Detection of unruptured XXXX on noninvasive imaging. Is there still a role for digital subtraction angiography?

@entity1 @entity439 @entity438
BACKGROUND: To determine the utility of digital subtraction angiography (DSA) in @entity1 with unruptured @entity438 (UIA) detected on noninvasive imaging, such as magnetic resonance angiography (MRA) and computed tomography angiography (CTA). The follow-up of @entity1 with untreated UIAs involves serial imaging; however, this diagnosis may be based on false positive (FP) results. We examined the incidence of FPs in our institutional series. METHODS: DSAs performed at our institution from January 2011 to June 2014 were retrospectively reviewed and @entity1 referred with UIA detected on noninvasive imaging were selected. Clinical presentation as well as @entity439 location, size, and number reported on DSA and noninvasive imaging were assessed. RESULTS: Two hundred and eighty six @entity1 (mean age 56.8 years, female 74.8%) with a total of 355 UIA were included. Thirty-one @entity1 had a symptomatic presentation. Analysis per @entity1 showed the pooled FP rate of noninvasive imaging was 15%. MRA FP was 13% (22/171) and CTA FP was 18% (22/120). FP increased significantly with @entity439 size < 3.5 mm on MRA (P < 0.001) and <4.0 mm on CTA (P = 0.01). Mean @entity439 size among symptomatic @entity1 was significantly larger (P < 0.001) as compared to the incidental group (17.8 vs. 7.7 mm). No location was significantly susceptible to false detection of @entity439 . CONCLUSION: DSA detection of FP UIA diagnosed on noninvasive imaging is significantly higher for @entity439 <4.0 mm. Accurate diagnosis with DSA may eliminate the need for further follow-up and its associated negative psychological and economic effects. Within the limitations of this retrospective study, we conclude that DSA has a diagnostic role in small @entity439 detected on noninvasive imaging.
