THE USEFULNESS OF MAGNETIC-RESONANCE ANGIOGRAPHY IN SURGERY FOR INTRACRANIAL ANEURYSMS THAT HAVE BLED

BACKGROUND Once it was confirmed that magnetic resonance imaging (MRI) including angiography (MRA) could demonstrate intracranial aneurysms, a study was set up to establish whether satisfactory images could be obtained to plan and execute early surgery on ruptured intracranial an eurysms without recourse to intra-arterial digital subtraction angiogr aphy (IA.DSA) in the acute phase of the illness. METHODS All patients presenting with a subarachnoid haemorrhage (SAH) were considered for M R studies. The patient selection was based on whether they were consid ered fit enough to tolerate scanning and did not have a known contrain dication. A standard protocol was used-a three-dimensional time-of-fli ght with T1 and T2-weighted sagittal and axial images. If an aneurysm was demonstrated and early surgery was undertaken they were entered in to the study. RESULTS Over a 25-month period, 122 patients were submit ted for MR studies, these being selected from over 200 patients presen ting with an SAH. Aneurysms were believed to be present in 55 patients who were clinically suitable for early surgery. There were 21 males a nd 34 females, with an age range of 23-79 years, a mean of 50.5 years. Sixty-three aneurysms in all were demonstrated and 55 of these were s urgically dealt with. There were two false positives. CONCLUSION MRI i s the investigation of choice to plan surgery in those patients presen ting with an SAH who, on clinical grounds, would be considered suitabl e for early surgery. The imaging is easily obtained, non-invasive, avo ids radiation, and in view of the multiple images obtained is often su perior to conventional DSA. (C) 1998 by Elsevier Science Inc.