159 Summary Patients with subarachnoid haemorrhage (SAH) need immediate diagnostic imaging and treatment where indicated. This poses a big challenge for physicians involved. Fortunately, spectacular improvements in both imaging and treatment have been achieved in the last two decades, and these have been thoroughly evaluated resulting in hundreds of articles being published on the subject. Chapter 1 of this thesis takes you on a journey from the first description of a SAH to current scientific activities in this field. If you read nothing else, reader of this Summary, I invite you to at least read the highly interesting story that is Chapter 1. Although this thesis, on the whole, focuses on diagnostic imaging, the evolution of SAH therapy is addressed as well. However, the concurrent development of different diagnostic modalities and the studies concerning these developments are elaborated on more extensively. Despite the fact that all steps taken in diagnostic tests have been, at least partially, investigated in the past few years, there are still gaps in our knowledge. In addition, the rapid development of diagnostic techniques requires continuous research. In subsequent chapters we present our work in this field, which fills some of the gaps. In 2002 we designed a study called ‘Magnetic resonance Angiography with Contrast for the detection of Cerebral Aneurysms’ (MACCA). The rationale behind the study was that magnetic resonance angiography (MRA) has large advantages in not involving patient exposure to either ionising radiation or iodinated contrast material. Furthermore, contrast enhanced MRA (CEMRA, using non-iodinated contrast material) was expected to give better quality images than non-contrast-enhanced MRA. A disadvantage of MRA is that patients must be transferred to a MR-suite after the standard non-contrast- enhanced CT made to detect the SAH, whereas computed tomographic angiography (CTA) can be performed directly without need for such a transfer. MRA would therefore be preferable only if it performed better than CTA in aneurysm detection or in determining optimal treatment. For the MACCA study 75 patients presenting with SAH underwent an additional MRA on top of the standard CTA and digital subtraction angiography (DSA), DSA serving as standard of reference. Due to logistics inclusion of patients took longer than expected, but in 2006 the last patient was included. Chapter 2 describes the MACCA study results with respect to aneurysm detection, showing that performance of CEMRA and CTA in detecting intracranial aneurysms does not significantly differ. The second part of the MACCA study evaluated the performance of CEMRA and CTA in assessing suitability of endovascular coiling - or ´coilability´- of detected aneurysms. Results are described in Chapter 3. We found no significant difference in the performance of CEMRA and CTA in assessing coilability.
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