Procjena cerebrovaskularne bolesti magnetskom rezonancijom mozga i magnetskom angiografijom

Magnetic resonance imaging (MRI) is an important imaging technique for evaluation of cerebral ischemic changes. Using magnetic resonance angiography (MRA), both large and medium sized intracranial arteries and veins can be visualized by selecting appropriate imaging parameters. The aim of this retrospective study was to evaluate our own results in the diagnosis of cerebrovascular diseases with MRI and MRA, and to compare them with literature data. Data on 278 patients with cerebrovascular symptomatology (158 female and 120 male, mean age 45-54 years), examined between April 2001 and November 2002, were analyzed. MRA was performed in all 278 and both MRA and MRI in 231 patients. On MRA, 90 pathologic alterations of intracranial arteries (69 aneurysms and 21 vascular malformations), 13Rintracranial arterial occlusions, 19 intracranial arterial stenoses, and 14 cases of intracranial arteriosclerotic changes were identified. On MRI, 114 strokes (73 brain infarctions, 22 cerebral hemorrhages and 19 sub-arachnoid hemorrhages), 14 vascular malformations and 14 cases of small vessel disease were detected. MRI was found to be a powerful tool to detect ischemic lesions immediately upon stroke onset. MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries. For cerebral venous and sinus thrombosis, MRI and MRA are first line studies. MRA of extracranial and intracranial vessels alone or in combination with transcranial color-coded duplex sonography (TCCD) as well as computed tomography angiography (CTA) may eliminate the need of intra-arterial digital subtraction angiography (DSA) in most patients studied for occlusive cerebrovascular disease. DSA may be reserved for those patients in whom there is a disagreement among the results obtained by use of noninvasive techniques, and for the diagnosis of arteriovenous malformations, whereas MRA can prove useful on follow-up examinations.Magnetska rezonancija (MR) mozga je važna tehnika prikazivanja u procjeni ishemijskih promjena moždanoga parenhima. Magnetskom angiografijom (MRA) se birajući odgovarajuće parametre prikaza mogu pokazati i velike i male intrakranijske arterije i vene. Cilj ove retrospektivne studije bila je procjena vlastitih rezultata u dijagnostici cerebrovaskularnih bolesti pomoću MR mozga i MRA, te njihova usporedba s literaturnim podacima. Analizirani su podaci 278 bolesnika (158 žena i 120 muškaraca srednje životne dobi od 45,54 godine), koji su bili pregledani u razdoblju od travnja 2001. do studenoga 2002. Učinjeno je 278 postupaka MRA, a u 231 bolesnika učinjena je i MR mozga. MRA je otkrila 88 patološki promijenjenih intrakranijskih krvnih žila (69 aneurizma i 21 vaskularnu malformaciju), 13 okluzija intrakranijskih arterija, 19 stenoza intrakranijskih arterija, te 14 slučajeva arteriosklerotskih promjena intrakranijskih arterija. MR mozga otkrila je 114 cerebrovaskularnih inzulta (73 cerebralne ishemije, 22 intracerebralne hemoragije i 19 subarahnoidnih hemoragija), 14 vaskularnih malformacija, te 14 slučajeva "patologije malih krvnih žila". MR mozga je moćno sredstvo u otkrivanju ishemijskih promjena neposredno nakon nastupa moždanog inzulta. RMRA ima visoku osjetljivost za otkrivanje okluzivne bolesti velikih intrakranijskih arterija. MR mozga i MRA su osnovne pretrage za dijagnozu tromboze moždanih vena i sinusa. Samo se pomoću MRA ekstrakranijskih i intrakranijskih krvnih žila ili u kombinaciji s obojenom dupleks sonografijom krvnih žila glave i vrata (TCCD) te kompjutoriziranom tomografijskom angiografijom (CTA) može isključiti potreba za intraarterijskom digitalnom subtrakcijskom angiografijom (DSA) u većine bolesnika pregledanih zbog okluzivne cerebrovaskularne bolesti. DSA može biti rezervirana za one bolesnike kod kojih postoji neslaganje između nalaza neinvazivnih metoda pregleda, te za dijagnozu arteriovenskih malformacija, dok se MRA može rabiti za daljnje praćenje

Vrijednost CT-a mozga u hitnoj službi: retrospektivna analiza

The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist\u27s assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist\u27s assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient\u27s state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm.Cilj ove studije bila je evaluacija i radiološko-klinička korelacija CT pretraga mozga u hitnoj službi. Tijekom dvogodišnjeg razdoblja (1. siječnja 2001. - 31. prosinca 2002.) analiziran je odnos hitnih i sveukupnih CT pretraga. Posebno su obrađeni hitni CT pregledi mozga prema kliničkim indikacijama, zastupljenosti pojedinih kliničkih struka i potrebi anesteziološke asistencije. CT nalazi su korelirani s kliničkim upitima i dijagnozama, te uspoređeni s literaturnim podacima. Tijekom 24 mjeseca na Kliničkom zavodu su izvedene 15.933 CT pretrage, od čega 3132 (19,66%) u hitnoj službi (1757 muškaraca i 1375 žena srednje dobi od 56,97 godina). Čak 2576 (82,25%) svih hitnih CT pretraga bile su hitne CT pretrage mozga (1398 muškaraca i 1178 žena srednje dobi od 57,80 godina). Raspoređenost hitnih CT pretraga mozga prema klinikama bila je slijedeća: neurologija 1441 (55,94%), neurokirurgija 632 (24,53%), interna medicina 186 (7,22%), kirurgija 138 (5,36%), ostale klinike 150 (5,82%) i vanjske ustanove 29 (1,13%). Kliničke indikacije za hitnu CT pretragu mozga bile su slijedeće: moždani udar 905 (35,13%), subarahnoidno krvarenje 128 (4,97%), trauma glave 617 (23,95%), poremećaj svijesti i konvulzije 389 (15,10%), intrakranijska ekspanzija 234 (9,08%), glavobolja i/ili vrtoglavica 141 (5,47%), cerebrovaskularna insuficijencija 50 (1,94%), infekcija 46 (1,79%), hidrocefalus 12 (0,47%), metabolične promjene 2 (0,08%) i nedostupni podaci u vrijeme studije 52 (2,02%). Anesteziološka asistencija pri hitnom CT pregledu mozga bila je potrebna u 234 (9,08%) slučaja. Korelacija CT nalaza s kliničkom dijagnozom (kliničkim upitom) pokazala je kako je 96 (3,73%) podataka bilo nedostupno u vrijeme studije, dok je od 2480 preostalih nalaza hitnih CT pregleda mozga bilo 639 (25,77%) normalnih i 1841 (74,23%) patoloških. Provedena je i usporedba s podacima iz literature. Zaključeno je kako je velik broj hitnih CT pretraga mozga s tendencijom stalnog porasta (cerebrovaskularne bolesti, novi terapijski pristupi, trauma glave). Otežano izvođenje pretrage zbog teškog stanja bolesnika i osjetljivost hitne interpretacije nalaza nameću potrebu veće dostupnosti neuroradiologa uz pridržavanje algoritma pretraga u hitnim stanjima

Vrijednost CT-a mozga u hitnoj službi: retrospektivna analiza

The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist\u27s assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist\u27s assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient\u27s state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm.Cilj ove studije bila je evaluacija i radiološko-klinička korelacija CT pretraga mozga u hitnoj službi. Tijekom dvogodišnjeg razdoblja (1. siječnja 2001. - 31. prosinca 2002.) analiziran je odnos hitnih i sveukupnih CT pretraga. Posebno su obrađeni hitni CT pregledi mozga prema kliničkim indikacijama, zastupljenosti pojedinih kliničkih struka i potrebi anesteziološke asistencije. CT nalazi su korelirani s kliničkim upitima i dijagnozama, te uspoređeni s literaturnim podacima. Tijekom 24 mjeseca na Kliničkom zavodu su izvedene 15.933 CT pretrage, od čega 3132 (19,66%) u hitnoj službi (1757 muškaraca i 1375 žena srednje dobi od 56,97 godina). Čak 2576 (82,25%) svih hitnih CT pretraga bile su hitne CT pretrage mozga (1398 muškaraca i 1178 žena srednje dobi od 57,80 godina). Raspoređenost hitnih CT pretraga mozga prema klinikama bila je slijedeća: neurologija 1441 (55,94%), neurokirurgija 632 (24,53%), interna medicina 186 (7,22%), kirurgija 138 (5,36%), ostale klinike 150 (5,82%) i vanjske ustanove 29 (1,13%). Kliničke indikacije za hitnu CT pretragu mozga bile su slijedeće: moždani udar 905 (35,13%), subarahnoidno krvarenje 128 (4,97%), trauma glave 617 (23,95%), poremećaj svijesti i konvulzije 389 (15,10%), intrakranijska ekspanzija 234 (9,08%), glavobolja i/ili vrtoglavica 141 (5,47%), cerebrovaskularna insuficijencija 50 (1,94%), infekcija 46 (1,79%), hidrocefalus 12 (0,47%), metabolične promjene 2 (0,08%) i nedostupni podaci u vrijeme studije 52 (2,02%). Anesteziološka asistencija pri hitnom CT pregledu mozga bila je potrebna u 234 (9,08%) slučaja. Korelacija CT nalaza s kliničkom dijagnozom (kliničkim upitom) pokazala je kako je 96 (3,73%) podataka bilo nedostupno u vrijeme studije, dok je od 2480 preostalih nalaza hitnih CT pregleda mozga bilo 639 (25,77%) normalnih i 1841 (74,23%) patoloških. Provedena je i usporedba s podacima iz literature. Zaključeno je kako je velik broj hitnih CT pretraga mozga s tendencijom stalnog porasta (cerebrovaskularne bolesti, novi terapijski pristupi, trauma glave). Otežano izvođenje pretrage zbog teškog stanja bolesnika i osjetljivost hitne interpretacije nalaza nameću potrebu veće dostupnosti neuroradiologa uz pridržavanje algoritma pretraga u hitnim stanjima

Dural MALT lymphoma with disseminated disease

Central nervous system (CNS) lymphoma involving the dura mater is very rare and histologically is usually a subtype of non-Hodgkin's lymphoma (NHL) termed mucosa-associated lymphoid tissue (MALT) lymphoma. We present a case of a 46-year old woman with dural MALT lymphoma that was found to also involve a lacrimal gland, inguinal lymph nodes, and bone marrow. Magnetic resonance imaging of the brain showed an extra-axial enhancing mass approximately 6 cm in maximum diameter along the right frontotemporal convexity. Histopathology of the resected dural mass showed MALT lymphoma expressing CD20, CD52, CD19, and CD38. Molecular studies of the B-cell receptor heavy chain demonstrated monoclonality at the involved sites. The patient was treated with four cycles of fludarabine, mitoxantrone, and rituximab with complete remission. She had recurrence in the subcutaneous tissue of the back at 12 months but has remained free of intracranial disease for 31 months. A review of the literature reveals 57 cases of dural MALT lymphoma. Only 4 had extra-CNS involvement at presentation, and only 3 had local recurrence of the dural tumor. Because of the indolent behavior of this tumor, the intracranial portion can be treated conservatively after resection with or without chemotherapy. Deferral of brain radiation can be considered with close clinical and neuroimaging follow up

Magnetic Resonance in Diagnostic Evaluation of Cerebral Aneurysms

Metode U prvom dijelu istraživanja je 59 uzastopnih bolesnika s akutnim subarahnoidnim krvarenjem (SAH) usporedno pregledano ciljanom angiografijom magnetskom rezonancom (MRA) i intraarterijskom digitalnom suptrakcijskom angiografijom (IA-DSA). Rezultati obje dijagnostičke metode u detekciji i evaluaciji aneurizmi uspoređene su s intraoperativnim kirurškim nalazom kao zlatnim standardom u 53 bolesnika (6 ispitanika je isključeno iz studije zbog nedostatka intraoperativne potvrde nalaza). MRA pretrage su vršene bez primjene paramagnetnog kontrastnog sredstva. U drugom dijelu istraživanja su analizirana 94 uzastopna bolesnika s cerebralnim aneurizmama, liječena endovaskularnom embolizacijom zavojnicama, bez otvorenog kirurškog zahvata. U prvih 39 bolesnika sa 49 aneurizmi uspješnost liječenja je evaluirana kontrolnim pregledima ciljanom MRA i IA-DSA, 6 mjeseci nakon embolizacije. U preostalih 49 bolesnika kontrolni pregled je obavljen samo ciljanom MRA (6 ispitanika je isključeno zbog izrazitih artefakata na MRA snimkama, uglavnom zbog nemira). Sve MRA pretrage drugog dijela istraživanja su uključivale i primjenu kontrastnog sredstva. ----- Rezultati U prvom dijelu istraživanja su intraoperativno utvrđene 44 cerebralne aneurizme u 39 bolesnika. Osjetljivost otkrivanja tih promjena je bila jednaka za obje dijagnostičke metode i iznosila 97,7%. Specifičnost je također bila jednaka, iznoseći 100%. Nisu nađene značajne razlike između dvije dijagnostičke metode u procjeni veličine, oblika ili vrata aneurizme, kao ni u određivanju arterije s koje aneurizma polazi. U drugom dijelu istraživanja analizirano je ukupno 108 aneurizmi. U prvih 49 je rezidualni protok unutar liječenih aneurizmi utvrđen u 36 (73,5%) MRA pregledom, a u 25 (51,0%) IA-DSA tehnikom. Rezidualni protok na MRA snimkama je kod svih aneurizmi bio jednak ili veći u usporedbi s IA-DSA. Primjena kontrastnog sredstva je pomogla u evaluaciji 7 aneurizmi (6,5%), dok je, uslijed venske kontaminacije, ometala analizu snimaka za njih 20 (18,5%). Korist kontrastnog sredstva je bila znatno češća (14,3%) u aneurizama prednje cerebralne cirkulacije veličine 5-10mm, no i u toj skupini je učestalost venske kontaminacije bila još veća (16,7%). Nije bilo statistički značajne razlike uspoređujući neovisno različite veličine i lokacije aneurizmi. Dodatna dijagnostička informacija postkontrastne MRA je bila minimalna i ni u jednom od 7 slučajeva nije utjecala na daljnje liječenje. ----- Zaključci 1) Ciljana MRA je usporediva s IA-DSA u procjeni moždanih aneurizmi. 2) Za praćenje moždanih aneurizama liječenih endovaskularnom embolizacijom pouzdanija je neinvazivna, ciljana MRA nego invazivna IA-DSA. 3) Primjena kontrastnog sredstva ne doprinosi dijagnostičkoj pouzdanosti MRA kod emboliziranih aneurizmi, uz moguće lažno pozitivne nalaze.Methods In the first part, 59 consecutive patients with acute subarachnoid hemorrhage were examined with targeted magnetic resonance angiography (MRA) and intra-arterial digital substraction angiography (IA-DSA). The results of both modalities in aneurysm detection and evaluation were compared to surgical findings in 53 patients. The second part included 94 consecutive patients with cerebral aneurysms treated by coil embolization. The first 39 patients harboring 49 aneurysms were evaluated by both targeted MRA and IA-DSA 6 months after embolization. For 49 patients the follow-up imaging was performed by MRA only. All MRA studies were performed without and with contrast media. -----Results In the first part there were 44 cerebral aneurysms in 39 patients. The sensitivity was the same for both diagnostic modalities at 97,7%. The specificity was also the same at 100%. No significant differences between the modalities were found for aneurysm size, shape or neck estimates, nor for the parent artery determination. In the second part 108 aneurysms were analyzed. In 49 residual flow within the treated aneurysms was detected in 36 (73,5%) on MRA, and in 25 (51,0%) by IA-DSA. The size of the residual aneurysm on MRA was the same or larger compared to IA-DSA for all aneurysms. Contrast agent helped in evaluation of 7 aneurysms (6,5%), while it made it more difficult due to venous contamination for 20 aneurysms (18,5%). The additional diagnostic information from postcontrast MRA did not affect patient management in any of the 7 cases. ----- Conclusions 1) Targeted MRA is comparable with IA-DSA for evaluation of cerebral aneurysms. 2) In follow-up of cerebral aneurysms treated with endovascular embolization targeted MRA is more accurate than IA-DSA. 3) Contrast agent administration does not contribute to diagnostic accuracy of MRA for embolized aneurysms

Magnetic Resonance in Diagnostic Evaluation of Cerebral Aneurysms

Metode U prvom dijelu istraživanja je 59 uzastopnih bolesnika s akutnim subarahnoidnim krvarenjem (SAH) usporedno pregledano ciljanom angiografijom magnetskom rezonancom (MRA) i intraarterijskom digitalnom suptrakcijskom angiografijom (IA-DSA). Rezultati obje dijagnostičke metode u detekciji i evaluaciji aneurizmi uspoređene su s intraoperativnim kirurškim nalazom kao zlatnim standardom u 53 bolesnika (6 ispitanika je isključeno iz studije zbog nedostatka intraoperativne potvrde nalaza). MRA pretrage su vršene bez primjene paramagnetnog kontrastnog sredstva. U drugom dijelu istraživanja su analizirana 94 uzastopna bolesnika s cerebralnim aneurizmama, liječena endovaskularnom embolizacijom zavojnicama, bez otvorenog kirurškog zahvata. U prvih 39 bolesnika sa 49 aneurizmi uspješnost liječenja je evaluirana kontrolnim pregledima ciljanom MRA i IA-DSA, 6 mjeseci nakon embolizacije. U preostalih 49 bolesnika kontrolni pregled je obavljen samo ciljanom MRA (6 ispitanika je isključeno zbog izrazitih artefakata na MRA snimkama, uglavnom zbog nemira). Sve MRA pretrage drugog dijela istraživanja su uključivale i primjenu kontrastnog sredstva. ----- Rezultati U prvom dijelu istraživanja su intraoperativno utvrđene 44 cerebralne aneurizme u 39 bolesnika. Osjetljivost otkrivanja tih promjena je bila jednaka za obje dijagnostičke metode i iznosila 97,7%. Specifičnost je također bila jednaka, iznoseći 100%. Nisu nađene značajne razlike između dvije dijagnostičke metode u procjeni veličine, oblika ili vrata aneurizme, kao ni u određivanju arterije s koje aneurizma polazi. U drugom dijelu istraživanja analizirano je ukupno 108 aneurizmi. U prvih 49 je rezidualni protok unutar liječenih aneurizmi utvrđen u 36 (73,5%) MRA pregledom, a u 25 (51,0%) IA-DSA tehnikom. Rezidualni protok na MRA snimkama je kod svih aneurizmi bio jednak ili veći u usporedbi s IA-DSA. Primjena kontrastnog sredstva je pomogla u evaluaciji 7 aneurizmi (6,5%), dok je, uslijed venske kontaminacije, ometala analizu snimaka za njih 20 (18,5%). Korist kontrastnog sredstva je bila znatno češća (14,3%) u aneurizama prednje cerebralne cirkulacije veličine 5-10mm, no i u toj skupini je učestalost venske kontaminacije bila još veća (16,7%). Nije bilo statistički značajne razlike uspoređujući neovisno različite veličine i lokacije aneurizmi. Dodatna dijagnostička informacija postkontrastne MRA je bila minimalna i ni u jednom od 7 slučajeva nije utjecala na daljnje liječenje. ----- Zaključci 1) Ciljana MRA je usporediva s IA-DSA u procjeni moždanih aneurizmi. 2) Za praćenje moždanih aneurizama liječenih endovaskularnom embolizacijom pouzdanija je neinvazivna, ciljana MRA nego invazivna IA-DSA. 3) Primjena kontrastnog sredstva ne doprinosi dijagnostičkoj pouzdanosti MRA kod emboliziranih aneurizmi, uz moguće lažno pozitivne nalaze.Methods In the first part, 59 consecutive patients with acute subarachnoid hemorrhage were examined with targeted magnetic resonance angiography (MRA) and intra-arterial digital substraction angiography (IA-DSA). The results of both modalities in aneurysm detection and evaluation were compared to surgical findings in 53 patients. The second part included 94 consecutive patients with cerebral aneurysms treated by coil embolization. The first 39 patients harboring 49 aneurysms were evaluated by both targeted MRA and IA-DSA 6 months after embolization. For 49 patients the follow-up imaging was performed by MRA only. All MRA studies were performed without and with contrast media. -----Results In the first part there were 44 cerebral aneurysms in 39 patients. The sensitivity was the same for both diagnostic modalities at 97,7%. The specificity was also the same at 100%. No significant differences between the modalities were found for aneurysm size, shape or neck estimates, nor for the parent artery determination. In the second part 108 aneurysms were analyzed. In 49 residual flow within the treated aneurysms was detected in 36 (73,5%) on MRA, and in 25 (51,0%) by IA-DSA. The size of the residual aneurysm on MRA was the same or larger compared to IA-DSA for all aneurysms. Contrast agent helped in evaluation of 7 aneurysms (6,5%), while it made it more difficult due to venous contamination for 20 aneurysms (18,5%). The additional diagnostic information from postcontrast MRA did not affect patient management in any of the 7 cases. ----- Conclusions 1) Targeted MRA is comparable with IA-DSA for evaluation of cerebral aneurysms. 2) In follow-up of cerebral aneurysms treated with endovascular embolization targeted MRA is more accurate than IA-DSA. 3) Contrast agent administration does not contribute to diagnostic accuracy of MRA for embolized aneurysms

Magnetska rezonanca u dijagnostici cerebralnih aneurizmi [Magnetic Resonance in Diagnostic Evaluation of Cerebral Aneurysms]

Methods In the first part, 59 consecutive patients with acute subarachnoid hemorrhage were examined with targeted magnetic resonance angiography (MRA) and intra-arterial digital substraction angiography (IA-DSA). The results of both modalities in aneurysm detection and evaluation were compared to surgical findings in 53 patients. The second part included 94 consecutive patients with cerebral aneurysms treated by coil embolization. The first 39 patients harboring 49 aneurysms were evaluated by both targeted MRA and IA-DSA 6 months after embolization. For 49 patients the follow-up imaging was performed by MRA only. All MRA studies were performed without and with contrast media. -----Results In the first part there were 44 cerebral aneurysms in 39 patients. The sensitivity was the same for both diagnostic modalities at 97,7%. The specificity was also the same at 100%. No significant differences between the modalities were found for aneurysm size, shape or neck estimates, nor for the parent artery determination. In the second part 108 aneurysms were analyzed. In 49 residual flow within the treated aneurysms was detected in 36 (73,5%) on MRA, and in 25 (51,0%) by IA-DSA. The size of the residual aneurysm on MRA was the same or larger compared to IA-DSA for all aneurysms. Contrast agent helped in evaluation of 7 aneurysms (6,5%), while it made it more difficult due to venous contamination for 20 aneurysms (18,5%). The additional diagnostic information from postcontrast MRA did not affect patient management in any of the 7 cases. ----- Conclusions 1) Targeted MRA is comparable with IA-DSA for evaluation of cerebral aneurysms. 2) In follow-up of cerebral aneurysms treated with endovascular embolization targeted MRA is more accurate than IA-DSA. 3) Contrast agent administration does not contribute to diagnostic accuracy of MRA for embolized aneurysms

Magnetic Resonance in Diagnostic Evaluation of Cerebral Aneurysms

Metode U prvom dijelu istraživanja je 59 uzastopnih bolesnika s akutnim subarahnoidnim krvarenjem (SAH) usporedno pregledano ciljanom angiografijom magnetskom rezonancom (MRA) i intraarterijskom digitalnom suptrakcijskom angiografijom (IA-DSA). Rezultati obje dijagnostičke metode u detekciji i evaluaciji aneurizmi uspoređene su s intraoperativnim kirurškim nalazom kao zlatnim standardom u 53 bolesnika (6 ispitanika je isključeno iz studije zbog nedostatka intraoperativne potvrde nalaza). MRA pretrage su vršene bez primjene paramagnetnog kontrastnog sredstva. U drugom dijelu istraživanja su analizirana 94 uzastopna bolesnika s cerebralnim aneurizmama, liječena endovaskularnom embolizacijom zavojnicama, bez otvorenog kirurškog zahvata. U prvih 39 bolesnika sa 49 aneurizmi uspješnost liječenja je evaluirana kontrolnim pregledima ciljanom MRA i IA-DSA, 6 mjeseci nakon embolizacije. U preostalih 49 bolesnika kontrolni pregled je obavljen samo ciljanom MRA (6 ispitanika je isključeno zbog izrazitih artefakata na MRA snimkama, uglavnom zbog nemira). Sve MRA pretrage drugog dijela istraživanja su uključivale i primjenu kontrastnog sredstva. ----- Rezultati U prvom dijelu istraživanja su intraoperativno utvrđene 44 cerebralne aneurizme u 39 bolesnika. Osjetljivost otkrivanja tih promjena je bila jednaka za obje dijagnostičke metode i iznosila 97,7%. Specifičnost je također bila jednaka, iznoseći 100%. Nisu nađene značajne razlike između dvije dijagnostičke metode u procjeni veličine, oblika ili vrata aneurizme, kao ni u određivanju arterije s koje aneurizma polazi. U drugom dijelu istraživanja analizirano je ukupno 108 aneurizmi. U prvih 49 je rezidualni protok unutar liječenih aneurizmi utvrđen u 36 (73,5%) MRA pregledom, a u 25 (51,0%) IA-DSA tehnikom. Rezidualni protok na MRA snimkama je kod svih aneurizmi bio jednak ili veći u usporedbi s IA-DSA. Primjena kontrastnog sredstva je pomogla u evaluaciji 7 aneurizmi (6,5%), dok je, uslijed venske kontaminacije, ometala analizu snimaka za njih 20 (18,5%). Korist kontrastnog sredstva je bila znatno češća (14,3%) u aneurizama prednje cerebralne cirkulacije veličine 5-10mm, no i u toj skupini je učestalost venske kontaminacije bila još veća (16,7%). Nije bilo statistički značajne razlike uspoređujući neovisno različite veličine i lokacije aneurizmi. Dodatna dijagnostička informacija postkontrastne MRA je bila minimalna i ni u jednom od 7 slučajeva nije utjecala na daljnje liječenje. ----- Zaključci 1) Ciljana MRA je usporediva s IA-DSA u procjeni moždanih aneurizmi. 2) Za praćenje moždanih aneurizama liječenih endovaskularnom embolizacijom pouzdanija je neinvazivna, ciljana MRA nego invazivna IA-DSA. 3) Primjena kontrastnog sredstva ne doprinosi dijagnostičkoj pouzdanosti MRA kod emboliziranih aneurizmi, uz moguće lažno pozitivne nalaze.Methods In the first part, 59 consecutive patients with acute subarachnoid hemorrhage were examined with targeted magnetic resonance angiography (MRA) and intra-arterial digital substraction angiography (IA-DSA). The results of both modalities in aneurysm detection and evaluation were compared to surgical findings in 53 patients. The second part included 94 consecutive patients with cerebral aneurysms treated by coil embolization. The first 39 patients harboring 49 aneurysms were evaluated by both targeted MRA and IA-DSA 6 months after embolization. For 49 patients the follow-up imaging was performed by MRA only. All MRA studies were performed without and with contrast media. -----Results In the first part there were 44 cerebral aneurysms in 39 patients. The sensitivity was the same for both diagnostic modalities at 97,7%. The specificity was also the same at 100%. No significant differences between the modalities were found for aneurysm size, shape or neck estimates, nor for the parent artery determination. In the second part 108 aneurysms were analyzed. In 49 residual flow within the treated aneurysms was detected in 36 (73,5%) on MRA, and in 25 (51,0%) by IA-DSA. The size of the residual aneurysm on MRA was the same or larger compared to IA-DSA for all aneurysms. Contrast agent helped in evaluation of 7 aneurysms (6,5%), while it made it more difficult due to venous contamination for 20 aneurysms (18,5%). The additional diagnostic information from postcontrast MRA did not affect patient management in any of the 7 cases. ----- Conclusions 1) Targeted MRA is comparable with IA-DSA for evaluation of cerebral aneurysms. 2) In follow-up of cerebral aneurysms treated with endovascular embolization targeted MRA is more accurate than IA-DSA. 3) Contrast agent administration does not contribute to diagnostic accuracy of MRA for embolized aneurysms