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How is a brain aneurysm diagnosed?

Early recognition of risk factors or symptoms of a brain aneurysm may help at-risk individuals to seek medical care faster.

The next critical step? Accurate diagnosis.

Approximately 500,000 people die each year from a ruptured brain aneurysm. Accurate detection and diagnosis are critical to improve outcomes and save lives. Recognizing signs and symptoms of a brain aneurysm rupture and seeking immediate medical care can help to facilitate earlier medical intervention.

Many unruptured brain aneurysms are found incidentally while screening for other conditions. While screening in the general public is not typically recommended, some individuals may be screened prior to onset of symptoms if they have certain risk factors. Common reasons for early screening are a family history of brain aneurysm or a known genetic disorder that increases risk. 

Early detection is ideal, but unfortunately not always the case. Brain aneurysms are often not detected unless they are large enough to cause symptoms or rupture. Most individuals with a brain aneurysm rupture will initially present to the emergency room. It is estimated that 1-4 of every 100 patients presenting to the emergency room with complaints of headache have a ruptured brain aneurysm.

If a brain aneurysm is suspected, a medical provider will order diagnostic testing. 
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What diagnostic tools are available to detect brain aneurysm?

  • Computed Tomography (CT): A CT is a non-invasive scan that uses X-Ray imaging and computer technology to create cross-sectional images of the brain. This is a quick test, and often the first ordered if a ruptured brain aneurysm or bleeding in the brain is suspected.

  • Computed Tomography Angiography (CTA): Variant of CT imaging that involves injection of contrast dye into the bloodstream through an IV. This allows better visualization of blood vessels and blood flow in the brain, and is used to detect presence of a ruptured or unruptured brain aneurysm. CTA can pick up more specific details of an aneurysm (i.e. type, size, location) than CT imaging.

  • Magnetic Resonance Imaging (MRI): A non-invasive imaging technique that uses a strong magnetic field and radio waves to create computer generated cross-sectional or three dimensional images of the brain. Unlike CT imaging, it does not expose a patient to radiation.

  • Magnetic Resonance Angiography (MRA): Variant of MRI that is used to visualize blood vessels and blow flow in more detail. Involves injection of a contrast dye into the bloodstream. 

  • Cerebral Angiogram: An invasive procedure that is utilized when other imaging techniques are insufficient or to confirm a brain aneurysm diagnosis. It involves insertion of a catheter into an artery (typically the groin). The catheter is passed through the artery to eventually reach the vessels in the neck and brain. A contrast dye is injected, and X-rays are taken.

  • Cerebral Spinal Fluid Test: An invasive procedure that is performed if a ruptured aneurysm or bleeding in the brain is suspected but not detected on initial imaging. The test involves inserting a needle into the lower back to withdraw a small amount of the fluid that surrounds the spinal cord (cerebral spinal fluid). This is the same fluid that surrounds the brain. It is then analyzed for any signs of blood that would indicate a brain bleed.

If MRI/MRA or CT/CTA are performed, a radiologist will visually analyze the medical images and compare the results with any previous scans. The results are then shared with other providers on the medical care team to determine next steps, including the potential need for further monitoring or therapeutic intervention.
How can Artificial Intelligence(AI) be used to detect and monitor a brain aneurysm?
 
Improvements in image recognition and deep learning have progressed the use of AI in areas of medicine that utilize diagnostic testing, particularly radiology. 

Multiple products are currently capable of using AI technology for detection or risk analysis of certain medical conditions such as heart attack, cancer, or stroke. The use of AI technology for brain aneurysm is less common. VasoGnosis is one of only two known market areas utilizing AI to detect and monitor brain aneurysms.
 
VasoGnosis’ virtual radiology assistant software and AI algorithms can scan a medical image to detect a brain aneurysm. A three-dimensional measurement of the aneurysm is performed allowing direct comparison to a patient’s previous scan(s). In a matter of seconds, a risk assessment and 3D change report are created for the radiologist to utilize. This ultimately improves physician workflow and limits time spent visually assessing the medical images.
 
The use of AI to assist physicians may decrease the overall time it takes to reach a diagnosis, allowing for earlier intervention if needed. Fast detection and accurate diagnosis of a brain aneurysm is important, as it is a potentially life-threatening condition and every second counts.

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Sources: 
  1. Artificial Intelligence in Radiology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6268174/
  2. Brain Aneurysm Foundation https://bafound.org
  3. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/diagnosis-treatment/drc-20361595
  4. Cerebral Aneurysms Fact Sheet https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/cerebral-aneurysms-fact-sheet#5