Purpose or Case Report: Intracranial aneurysms are rare in children. The utility, yield, and effectiveness of screening for aneurysms in children and young adults with a predisposing history for aneurysms or a family history of aneurysms is not known. The purpose of this study is to assess the prevalence of positive imaging studies performed for screening of intracranial aneurysms in children with familial history of intracranial aneurysms, and determine the utility and yield of these studies.
Methods & Materials: Children with familial history of intracranial aneurysms who had brain vascular imaging for screening of possible intracranial aneurysms from June 1993 to September 2016 were included in this retrospective study. The images of the studies reporting aneurysm or questionable small aneurysms were reviewed. Follow-up studies were also reviewed. Relevant demographical and clinical data were also recorded, including details about the familial history of aneurysm when available (familial history in 1st or 2nd degree relative, number of affected relatives, and history of ruptured versus non-ruptured aneurysms). This study was approved by our institutional research ethics review board.
Results: Between June 1993 and September 2016, there were 267 brain MRA exams performed to assess for possible intracranial aneurysms in patients with familial history of intracranial aneurysms, either in asymptomatic patients or in patients presenting with headaches or less often other symptoms. No CTA was performed as the first imaging modality for this purpose. The brain MRA studies were performed in 119 males (44.6%) and 148 females (55.4%), aged between 7 months and 19 years and 7 months. 262 (98.1%) of these studies were negative. 5 studies (1.9%) were initially reported as positive. Further investigation by a brain CTA was performed in 2 and by an angiogram in 2. A brain MRA follow-up was performed in the 1 remaining case. On further investigation or follow-up, all proved to be false positives.
Conclusions: There is no known or defined benefit of noninvasive screening imaging for family history of intracranial aneurysms in children. We show that the yield of aneurysm screening is extremely low if not absent, therefore questioning the relevance and utility of the clinical practice of performing such screening studies, bearing in mind the associated costs and optimal use of available resources.