ADPKD ICA Screening MRA Family History — ESENeph MCQ

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HardPolycystic Kidney DiseaseADPKD ICA Screening MRA Family HistoryESENeph

A 50-year-old with ADPKD has two first-degree relatives who had aneurysmal subarachnoid haemorrhage. Screening is agreed after counselling. Which imaging test is preferred?

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Correct answer: A — Non-contrast time-of-flight intracranial MR angiography

The best answer is “Non-contrast time-of-flight intracranial MR angiography”. KDIGO 2025 identifies time-of-flight MRA without gadolinium as the preferred screening method when intracranial-aneurysm screening is pursued in ADPKD; CTA is an alternative. “Unenhanced CT of the head” is less appropriate because this does not provide adequate angiographic assessment for an unruptured aneurysm “Catheter cerebral angiography as the screening test” is less appropriate because this invasive test is not first-line screening when non-invasive angiography is available “Lumbar puncture for xanthochromia” is less appropriate because lumbar puncture investigates suspected recent subarachnoid haemorrhage rather than an asymptomatic aneurysm “Carotid Doppler ultrasonography” is less appropriate because this does not visualise the intracranial arterial circulation adequately

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