Preliminary Diagnosis: Mycotic Aneurysm

I. What imaging technique is first-line for this diagnosis?

  • The first-line imaging modality is CTA imaging with IV contrast of the area of concern

II. Describe the advantages and disadvantages of this technique for diagnosis of mycotic aneurysm.

Advantages

  • May help guide and plan percutaneous intervention

  • Offers exquisite visualization of the surrounding soft tissues, osseous structures, and vascular structures

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Disadvantages

  • Exposes patients to ionizing radiation

  • Used only for diagnostic purposes

  • Limited in detailing fine endothelial abnormalities

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients and those patients with severe renal failure on an inadequate dialysis regimen

IV. What alternative imaging techniques are available?

  • MRA imaging of the area of concern with and without contrast

  • Catheter angiography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mycotic aneurysm.

MRA imaging
Advantages

  • Does not expose patients to ionizing radiation

  • Offers exquisite visualization of the soft tissues

  • Without contrast per time-of-flight protocol may help detail the vasculature of concern in patients with abnormal renal function who cannot receive gadolinium-based contrast medium

Disadvantages

  • Less sensitive and less specific in analyzing the vasculature of concern and detailing any endothelial abnormalities

  • May be subject to motion and susceptibility-weighted artifact degrading image quality

  • Solely a diagnostic modality

Catheter Angiography
Advantages

  • Gold standard in both diagnosing and potentially treating mycotic aneurysms

  • Highly sensitive and specific in detailing and characterizing the endothelial structure of the vasculature of concern

Disadvantages

  • Exposes patients to increased morbidity and mortality due to the invasiveness of the procedure

  • Less adept in detailing the surrounding soft tissues and osseous structures

VI. What are the contraindications for the alternative imaging techniques?

  • MRA imaging may be contraindicated in patients with non–MR-compatible hardware.

  • Catheter angiography is contraindicated in patients who are in a severe hypocoagulable state.

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