What are the recommended imaging modalities for diagnosing unruptured cerebral aneurysms in primary care?

In primary care, there are no direct recommendations to perform imaging for diagnosing unruptured cerebral aneurysms. If an unruptured aneurysm is suspected or identified, referral to a specialist multidisciplinary team (MDT) including an interventional neuroradiologist and neurosurgeon is recommended for further evaluation and management. The specialist team typically uses imaging modalities such as CT angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA) to diagnose and assess cerebral aneurysms. CTA is the first-line imaging modality to identify intracranial arterial aneurysms, with MRA or DSA considered if CTA is inconclusive or contraindicated. Primary care’s role is to refer patients with suspected aneurysms or related symptoms promptly to secondary care for these imaging investigations and specialist assessment NICE NG228.