Diagnosis and Treatment of Ruptured Cerebral Aneurysm by 3D-MRA

We evaluated three-dimensional MR angiography (3D-MRA) for the diagnosis and treatment of ruptured cerebral aneurysms. During the past 5 years, 46 patients with subarachnoid hemorrhage (SAH) from cerebral aneurysms were operated on in our hospital. MRI FLAIR image was very useful for the diagnosis of SAH, especially in a subacute stage. Of the 46 patients, 1 patient was examined by conventional angiography due to the past history with non-titanium clip placement after SAH. Three patients were examined both by 3D-MRA and conventional angiography, and 42 patients were studied using 3D-MRA without conventional angiography. Conventional angiography was necessary after 3D-MRA because of the existence of 1 distal anterior cerebral artery aneurysm, 1 distal anterior inferior cerebellar artery aneurysm and 1 thrombosed anterior communicating artery aneurysm. Forty-two aneurysms, including 8 associated unruptured cerebral aneurysms, were visualized by 3D-MRA and verified at surgery. All aneurysms were clipped or wrapped successfully. 3D-MRA is a noninvasive tool that does not require contrast media and has enabled a more accurate diagnosis of cerebral aneurysm by developing three-dimensional image reconstruction. We consider that it will be possible to operate on most ruptured cerebral aneurysms using only 3D-MRA without conventional angiography except for special cases, such as peripheral aneurysm, dissecting aneurysm, and large or giant aneurysm.