Burchell, Amy E.

Hamilton, Mark

Hart, Emma C.

Hassan, Neelam

Manghat, Nathan E.

Nightingale, Angus K.

Paton, Julian F.

Ratcliffe, Laura E.

Rodrigues, Jonathan C.

Williams, Mandy

Journal of Cardiovascular Magnetic Resonance

PubMed

Jonathan C Rodrigues

Neelam Hassan

Mandy Williams

Amy E Burchell

Laura E Ratcliffe

Mark Hamilton

Emma C Hart

Angus K Nightingale

Julian F Paton

Nathan E Manghat

Springer - Publisher Connector

Should we screen for intracranial aneurysms (IAs) in systemic hypertension at the time of cardiac magnetic resonance (CMR)?

Explore Bristol Research

Rodrigues, J. C., Hassan, N., Williams, M., Burchell, A. E., Ratcliffe, L.E., Hamilton, M., Hart, E. C., Nightingale, A. K., Paton, J. F., &Manghat, N. E. (2015). Should we screen for intracranial aneurysms(IAs) in systemic hypertension at the time of cardiac magneticresonance (CMR)? Journal of Cardiovascular Magnetic Resonance,17(1), 1-2. Article P411. https://doi.org/10.1186/1532-429X-17-S1-P411Publisher's PDF, also known as Version of recordLicense (if available):CC BYLink to published version (if available):10.1186/1532-429X-17-S1-P411Link to publication record on the Bristol Research PortalPDF-documentThis is the final published version of the article (version of record). It first appeared online via BioMed Central at10.1186/1532-429X-17-S1-P411.University of Bristol – Bristol Research PortalGeneral rightsThis document is made available in accordance with publisher policies. Please cite only thepublished version using the reference above. Full terms of use are available:http://www.bristol.ac.uk/red/research-policy/pure/user-guides/brp-terms/POSTER PRESENTATION Open AccessShould we screen for intracranial aneurysms (IAs)in systemic hypertension at the time of cardiacmagnetic resonance (CMR)?Jonathan C Rodrigues1,2*, Neelam Hassan3, Mandy Williams4, Amy E Burchell5, Laura E Ratcliffe5, Mark Hamilton1,Emma C Hart5,2, Angus K Nightingale5, Julian F Paton5,2, Nathan E Manghat1From 18th Annual SCMR Scientific SessionsNice, France. 4-7 February 2015BackgroundIAs are detected in 2.3% of adults. Systemic hyperten-sion is a risk factor. Screening for IA in certain high-risk groups, such as patients with coarctation of theaorta, has been discussed in international guidelines.Patients with coarctation often have concomitant sys-temic hypertension. Moreover, the prevalence of hyper-tension in patients with coarctation and IA issignificantly higher than those without IA. It is uncer-tain whether hypertension alone represents a sufficientrisk factor to prompt screening for IAs.MethodsConsecutive patients referred from our tertiary hyperten-sion clinic underwent comprehensive magnetic resonanceassessment including CMR and 3D time-of-flight MRAimaging at 1.5T. The study was conducted in accordancewith The Governance Arrangements for Research EthicsCommittees. Cerebral MRAs were double reported by ablinded Neuroradiologist. Demographic data, includingpresentation office systolic (SBP) and diastolic blood pres-sures (DBP), aneurysm data and CMR-derived left ventri-cular mass (LVM) indexed to body surface area, age andgender were recorded. Continuous variables were com-pared by Student t tests and categoric variables by Fisherexact test (p<0.05 = significant).ResultsOne hundred and twenty one (n=121) MRAs wereincluded (52% male, mean age 52±14.6 years). IAs weredetected in 10 patients (8.2%) (table 1), significantlymore than expected in the general population on thebasis of 2% prevalence (p<0.05) and similar to the coarc-tation population (10.3%). Mean aneurysm size was2.1±0.7mm (range 1-4mm). Subgroup analysis demon-strated no significant differences between those withoutIA (n = 111) and those with IA (n=10) by age (52.0±14.2 vs 52.3±19.7 years, p=0.9463) or gender (53% vs40% male, p=0.5176). No difference in prevalence ofhypertension subtype demonstrated between those with-out IA and those with IA (resistant: 45% vs 30%, p =0.5103, difficult to treat: 12.6% vs 20%, p=0.3369, drugintolerant: 14.4% vs 30%, p=0.1913, young-onset: 18.9%vs 10%, p=0.6874, medication-controlled: 9% vs 10%,p=0.999). Inferred hypertension severity and chronicitywas similar between those without IA and with IA (SBP:171.9±28.6 vs 158.8±35.5 mmHg, p=0.1768, DBP:97.7±14.9 vs 91.4±16.8 mmHg, p=0.2066 and indexedLV mass: 88.2±24.8 vs 87.6±25.5 g.m-2 p=0.9375, num-ber of antihypertensive medications: 3.0±2.0 vs 2.6±1.6p=0.5015).ConclusionsThe prevalence of IA in this cohort is significantly higherthan the general population. Subgroup analysis failed toidentify particularly high-risk groups within the hyper-tension cohort studied. All aneurysms detected weresmall and managed conservatively, consequently the clin-ical benefit of routine screening for IAs at the time ofCMR in hypertensive patients remains unanswered.FundingNIHR Cardiovascular Biomedical Research Unit, BristolHeart Institute.1CMR Unit, NIHR Cardiovascular Biomedical Research Unit, Bristol HeartInstitute, Bristol, UKFull list of author information is available at the end of the articleRodrigues et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P411http://www.jcmr-online.com/content/17/S1/P411© 2015 Rodrigues et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.JCLR: Clinical Society of Bath Postgraduate ResearchBursary.ECH: BHF grant IBSRF FS/11/1/28400.Authors’ details1CMR Unit, NIHR Cardiovascular Biomedical Research Unit, Bristol HeartInstitute, Bristol, UK. 2School of Physiology and Pharmacology, The Universityof Bristol, Bristol, UK. 3Foundation School, Severn Postgraduate Deanery,Bristol, UK. 4Department of Radiology, Bristol Royal Infirmary, Bristol, UK.5Cardionomics Research Group, Bristol Heart Institute, Bristol, UK.Published: 3 February 2015doi:10.1186/1532-429X-17-S1-P411Cite this article as: Rodrigues et al.: Should we screen for intracranialaneurysms (IAs) in systemic hypertension at the time of cardiacmagnetic resonance (CMR)? Journal of Cardiovascular Magnetic Resonance2015 17(Suppl 1):P411.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitTable 1 Details of aneurysm and patient demographics.Site of aneurysm Size (mm) Genger Age (years)Right MCA 1-2 Male 47Right ICA bifurcation 2 Female 52Right ACA 2 Male 58Left PCom 2 Female 74Right distal ICA 4 Female 81Basilar tip 2 Female 45Left MCA 2 Female 75Left MCA 2 Male 39Right SCA 2 Male 26Basilar tip 2 Female 26MCA = middle cerebral artery, ICA = internal carotid artery, ACA = anteriorcommunicating artery, PCom = posterior communicating artery, SCA =superior cerebellar artery, PCA = posterior cerebellar.Rodrigues et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P411http://www.jcmr-online.com/content/17/S1/P411Page 2 of 2

English

POSTER PRESENTATION Open Access
Should we screen for intracranial aneurysms (IAs)
in systemic hypertension at the time of cardiac
magnetic resonance (CMR)?
Jonathan C Rodrigues1,2*, Neelam Hassan3, Mandy Williams4, Amy E Burchell5, Laura E Ratcliffe5, Mark Hamilton1,
Emma C Hart5,2, Angus K Nightingale5, Julian F Paton5,2, Nathan E Manghat1
From 18th Annual SCMR Scientific Sessions
Nice, France. 4-7 February 2015
Background
IAs are detected in 2.3% of adults. Systemic hyperten-
sion is a risk factor. Screening for IA in certain high-
risk groups, such as patients with coarctation of the
aorta, has been discussed in international guidelines.
Patients with coarctation often have concomitant sys-
temic hypertension. Moreover, the prevalence of hyper-
tension in patients with coarctation and IA is
significantly higher than those without IA. It is uncer-
tain whether hypertension alone represents a sufficient
risk factor to prompt screening for IAs.
Methods
Consecutive patients referred from our tertiary hyperten-
sion clinic underwent comprehensive magnetic resonance
assessment including CMR and 3D time-of-flight MRA
imaging at 1.5T. The study was conducted in accordance
with The Governance Arrangements for Research Ethics
Committees. Cerebral MRAs were double reported by a
blinded Neuroradiologist. Demographic data, including
presentation office systolic (SBP) and diastolic blood pres-
sures (DBP), aneurysm data and CMR-derived left ventri-
cular mass (LVM) indexed to body surface area, age and
gender were recorded. Continuous variables were com-
pared by Student t tests and categoric variables by Fisher
exact test (p<0.05 = significant).
Results
One hundred and twenty one (n=121) MRAs were
included (52% male, mean age 52±14.6 years). IAs were
detected in 10 patients (8.2%) (table 1), significantly
more than expected in the general population on the
basis of 2% prevalence (p<0.05) and similar to the coarc-
tation population (10.3%). Mean aneurysm size was
2.1±0.7mm (range 1-4mm). Subgroup analysis demon-
strated no significant differences between those without
IA (n = 111) and those with IA (n=10) by age (52.0
±14.2 vs 52.3±19.7 years, p=0.9463) or gender (53% vs
40% male, p=0.5176). No difference in prevalence of
hypertension subtype demonstrated between those with-
out IA and those with IA (resistant: 45% vs 30%, p =
0.5103, difficult to treat: 12.6% vs 20%, p=0.3369, drug
intolerant: 14.4% vs 30%, p=0.1913, young-onset: 18.9%
vs 10%, p=0.6874, medication-controlled: 9% vs 10%,
p=0.999). Inferred hypertension severity and chronicity
was similar between those without IA and with IA (SBP:
171.9±28.6 vs 158.8±35.5 mmHg, p=0.1768, DBP:
97.7±14.9 vs 91.4±16.8 mmHg, p=0.2066 and indexed
LV mass: 88.2±24.8 vs 87.6±25.5 g.m-2 p=0.9375, num-
ber of antihypertensive medications: 3.0±2.0 vs 2.6±1.6
p=0.5015).
Conclusions
The prevalence of IA in this cohort is significantly higher
than the general population. Subgroup analysis failed to
identify particularly high-risk groups within the hyper-
tension cohort studied. All aneurysms detected were
small and managed conservatively, consequently the clin-
ical benefit of routine screening for IAs at the time of
CMR in hypertensive patients remains unanswered.
Funding
NIHR Cardiovascular Biomedical Research Unit, Bristol
Heart Institute.
1CMR Unit, NIHR Cardiovascular Biomedical Research Unit, Bristol Heart
Institute, Bristol, UK
Full list of author information is available at the end of the article
Rodrigues et al. Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P411
http://www.jcmr-online.com/content/17/S1/P411
© 2015 Rodrigues et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
JCLR: Clinical Society of Bath Postgraduate Research
Bursary.
ECH: BHF grant IBSRF FS/11/1/28400.
Authors’ details
1CMR Unit, NIHR Cardiovascular Biomedical Research Unit, Bristol Heart
Institute, Bristol, UK. 2School of Physiology and Pharmacology, The University
of Bristol, Bristol, UK. 3Foundation School, Severn Postgraduate Deanery,
Bristol, UK. 4Department of Radiology, Bristol Royal Infirmary, Bristol, UK.
5Cardionomics Research Group, Bristol Heart Institute, Bristol, UK.
Published: 3 February 2015
doi:10.1186/1532-429X-17-S1-P411
Cite this article as: Rodrigues et al.: Should we screen for intracranial
aneurysms (IAs) in systemic hypertension at the time of cardiac
magnetic resonance (CMR)? Journal of Cardiovascular Magnetic Resonance
2015 17(Suppl 1):P411.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Table 1 Details of aneurysm and patient demographics.
Site of aneurysm Size (mm) Genger Age (years)
Right MCA 1-2 Male 47
Right ICA bifurcation 2 Female 52
Right ACA 2 Male 58
Left PCom 2 Female 74
Right distal ICA 4 Female 81
Basilar tip 2 Female 45
Left MCA 2 Female 75
Left MCA 2 Male 39
Right SCA 2 Male 26
Basilar tip 2 Female 26
MCA = middle cerebral artery, ICA = internal carotid artery, ACA = anterior
communicating artery, PCom = posterior communicating artery, SCA =
superior cerebellar artery, PCA = posterior cerebellar.
Rodrigues et al. Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P411
http://www.jcmr-online.com/content/17/S1/P411
Page 2 of 2


Crossref

                          Rodrigues, J. C., Hassan, N., Williams, M., Burchell, A. E., Ratcliffe, L. E.,Hamilton, M., ... Manghat, N. E. (2015). Should we screen for intracranialaneurysms (IAs) in systemic hypertension at the time of cardiac magneticresonance (CMR)? Journal of Cardiovascular Magnetic Resonance, 17(1), 1-2. [P411]. DOI: 10.1186/1532-429X-17-S1-P411Publisher's PDF, also known as Version of recordLicense (if available):CC BYLink to published version (if available):10.1186/1532-429X-17-S1-P411Link to publication record in Explore Bristol ResearchPDF-documentThis is the final published version of the article (version of record). It first appeared online via BioMed Central at10.1186/1532-429X-17-S1-P411.University of Bristol - Explore Bristol ResearchGeneral rightsThis document is made available in accordance with publisher policies. Please cite only the publishedversion using the reference above. Full terms of use are available:http://www.bristol.ac.uk/pure/about/ebr-terms.htmlPOSTER PRESENTATION Open AccessShould we screen for intracranial aneurysms (IAs)in systemic hypertension at the time of cardiacmagnetic resonance (CMR)?Jonathan C Rodrigues1,2*, Neelam Hassan3, Mandy Williams4, Amy E Burchell5, Laura E Ratcliffe5, Mark Hamilton1,Emma C Hart5,2, Angus K Nightingale5, Julian F Paton5,2, Nathan E Manghat1From 18th Annual SCMR Scientific SessionsNice, France. 4-7 February 2015BackgroundIAs are detected in 2.3% of adults. Systemic hyperten-sion is a risk factor. Screening for IA in certain high-risk groups, such as patients with coarctation of theaorta, has been discussed in international guidelines.Patients with coarctation often have concomitant sys-temic hypertension. Moreover, the prevalence of hyper-tension in patients with coarctation and IA issignificantly higher than those without IA. It is uncer-tain whether hypertension alone represents a sufficientrisk factor to prompt screening for IAs.MethodsConsecutive patients referred from our tertiary hyperten-sion clinic underwent comprehensive magnetic resonanceassessment including CMR and 3D time-of-flight MRAimaging at 1.5T. The study was conducted in accordancewith The Governance Arrangements for Research EthicsCommittees. Cerebral MRAs were double reported by ablinded Neuroradiologist. Demographic data, includingpresentation office systolic (SBP) and diastolic blood pres-sures (DBP), aneurysm data and CMR-derived left ventri-cular mass (LVM) indexed to body surface area, age andgender were recorded. Continuous variables were com-pared by Student t tests and categoric variables by Fisherexact test (p<0.05 = significant).ResultsOne hundred and twenty one (n=121) MRAs wereincluded (52% male, mean age 52±14.6 years). IAs weredetected in 10 patients (8.2%) (table 1), significantlymore than expected in the general population on thebasis of 2% prevalence (p<0.05) and similar to the coarc-tation population (10.3%). Mean aneurysm size was2.1±0.7mm (range 1-4mm). Subgroup analysis demon-strated no significant differences between those withoutIA (n = 111) and those with IA (n=10) by age (52.0±14.2 vs 52.3±19.7 years, p=0.9463) or gender (53% vs40% male, p=0.5176). No difference in prevalence ofhypertension subtype demonstrated between those with-out IA and those with IA (resistant: 45% vs 30%, p =0.5103, difficult to treat: 12.6% vs 20%, p=0.3369, drugintolerant: 14.4% vs 30%, p=0.1913, young-onset: 18.9%vs 10%, p=0.6874, medication-controlled: 9% vs 10%,p=0.999). Inferred hypertension severity and chronicitywas similar between those without IA and with IA (SBP:171.9±28.6 vs 158.8±35.5 mmHg, p=0.1768, DBP:97.7±14.9 vs 91.4±16.8 mmHg, p=0.2066 and indexedLV mass: 88.2±24.8 vs 87.6±25.5 g.m-2 p=0.9375, num-ber of antihypertensive medications: 3.0±2.0 vs 2.6±1.6p=0.5015).ConclusionsThe prevalence of IA in this cohort is significantly higherthan the general population. Subgroup analysis failed toidentify particularly high-risk groups within the hyper-tension cohort studied. All aneurysms detected weresmall and managed conservatively, consequently the clin-ical benefit of routine screening for IAs at the time ofCMR in hypertensive patients remains unanswered.FundingNIHR Cardiovascular Biomedical Research Unit, BristolHeart Institute.1CMR Unit, NIHR Cardiovascular Biomedical Research Unit, Bristol HeartInstitute, Bristol, UKFull list of author information is available at the end of the articleRodrigues et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P411http://www.jcmr-online.com/content/17/S1/P411© 2015 Rodrigues et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.JCLR: Clinical Society of Bath Postgraduate ResearchBursary.ECH: BHF grant IBSRF FS/11/1/28400.Authors’ details1CMR Unit, NIHR Cardiovascular Biomedical Research Unit, Bristol HeartInstitute, Bristol, UK. 2School of Physiology and Pharmacology, The Universityof Bristol, Bristol, UK. 3Foundation School, Severn Postgraduate Deanery,Bristol, UK. 4Department of Radiology, Bristol Royal Infirmary, Bristol, UK.5Cardionomics Research Group, Bristol Heart Institute, Bristol, UK.Published: 3 February 2015doi:10.1186/1532-429X-17-S1-P411Cite this article as: Rodrigues et al.: Should we screen for intracranialaneurysms (IAs) in systemic hypertension at the time of cardiacmagnetic resonance (CMR)? Journal of Cardiovascular Magnetic Resonance2015 17(Suppl 1):P411.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitTable 1 Details of aneurysm and patient demographics.Site of aneurysm Size (mm) Genger Age (years)Right MCA 1-2 Male 47Right ICA bifurcation 2 Female 52Right ACA 2 Male 58Left PCom 2 Female 74Right distal ICA 4 Female 81Basilar tip 2 Female 45Left MCA 2 Female 75Left MCA 2 Male 39Right SCA 2 Male 26Basilar tip 2 Female 26MCA = middle cerebral artery, ICA = internal carotid artery, ACA = anteriorcommunicating artery, PCom = posterior communicating artery, SCA =superior cerebellar artery, PCA = posterior cerebellar.Rodrigues et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P411http://www.jcmr-online.com/content/17/S1/P411Page 2 of 2

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Should we screen for intracranial aneurysms (IAs) in systemic hypertension at the time of cardiac magnetic resonance (CMR)?

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