DETECTION ET BILAN PRETHERAPEUTIQUE DES ANEVRYSMES INTRACRANIENS
Recommandations 2005 de l’HAS: Guide du bon usage des examens d’imagerie
Comparaison: artériographieangio-TDM - angio-IRM . JFR, Octobre 2005
• Directive 97/43 Euratom: une obligation légale. • Limitation des renouvellements de salle d’artériographie par les ARH, conditionné par l’activité interventionnelle. • L’activité de NRI est soumise à autorisation auprès des ARH.
ANGIO - IRM
TECHNIQUES D’IMAGERIE • Artériographie, Angio-IRM, Angio-Scanner • • • •
Pas d’étude randomisée Année de l’étude Nombre de barrettes ? reconstruction 3D ou non ?
Angio - IRM Neuroradiology. 2004 Nov; 46(11):867-75. Epub 2004 Oct 20.
Magnetic resonance angiography in the selection of patients suitable for neurosurgical intervention of ruptured intracranial aneurysms. Westerlaan HE, van der Vliet AM, Hew JM, Metzemaekers JD, Mooij JJ, Oudkerk M. Department of Radiology, University Hospital, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
[email protected] This study was aimed at establishing whether magnetic resonance angiography (MRA) can be applied to planning and performing surgery on ruptured intracranial aneurysms, especially in the early phase, without recourse to intra-arterial angiography (DSA). In this study, 205 consecutive patients (mean age 52.7 years, 69% women) were included. In 133 patients (64.9%) MRA demonstrated an aneurysm, directly followed by neurosurgical intervention. In 33 patients (16.1%) MRA findings were categorized as inconclusive. In 39 patients (19.0%) MRA results were negative. No false-negative ruptured aneurysms were selected by MRA. In only one patient surgical intervention was performed based on false-positive MRA findings. MRA can replace DSA as a first diagnostic modality in the selection of patients suitable for surgical treatment of ruptured intracranial aneurysms.
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Méthode non invasive, non irradiante Technique: TOF ou séquence injectée étude du parenchyme: anévrysme géant pas d ’artéfact en étoile sur les coïls – contrôle post-embolisation – Mais contrôle post-chirurgie souvent impossible
Angio-TDM: en première intention dans le bilan de l’HSA. Mais attention au seuillage ! • Prédire la faisabilité du traitement endovasculaire • Largeur du collet • Diamètre de l’artère afférente
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ANGIO SCANNER
ANGIO SCANNER
Neurosurgery. 2003 Mar; 52(3):624-31; discussion 630-1.
AJNR Am J Neuroradiol. 2002 Aug; 23(7):1187-98.
Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis.
Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography.
Chappell ET, Moure FC, Good MC.
Villablanca JP, Jahan R, Hooshi P, Lim S, Duckwiler G, Patel A, Sayre J, Martin N, Frazee J, Bentson J, Vinuela F.
Department of Neurological Surgery, University of California, Irvine, Medical Center, Orange, California 92868-3298, USA.
[email protected] Twenty-one references met the criteria for use in the meta-analysis. 1251 patients CTA: sensitivity 92.7%, and specificity 77.2% CONCLUSION: On the basis of this meta-analysis, DSA remains the standard method. However, many who use CTA have reported it to be as good as or better than DSA in the diagnosis and treatment of cerebral aneurysms, as well as being of less risk and discomfort to their patients and easier and less expensive to perform.
Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA. BACKGROUND AND PURPOSE: Many cases of subarachnoid hemorrhage are due to rupture of small cerebral aneurysms. Our purpose was to evaluate the usefulness of helical CT angiography (CTA) in the detection and characterization of very small (
