Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated with the WEB Device

Abstract

Despite acceptable interobserver reproducibility and predictive values, the low sensitivity of contrast-enhanced MRA and 3D-TOF-MRA for aneurysm remnant detection suggests that MRA is a useful screening procedure for WEB-treated aneurysms, but similar to stents and flow diverters, DSA remains the criterion standard for follow-up.

Safety and Efficacy of Aneurysm Treatment with the WEB: Results of the WEBCAST 2 Study

“…24,25 Finally, anatomic results were evaluated with heterogeneous imaging techniques (DSA, MRA, and CTA), and MRA has a relatively low sensitivity for aneurysm remnant detection. 26…”

Multiparametric MRI of intracranial aneurysms treated with the Woven EndoBridge (WEB): a case of Faraday’s cage?

“…They found that CE-MRA alone is not sufficient for detection of inadequately occluded intracranial aneurysms, however the examined cohort comprised only 15 patients 4. Timsit et al 12 also postulated that follow-up with CE-MRA and 3D-TOF MRA after WEB device treatment is not satisfactory for the detection of aneurysm remnant due to signal loss in MRA, and DSA remains the criterion standard for follow-up. All these methods seem sufficient to depict a relevant relapse but none of the methods—apart from DSA—would be suitable to confirm stable early thrombus formation within the WEB.…”

“…Overall short- and mid-term follow-up showed complete occlusion rates of 84% initially and 76% at mid-term follow-up, which is consistent with previous publications, as is the agreement between the modalities 4 12. Since our objective in evaluating occlusion rates was not to reproduce the work of Timsit et al ,12 inter-rater reliability testing was not performed.…”

CT Angiography in Occlusion Assessment of Intracranial Aneurysms Treated with the WEB Device

“…Mine et al compared CE‐MRA on a 1.5 T device and DSA for follow‐up of intracranial aneurysms treated with the WEB DL system and found excellent (κ = .809) interobserver agreement for MRA and good (κ = .669) intertechnique agreement. However, Timsit et al found only fair intermodality agreement with DSA with both CE‐MRA (κ = .36) and 3‐dimensional‐TOF‐MRA (κ = .36) on a 3T scanner for evaluation of total occlusion.…”

“…Digital subtraction angiography (DSA) has been accepted as the gold standard in the follow‐up of aneurysms treated with the WEB device but there are unresolved issues in the literature regarding the choice of noninvasive imaging modality in the mid‐ and long‐term follow‐up of patients. There are already published studies focusing on time‐of‐flight (TOF) and contrast‐enhanced (CE) magnetic resonance angiography (MRA) which showed promising results but the capabilities of the computed tomography angiography (CTA) has not been thoroughly investigated yet . To the best of our knowledge, there is only one study in the literature evaluating the role of CTA in patients treated with WEB .…”