Drawbacks for surveillance include invasiveness and small risk of vascular complication. CT Head Perfusion There is no relevant literature to support the use of CT head perfusion in the surveillance of known, treated cerebral aneurysm. CT Head There is no relevant literature to support the use of CT head in the surveillance of known, treated cerebral aneurysm. CTA Head CTA head is useful for surveillance imaging of treated cerebral aneurysms because of its noninvasive nature. However, CTA is limited by large metallic streak artifacts encountered with metallic coils, stents, and devices. Although artifact from metal cannot be removed, several metal artifact reduction techniques are available to improve evaluation of treated aneurysms and the parent vessels [53-57]. CTA Neck There is no relevant literature to support the use of CTA neck in the surveillance of known, treated cerebral aneurysm. CTV Head There is no relevant literature to support the use of CTV head in the surveillance of known, treated cerebral aneurysm. CVD-Aneurysm, Vascular Malformation, and SAH MRA Head MRA head is a noninvasive examination commonly used for treated aneurysm surveillance. This examination can be obtained without IV contrast using time-of-flight imaging, with IV contrast to improve flow-related artifacts occasionally encountered in aneurysms, or a combination of both. In the setting of coiled aneurysms, a meta-analysis found similar performance of both noncontrast and contrast-enhanced examinations with sensitivities of 86% for both time-of-flight and contrast-enhanced MRA, as well as specificities of 84% and 89%, respectively [58]. MRA head was also compared directly with catheter-directed angiography and found to result in substantial agreement (kappa 0.73) regarding treatment recommendations between the 2 examinations [59]. Treatment with stents or flow diverters results in challenges in MRA intraluminal evaluation of the stent.
Cerebrovascular Diseases Aneurysm Vascular Malformation and Subarachnoid Hemorrhage PCAs. Drawbacks for surveillance include invasiveness and small risk of vascular complication. CT Head Perfusion There is no relevant literature to support the use of CT head perfusion in the surveillance of known, treated cerebral aneurysm. CT Head There is no relevant literature to support the use of CT head in the surveillance of known, treated cerebral aneurysm. CTA Head CTA head is useful for surveillance imaging of treated cerebral aneurysms because of its noninvasive nature. However, CTA is limited by large metallic streak artifacts encountered with metallic coils, stents, and devices. Although artifact from metal cannot be removed, several metal artifact reduction techniques are available to improve evaluation of treated aneurysms and the parent vessels [53-57]. CTA Neck There is no relevant literature to support the use of CTA neck in the surveillance of known, treated cerebral aneurysm. CTV Head There is no relevant literature to support the use of CTV head in the surveillance of known, treated cerebral aneurysm. CVD-Aneurysm, Vascular Malformation, and SAH MRA Head MRA head is a noninvasive examination commonly used for treated aneurysm surveillance. This examination can be obtained without IV contrast using time-of-flight imaging, with IV contrast to improve flow-related artifacts occasionally encountered in aneurysms, or a combination of both. In the setting of coiled aneurysms, a meta-analysis found similar performance of both noncontrast and contrast-enhanced examinations with sensitivities of 86% for both time-of-flight and contrast-enhanced MRA, as well as specificities of 84% and 89%, respectively [58]. MRA head was also compared directly with catheter-directed angiography and found to result in substantial agreement (kappa 0.73) regarding treatment recommendations between the 2 examinations [59]. Treatment with stents or flow diverters results in challenges in MRA intraluminal evaluation of the stent.