52 Chapter 2 still the standard of reference for the detection of cerebral aneurysms, DSA is used as gold standard in our study. If CEMRA were to perform better than CTA in the detection of intracranial aneurysms this would be an argument to add CEMRA to the work-up protocol of patients presenting with a SAH. MaterialsandMethods Study design Patients admitted with the diagnosis of a non-traumatic SAH between 2004 and 2006 were included in the study. All patients underwent CTA for detection of a possible cerebral aneurysm. Diagnostic catheter DSA was performed as an additional diagnostic procedure in case of an initially negative CTA study, or where there was uncertainty about the preferred treatment strategy. Moreover, DSA is an essential part of the endovascular coiling procedure (see flow chart in figure 1). If endovascular treatment was not considered feasible on the basis of the CTA images the patient was referred to the neurosurgeon. Diagnostic DSA was performed at the request of the neurosurgeon if more detailed information was required about the aneurysm and its surrounding arterial branches. Figure 1. Flow chart of the work up of a patient presenting with a SAH. Within 48 hours of CTA, patients meeting the inclusion criteria for the study underwent an additional CEMRA study before endovascular or surgical treatment. Inclusion of the patient was only allowed, however, if the performance of the additional CEMRA study would not delay treatment. Informed consent was obtained from all patients or, in unresponsive patients, from a legally responsible person. DSA served as standard of reference in included patients. The Institutional Review Board of our center approved the study. Approval was also given by the national center for patient related research (CCMO) because of the anticipated inclusion of patients unable to give informed consent.
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