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ADPKD Intracranial Aneurysm Screening — ESENeph MCQ

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HardPolycystic Kidney DiseaseADPKD Intracranial Aneurysm ScreeningESENeph

A 44-year-old with ADPKD has normal neurology but a mother and maternal aunt who suffered subarachnoid haemorrhage. Which screening test is preferred?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Non-contrast time-of-flight MR angiography of the intracranial circulation

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

E is correct. A family history of intracranial aneurysm or subarachnoid haemorrhage places an adult with ADPKD in a higher-risk group for whom screening should be offered after counselling. Non-contrast time-of-flight MRA avoids radiation and iodinated contrast and is the usual screening modality. A cannot screen for an unruptured aneurysm. B is invasive and reserved for selected diagnostic or interventional questions. C creates unnecessary repeated radiation and contrast exposure. D defeats the purpose of preventive screening. Follow-up after a negative scan is individualised according to family history, age, risk exposure and life plans rather than an automatic annual schedule.

Reference: KDIGO 2025 guideline for ADPKD: https://kdigo.org/wp-content/uploads/2025/01/KDIGO-2025-ADPKD-Guideline.pdf