Sainte-Anne Hospital, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France
| | - J Hodel
- Department of Neuroradiology, Lille Nord de France University, Roger Salengro Hospital, Lille University Hospitals, avenue Émile-Laine, 59037 Lille cedex, France
| | - R Aboukais
- Department of Neurosurgery, Lille Nord de France University, Roger Salengro Hospital, Lille University Hospitals, avenue Émile-Laine, 59037 Lille cedex, France
| | - D Trystram
- Inserm UMR 894, Department of Neuroradiolgy, Faculty of Medicine Paris Descartes University, Pyschiatry and Neurosciences Centers, Sainte-Anne Hospital, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France
| | - J-P Pruvo
- Department of Neuroradiology, Lille Nord de France University, Roger Salengro Hospital, Lille University Hospitals, avenue Émile-Laine, 59037 Lille cedex, France
| | - J-F Meder
- Inserm UMR 894, Department of Neuroradiolgy, Faculty of Medicine Paris Descartes University, Pyschiatry and Neurosciences Centers, Sainte-Anne Hospital, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France
| | - C Oppenheim
- Inserm UMR 894, Department of Neuroradiolgy, Faculty of Medicine Paris Descartes University, Pyschiatry and Neurosciences Centers, Sainte-Anne Hospital, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France
| | - J-P Lejeune
- Department of Neurosurgery, Lille Nord de France University, Roger Salengro Hospital, Lille University Hospitals, avenue Émile-Laine, 59037 Lille cedex, France
| | - X Leclerc
- Department of Neuroradiology, Lille Nord de France University, Roger Salengro Hospital, Lille University Hospitals, avenue Émile-Laine, 59037 Lille cedex, France
| | - O Naggara
- Inserm UMR 894, Department of Neuroradiolgy, Faculty of Medicine Paris Descartes University, Pyschiatry and Neurosciences Centers, Sainte-Anne Hospital, Sorbonne Paris Cité, 1, rue Cabanis, 75014 Paris, France
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Rodriguez-Régent C, Edjlali-Goujon M, Trystram D, Boulouis G, Ben Hassen W, Godon-Hardy S, Nataf F, Machet A, Legrand L, Ladoux A, Mellerio C, Souillard-Scemama R, Oppenheim C, Meder JF, Naggara O. Non-invasive diagnosis of intracranial aneurysms. Diagn Interv Imaging 2014; 95:1163-74. [DOI: 10.1016/j.diii.2014.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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