Imaging recommendations include initial evaluation of suspected SAH with nonenhanced CT (NECT). If NECT is positive for SAH, the study should be followed by multiplanar CTA which gives important complementary anatomic detail to DSA. Proceed directly to DSA if NECT is consistent with SAH, but CTA fails to demonstrate the culprit aneurysm. Consider MRI with or without MRA in cases of large complex aneurysms with suspected mass effect and resultant cranial nerve dysfunction as well as in cases where DSA and CTA fail to demonstrate an aneurysm. Lastly, rely on MRI with MRA in the surveillance of unruptured and treated aneurysms.
For more information, please see the corresponding chapter in Radiopaedia, and the Giant Cerebral Aneurysms chapter within the Brain Tumor Mimics sub-volume of the Neurosurgical Atlas.
Contributor: Daniel Murph, MD
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