FOLLOW-UP OF INTRACRANIAL ANEURYSMS IN AUTOSOMAL-DOMINANT POLYCYSTIC KIDNEY-DISEASE BY MAGNETIC-RESONANCE ANGIOGRAPHY

The purpose of this study was to assess the value of magnetic resonanc e angiography (MRA) in the follow-up of patients with autosomal domina nt polycystic kidney disease (ADPKD) and saccular intracranial aneurys ms (ICA), the risk of MRA-defined growth of asymptomatic incidental IC A, and the rate of development of MRA-defined de nova ICA in these pat ients. Between 1989 and 1995, 15 asymptomatic incidental ICA measuring 1.5 to 6.5 mm in diameter, three symptomatic aneurysms, and one asymp tomatic concurrent aneurysm were detected by MRA in this study in 18 p atients from 15 families. Four-vessel cerebral angiography in the thre e patients with symptomatic ICA and autopsy in one patient with an asy mptomatic incidental ICA did not reveal additional aneurysms undetecte d by MRA. Thirty MRA studies were obtained in 10 of the 15 patients wi th incidental ICA during a cumulative clinical follow-up of 500 months (mean, 33.3; range, 0 to 65 months). The cumulative interval between the initial and the last MRA was 306 months (mean, 30.6; range, 14 to 51 months), No change in aneurysmal size or development of de novo ane urysms was detected. Eight MRA studies were obtained in the three pati ents with symptomatic ICA during a cumulative clinical follow-up of 13 0 months (mean, 43.3; range, 23 to 64 months). The cumulative interval between the first and the last MRA was 95 months (mean, 31.7; range, 15 to 49 months). Development of de novo aneurysms was not detected. T hese results indicate that MRA is an appropriate technique to follow s mall asymptomatic incidental ICA in patients with ADPKD and that the r isk for rapid growth of these aneurysms is low, Although the results o f this study should be viewed as preliminary, they do not suggest a hi gher rate of development of de nova aneurysms or a higher frequency of multiple aneurysms in patients with ADPKD and ICA as compared with pa tients with sporadic ICA in the general population.