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CEREBRAL ANEURYSMS

Diagnosis

The gold standard for the diagnosis and characterization of cerebral aneurysms is cerebral angiography. It will demonstrate the source of SAH 80-85% of the time¹. While it remains the method of choice in the face of non-traumatic subarachnoid hemorrhage, CT angiography or MR angiography are preferred non-invasive methods for diagnosing non-ruptured aneurysms.  According to Greenberg’s Handbook of Neurosurgery “At this time, MRA may be useful as a screening test in high risk patients including first degree relatives of patients with intracranial aneurysms.”¹ Sensitivity for detecting aneurysms >3mm is estimated at 86-95%, with a false positive rate as high as 16%¹. CTA boasts a sensitivity of 95% and specificity of 83% for aneurysms >2.2mm¹. CTA’s advantage is that it “shows a 3D image and demonstrates relation to nearby bony structures.¹” Finally, Aneurysms that are large or calcified will appear on conventional CT imaging.

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