What is the role of imaging studies in the diagnosis of cerebral aneurysms?

Updated: Dec 06, 2018
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Imaging studies used in the workup of cerebral aneurysms include the following:

  • Computed tomography (CT) scanning: Aneurysmal SAH may be detected in 90-95% of cases

  • Magnetic resonance imaging (MRI): Fluid-attenuated inversion recovery (FLAIR) sequences are very sensitive for SAH, although the comparison of CT scanning with MRI in the detection of SAH is controversial; dolichoectatic and giant aneurysms are identified readily with MRI

  • Angiography: Conventional angiography is the definitive procedure for the detection and characterization of cerebral aneurysms

  • Transcranial Doppler ultrasonography: This modality facilitates the diagnosis of vasospasm and serial monitoring of cerebral blood flow at the bedside

  • Single-photon emission CT (SPECT) scanning, positron emission tomography (PET) scanning, xenon-CT (XeCT) scanning: With these techniques, cerebral blood flow studies may depict ischemia associated with vasospasm, although these modalities are not routinely employed

  • Cervical spine imaging: Radiographic assessment of the cervical spine should be performed in all comatose patients with an unwitnessed loss of consciousness

  • Echocardiography: Cardiac sources of embolism, including endocarditis and myxomas, may be visualized in cases of infectious or neoplastic aneurysms.

  • Lumbar puncture may help establish the diagnosis of SAH in the absence of focal signs of mass effects. Aneurysmal SAH demonstrates hemorrhagic cerebrospinal fluid with a xanthochromic supernatant, although these findings may be absent within the first few hours following aneurysmal rupture.

See Workup for more detail.

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