What’s the best MR angiography strategy to screen for aneurysm in patients with hereditary kidney disease?

Autosomal dominant polycystic kidney disease (ADPKD) is among the most common hereditary diseases, and is associated with complications such as intracranial aneurysm. A lack of screening guidelines prompted a group of researchers to evaluate the cost-effectiveness of various MR angiography strategies.

The results of the analysis were published online Feb. 19 in Radiology.

“There is uncertainty regarding the benefits of screening for intracranial aneurysm in patients with ADPKD owing to the lack of data from randomized, prospective clinical trials,” wrote Ajay Malhotra, of Yale School of Medicine in New Haven, Connecticut, and colleagues. “The initial age at screening, the frequency and duration of repeat screening, the use of surveillance imaging after intracranial aneurysm detection, and the utility of treatment of unruptured intracranial aneurysms in patients with ADPKD are not clearly defined.”

The authors created a Markov decision-analytic model to evaluate the costs and outcomes of five different MR angiography management strategies covering the lifespan of a patient up to 80 years old.

Overall, the best strategy is MR angiography screening every five years and annual follow-up in those with detected intracranial aneurysm. The strategy became more favorable when life expectancy is more than six years.

They also found if the rupture risk of unruptured intracranial aneurysm is between 0.015 percent and 0.35 percent, one-time MR angiography screening plus annual MR angiography follow up “may be dominant,” the authors wrote.

“Screening for intracranial aneurysms in patients with autosomal dominant polycystic kidney disease is cost-effective, and repeat screening every 5 years after a negative initial study should be considered,” the authors wrote. “Annual surveillance imaging may be optimal in patients with incidentally detected intracranial aneurysms and in the treatment of patients with growing, high-risk aneurysms.”