PATIENTS WITH POLYCYSTIC KIDNEY-DISEASE WOULD BENEFIT FROM ROUTINE MAGNETIC-RESONANCE ANGIOGRAPHIC SCREENING FOR INTRACEREBRAL ANEURYSMS - A DECISION-ANALYSIS

AUTOSOMAL DOMINANT POLYCYSTIC kidney disease (ADPKD) is associated wit h increased prevalence of cerebral aneurysms and increased risk of sub arachnoid hemorrhage. A decision analysis by Levey et al. in 1983 demo nstrated that patients with ADPKD would not significantly benefit from routine arteriographic screening for cerebral aneurysms. We reexamine d this conclusion in light of new clinical data and the introduction o f magnetic resonance imaging (MRI) as a screening method. We compared an MRI screening strategy with a nonscreening strategy. The screening strategy specified MRI screening and then neurosurgical management of detected aneurysms. The nonscreening strategy specified cerebrovascula r care only in the event of subarachnoid hemorrhage. The decision tree incorporated estimates derived from the clinical literature for the p revalence of asymptomatic aneurysms in patients with ADPKD (15%), the annual incidence of aneurysmal rupture (1.6%), the morbidity and morta lity rates associated with subarachnoid hemorrhage (70 and 56%, respec tively), the risk of transfemoral arteriography (0.2%), the sensitivit y and specificity of MRI, the morbidity and mortality rates associated with surgical treatment of an unruptured aneurysm (4.1 and 1.0%, resp ectively), and the life expectancy of patients with ADPKD. The model p redicted that the screening strategy would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD. A sensitivity analysis showed that the model was most sensitiv e to estimates of the prevalence of aneurysms in ADPKD, the annual inc idence of rupture, and the morbidity and mortality rates associated wi th rupture. A financial analysis showed that a screening strategy is l ikely to cost less than a nonscreening strategy. The model predicts th at an MRI screening strategy would increase the life expectancy of you ng patients with ADPKD and reduce the financial impact on society of A DPKD.