PT  - JOURNAL ARTICLE
AU  - Allaw, Sammy
AU  - Khabaz, Kameel
AU  - Given, Tyler C.
AU  - Montas, Dominic
AU  - Alcazar-Felix, Roberto J.
AU  - Srinath, Abhinav
AU  - Kass-Hout, Tareq
AU  - Carroll, Timothy J.
AU  - Hurley, Michael C.
AU  - Polster, Sean P.
TI  - A Review of Intracranial Aneurysm Imaging Modalities, from CT to State-of-the-Art MR
AID  - 10.3174/ajnr.A8549
DP  - 2025 Jun 01
TA  - American Journal of Neuroradiology
PG  - 1082--1092
VI  - 46
IP  - 6
4099  - http://www.ajnr.org/content/46/6/1082.short
4100  - http://www.ajnr.org/content/46/6/1082.full
SO  - Am. J. Neuroradiol.2025 Jun 01; 46
AB  - SUMMARY: Traditional guidance for intracranial aneurysm (IA) management is dichotomized by rupture status. Fundamental to the management of ruptured aneurysm is the detection and treatment of SAH, along with securing the aneurysm by the safest technique. On the other hand, unruptured aneurysms first require a careful assessment of their natural history versus treatment risk, including an imaging assessment of aneurysm size, location, and morphology, along with additional evidence-based risk factors such as smoking, hypertension, and family history. Unfortunately, a large proportion of ruptured aneurysms are in the lower risk size category (<7 mm), putting a premium on discovering a more refined noninvasive biomarker to detect and stratify aneurysm instability before rupture. In this review of aneurysm work-up, we cover the gamut of established imaging modalities (eg, CT, CTA, DSA, FLAIR, 3D TOF-MRA, contrast-enhanced-MRA) as well as more novel MR techniques (MR vessel wall imaging, dynamic contrast-enhanced MRI, computational fluid dynamics). Additionally, we evaluate the current landscape of artificial intelligence software and its integration into diagnostic and risk-stratification pipelines for IAs. These advanced MR techniques, increasingly complemented with artificial intelligence models, offer a paradigm shift by evaluating factors beyond size and morphology, including vessel wall inflammation, permeability, and hemodynamics. Additionally, we provide our institution’s scan parameters for many of these modalities as a reference. Ultimately, this review provides an organized, up-to-date summary of the array of available modalities/sequences for IA imaging to help build protocols focused on IA characterization.AIartificial intelligenceAIFarterial input functionAUCarea under the curveAWE?CAcontrast agentCEcontrast-enhancedCFDcomputational fluid dynamicsDCEdynamic contrast-enhancedDLdeep learning3DRA3D rotational angiographyFTfourier transformIAintracranial aneurysmKtransvolume transfer constantLPlumbar puncturePHASESPopulation, Hypertension, Age, Size of Aneurysm, Earlier subarachnoid hemorrhage from another aneurysm, and Site of aneurysmRFradiofrequencyTCCtissue concentration-time curveTICtemporal signal intensity curveUIAunruptured intracranial aneurysmVWIvessel wall imagingWSSwall shear stress