Can we now dispense with DSA in the evaluation of aneurysm occlusion even in the most crucial first follow-up after endovascular treatment?

Gramsch, Carolin; Zülow, Stefan; Nensa, Felix; Maderwald, Stefan; Göricke, Sophia; Ringelstein, Adrian; Müller, Oliver; Sure, Ulrich; Wanke, Isabel; Schlamann, Marc

doi:10.1016/j.clineuro.2016.08.005

Cited by 7 publications

(4 citation statements)

References 42 publications

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“…A study by Pierot demonstrated that the sensitivity, specificity, PPV, and NPV in the detection of aneurysm remnants by TOF MRA on a 1.5-T MR scanner were 0.54, 0.98, 0.90, and 0.85, respectively (16). Previous studies also showed that TOF MRA was a sensitive and safe technique for evaluating coiled aneurysms (17–19). However, there are certain levels of false-negatives and false-positives in TOF MRA when evaluating the remnants of intracranial aneurysm with endovascular intervention treatment.…”

Section: Discussionmentioning

confidence: 95%

Application of zero echo time MR angiography in follow-up of intracranial aneurysm remnant and in-stent lumen after embolization: a comparison study with digital subtraction angiography

Song

Huang

et al. 2019

Acta Radiol

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Background Intracranial aneurysm with endovascular treatment needs to be followed-up with a proper imaging method. Purpose To evaluate the performance of magnetic resonance angiography (MRA) with zero echo time at 1.5-T in assessing the intracranial aneurysm remnant and in-stent lumen as compared with time-of-flight MRA, with digital subtraction angiography as the gold standard. Material and Methods A total of 46 patients (17 men; mean age = 56.6±13.7 years) with 54 aneurysms who underwent coil embolization with or without stent were enrolled in this study. The presence of aneurysm remnant and the visualization of in-stent lumen were evaluated. The agreement of remnant identification between MRA with zero echo time and time-of-flight MRA with digital subtraction angiography was evaluated using Cohen’s kappa analysis. The performance of in-stent lumen visualization between MRA with zero echo time and time-of-flight MR angiography was compared with Chi-square test. Results Of 54 aneurysms, 27 were found to have remnants by digital subtraction angiography. The kappa value in identification of remnant of aneurysm was 0.852 between MRA with zero echo time and digital subtraction angiography and 0.741 between time-of-flight MRA and digital subtraction angiography. In detecting remnant of aneurysm, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.3%, 88.9%, 89.7%, and 96.0% for MRA with zero echo time and 91.7%, 83.3%, 81.5%, and 92.6% for time-of-flight MRA, respectively. In visualizing in-stent lumen, MRA with zero echo time had better performance than time-of-flight MRA ( P < 0.001). Conclusion MR angiography with zero echo time might be a better non-invasive approach in assessing remnant of aneurysms and in-stent lumen as compared with time-of-flight MRA.

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Section: Discussionmentioning

confidence: 95%

Application of zero echo time MR angiography in follow-up of intracranial aneurysm remnant and in-stent lumen after embolization: a comparison study with digital subtraction angiography

Song

Huang

et al. 2019

Acta Radiol

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“…Some reported that MRA is better than DSA because of artifacts resulting from subtraction methods and opaque coil packages limiting DSA. Finally, MRA has begun to replace DSA for the detection of residual or recurrent aneurysms in follow-up of aneurysms treated with endovascular coil occlu-sion (7), although some studies were still suspicious for MRA (11,20). Furthermore, endovascular coil mass has high hyperdense artifact on CT techniques.…”

Section: █ Discussionmentioning

confidence: 99%

“…The coil-related artifacts typically obscure not only the aneurysm but also the adjacent parenchyma and branch vessels as well as the surrounding brain parenchyma on CT, CTA imaging. CT techniques also have radiation exposure hazards (7).…”

Section: █ Discussionmentioning

confidence: 99%

“…Technical advancements have made MRI techniques more effective. Several studies have reported 3T to be superior to 1.5 T when utilized for follow-up of coiled intracranial aneurysms, and although artifacts are more pronounced in 3T than 1.5T, remnant aneurysm are better shown in 3T (7,15,22,23). MRI techniques, such as short TE acquisition and doubled receiver bandwidth, are used to decrease coil-related artifact in both CE-MRA and TOF-MRA (21,22).…”

Section: █ Discussionmentioning

confidence: 99%

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Comparison of tof mra, contrast-enhanced mra and subtracted cta from ctp in residue evaluation of treated intracranial aneurysms

Dündar¹,

Aralaşmak²,

Özdemir³

et al. 2017

Turkish Neurosurgery

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Perfusion abnormality was noted in % 81 of clipped and none of coiled patients. Vessel visualization in the vicinity of aneurysm was better in sub-CTA, followed by CE-MRA. In clipped aneurysms, sub-CTA revealed residue aneurysms in % 16,7 of the patients while 3D-TOF-MRA and CE-MRA revealed none. In coiled aneurysms, CE-MRA revealed residue aneurysms in 100 %, and TOF-MRA in 33,3 % while sub-CTA revealed none. Although dramatic differences were noted in the evaluation of residue aneurysm as well as nearby vessel visualization, no statistical significance noted due to very few patients in subcategories Conclusion: This is first study comparing the effectiveness of CE-MRA, 3D-TOF MRA and sub-CTA in residue aneurysms evaluation. Vessel visualization in the vicinity of aneurysm was better in sub-CTA in all regardless of coiling or clipping. Residue aneurysms were more commonly revealed by CE-MRA in coiled patients and more commonly and better shown by sub-CTA in clipped patients in addition of showing perfusion abnormality that's is more common in clipped patients.

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The clinical value of ceMRA versus DSA for follow-up of intracranial aneurysms treated by coil embolization: an assessment of occlusion classifications and impact on treatment decisions

et al. 2020

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Can we now dispense with DSA in the evaluation of aneurysm occlusion even in the most crucial first follow-up after endovascular treatment?

Cited by 7 publications

References 42 publications

Application of zero echo time MR angiography in follow-up of intracranial aneurysm remnant and in-stent lumen after embolization: a comparison study with digital subtraction angiography

Application of zero echo time MR angiography in follow-up of intracranial aneurysm remnant and in-stent lumen after embolization: a comparison study with digital subtraction angiography

Comparison of tof mra, contrast-enhanced mra and subtracted cta from ctp in residue evaluation of treated intracranial aneurysms

The clinical value of ceMRA versus DSA for follow-up of intracranial aneurysms treated by coil embolization: an assessment of occlusion classifications and impact on treatment decisions

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