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      Diagnosis of Cerebral Aneurysm Via Magnetic Resonance Angiography Screening: Emphasis on Legal Responsibility Increases False Positive Rate

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          Abstract

          Purpose

          False positive diagnoses of cerebral aneurysm via magnetic resonance angiography (MRA) screening may increase unnecessary cerebral catheter angiography. The purpose of this study was to investigate the effects of medical liability on medical decision-making during radiologic interpretation.

          Materials and Methods

          We included 56 consecutive patients who were referred with suspected aneurysm based on MRA or computed tomography angiography (CTA) and showed no aneurysm on subsequent digital subtraction angiography (DSA). MRA and CTA were reviewed twice by two neuroradiology fellows who were blind as to whether the suspected lesions were true aneurysms or not. The second review was repeated after proposing that their decision was subject to legal liability and they would be responsible for medico-legal problems related to their diagnoses. Diagnostic differences based on each review were analyzed, focusing on changes in false positive diagnosis rates.

          Results

          A total of 63 suspected aneurysmal lesions detected via MRA or CTA were found to be negative based on DSA. At first review, 32 lesions were diagnosed as true aneurysms by observer 1 and 27 by observer 2, corresponding to false positive rates of 51% and 43% respectively. At the second review, 39 lesions (62%) were diagnosed by observer 1, and 30 (48%) by observer 2. Thus, there was an overall increase in false positive aneurysm diagnosis of 11% for observer 1 and 5% for observer 2, after emphasizing their responsibilities in the context of medical litigation.

          Conclusion

          Concerns about medical liability could result in increased false positive diagnoses of cerebral aneurysms via MRA screening. Whether repeated follow-up of the suspected lesion or catheter angiographic confirmation is better with regard to long-term patient outcomes requires further study.

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          Most cited references22

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          Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients.

          To retrospectively evaluate the complications of diagnostic cerebral catheter angiography in 19,826 consecutive patients. This HIPAA-compliant study had institutional review board approval, with waiver of informed consent. Demographic, procedural, and complication data in 19 826 consecutive patients undergoing diagnostic cerebral angiography at one institution from 1981 through 2003 were retrospectively reviewed. Neurologic, systemic, and local complications were recorded on the basis of clinical follow-up results after each angiographic examination. Events that occurred within 24 hours of angiography were considered to be complications of the procedure. Multivariable analysis was employed to identify patient and procedural factors significantly associated with neurologic complications. Neurologic complications occurred in 522 examinations (2.63%), and 27 of these (0.14%) were strokes with permanent disability. Twelve deaths occurred (0.06%). Access-site hematoma was the most common complication overall (4.2%). Factors independently associated with an increased risk of neurologic complication included the indication of atherosclerotic cerebrovascular disease (odds ratio [OR], 2.494), the indication of subarachnoid hemorrhage (OR, 2.523), and the comorbidity of frequent transient ischemic attack (OR, 1.674). Factors independently associated with a decreased risk of neurologic complication were increasing chronologic year in which the procedure was performed (OR, 0.659 per 5-year interval) and involvement of a trainee in the procedure (OR, 0.710). In this review, diagnostic catheter cerebral angiography was found to have relatively low complication rates. (c) RSNA, 2007.
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            Cognitive and system factors contributing to diagnostic errors in radiology.

            In this article, we describe some of the cognitive and system-based sources of detection and interpretation errors in diagnostic radiology and discuss potential approaches to help reduce misdiagnoses.
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              An overview of intracranial aneurysms

              Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Unruptured aneurysms may cause symptoms mainly due to a mass effect, but the real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage. Most aneurysms are asymptomatic and will not rupture, but they grow unpredictably and even small aneurysms carry a risk of rupture. Intracranial aneurysms are diagnosed and monitored with imaging including intra-arterial digital subtraction angiography, computed tomography angiography, magnetic resonance angiography, and recently transcranial Doppler ultrasonograpy has been proposed as a potential modality. Treatment options include observation, endovascular coiling, and surgical clipping. This paper will review the epidemiology, pathogenesis, clinical presentation, diagnosis, natural history, and management of unruptured saccular intracranial aneurysms.
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                Author and article information

                Journal
                Neurointervention
                Neurointervention
                NI
                Neurointervention
                Korean Society of Interventional Neuroradiology
                2093-9043
                2233-6273
                March 2018
                02 March 2018
                : 13
                : 1
                : 48-53
                Affiliations
                [1 ]Department of Neurosurgery, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                [2 ]Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                [3 ]Department of Radiology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Korea.
                [4 ]Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.
                Author notes
                Correspondence to: Dae Chul Suh, MD, PhD. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel. +82.2.3010.4366, Fax. +82.2.476.0090, dcsuh@ 123456amc.seoul.kr
                Article
                10.5469/neuroint.2018.13.1.48
                5847890
                434296eb-9790-445c-94b9-0cddd844e957
                Copyright © 2018 Korean Society of Interventional Neuroradiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 January 2018
                : 23 February 2018
                : 25 February 2018
                Categories
                Original Paper

                Neurosciences
                intracranial aneurysm,junctional dilatation,magnetic resonance angiography,digital subtraction angiography

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