Using digital subtraction angiography as the gold standard, CTA has a reported sensitivity of 74% and specificity of 96% for the demonstration of residual aneurysm post-treatment [66]. MRI Head MRI is not typically an initial imaging study in patients with suspected SAH. However, SWI is sensitive to the presence of subarachnoid blood. MRI may be useful in classifying the aneurysms into saccular, dissecting, giant, and infectious [60]. MRI may be used to evaluate potential complications of treatment, including cerebral infarction or hemorrhage [63]. Only patients with MRI-safe aneurysm clips should be imaged with MR. MRA Head MRA is a noninvasive alternative to catheter angiography to show an underlying vascular cause of SAH. MRA of the brain is the examination of choice for children with unruptured aneurysms being followed prior to treatment [51]. A meta-analysis of the literature shows the sensitivity and specificity of MRA for the detection of intracranial aneurysm to be 95% and 89%, respectively [67]. Given the limited number of children who will develop an aneurysm under the age of 20, routine screening with MRA of children with a positive family history of aneurysm is not supported in the literature [68]. Arteriography Cervicocerebral Catheter angiography remains the gold standard for the demonstration of high-flow vascular anomalies and aneurysms as a cause of SAH. Catheter angiography can be performed for pretreatment planning and for post- treatment assessment. Catheter angiography is associated with a low incidence of procedural complications in children [51,60]. Catheter angiography is the gold standard for the diagnosis and pretreatment evaluation of intracranial aneurysm and may also be required for post-treatment follow-up in some patients [60]. US Duplex Doppler Transcranial Head US is not sensitive for the presence of subarachnoid blood or vascular causes of intracranial hemorrhage.
Cerebrovascular Disease Child PCAs. Using digital subtraction angiography as the gold standard, CTA has a reported sensitivity of 74% and specificity of 96% for the demonstration of residual aneurysm post-treatment [66]. MRI Head MRI is not typically an initial imaging study in patients with suspected SAH. However, SWI is sensitive to the presence of subarachnoid blood. MRI may be useful in classifying the aneurysms into saccular, dissecting, giant, and infectious [60]. MRI may be used to evaluate potential complications of treatment, including cerebral infarction or hemorrhage [63]. Only patients with MRI-safe aneurysm clips should be imaged with MR. MRA Head MRA is a noninvasive alternative to catheter angiography to show an underlying vascular cause of SAH. MRA of the brain is the examination of choice for children with unruptured aneurysms being followed prior to treatment [51]. A meta-analysis of the literature shows the sensitivity and specificity of MRA for the detection of intracranial aneurysm to be 95% and 89%, respectively [67]. Given the limited number of children who will develop an aneurysm under the age of 20, routine screening with MRA of children with a positive family history of aneurysm is not supported in the literature [68]. Arteriography Cervicocerebral Catheter angiography remains the gold standard for the demonstration of high-flow vascular anomalies and aneurysms as a cause of SAH. Catheter angiography can be performed for pretreatment planning and for post- treatment assessment. Catheter angiography is associated with a low incidence of procedural complications in children [51,60]. Catheter angiography is the gold standard for the diagnosis and pretreatment evaluation of intracranial aneurysm and may also be required for post-treatment follow-up in some patients [60]. US Duplex Doppler Transcranial Head US is not sensitive for the presence of subarachnoid blood or vascular causes of intracranial hemorrhage.