Higher Incidence of Unruptured Intracranial Aneurysms among Black and Hispanic Women on Screening MRA in Large Urban Populations

BACKGROUND AND PURPOSE: Intracranial aneurysms have a reported prevalence of 1%–2% in the general population. Currently, only patients with a strong family history or autosomal dominant polycystic kidney disease are screened for intracranial aneurysms using MRA. The purpose of this study was to determine whether there are other specific patient populations at risk that should be offered screening for intracranial aneurysms.

MATERIALS AND METHODS: This is a retrospective case-control study of adult patients who underwent a screening MRA of their brain at our comprehensive stroke center from 2011 to 2020. Patients with a history of a known brain aneurysm were excluded. Data were extracted on patient demographics and medical comorbidities. Bivariate analyses were performed, followed by multivariable logistic regression, to identify factors associated with a positive MRA screen for incidental aneurysms.

RESULTS: Of 24,397 patients eligible for this study, 2084 screened positive for a possible intracranial aneurysm. On bivariate analysis, significant differences were present in the following categories: age, sex, race and ethnicity, chronic constipation, and hyperlipidemia. On logistic regression analysis, older age (+10 years: OR = 10.01; 95% CI, 10.01–10.02; P = .001), female sex (OR = 1.37; 95% CI, 1.24–1.51; P = .001), non-Hispanic Black (OR = 1.19; 95% CI, 1.02–1.40; P = .031), and Hispanic ethnicity (OR = 1.35; 95% CI, 1.16–1.58; P = .001) versus non-Hispanic White remained significant when adjusted for other factors.

CONCLUSIONS: Targeted screening for high-risk elderly women of Black or Hispanic descent will yield higher positive findings for brain aneurysms, which may mitigate the risk of rupture. Whether this is a cost-effective approach has yet to be determined.