Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review

Turan, Nefize; Heider, Robert A.; Roy, Anil K.; Miller, Brandon A.; Mullins, Mark E.; Barrow, Daniel L.; Grossberg, Jonathan A; Pradilla, Gustavo

doi:10.1016/j.wneu.2018.01.054

Cited by 32 publications

(28 citation statements)

References 84 publications

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“…Diagnosis of unruptured aneurysms is a critically important clinical task: intracranial aneurysms occur in 1% to 3% of the population and account for more than 80% of nontraumatic life-threatening subarachnoid hemorrhages. 1 Computed tomographic angiography (CTA) is the primary, minimally invasive imaging modality currently used for diagnosis, surveillance, and presurgical planning of intracranial aneurysms, 2 , 3 but interpretation is time consuming even for subspecialty-trained neuroradiologists. Low interrater agreement poses an additional challenge for reliable diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Deep Learning–Assisted Diagnosis of Cerebral Aneurysms Using the HeadXNet Model

et al. 2019

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Key Points Question How does augmentation with a deep learning segmentation model influence the performance of clinicians in identifying intracranial aneurysms from computed tomographic angiography examinations? Findings In this diagnostic study of intracranial aneurysms, a test set of 115 examinations was reviewed once with model augmentation and once without in a randomized order by 8 clinicians. The clinicians showed significant increases in sensitivity, accuracy, and interrater agreement when augmented with neural network model–generated segmentations. Meaning This study suggests that the performance of clinicians in the detection of intracranial aneurysms can be improved by augmentation using deep learning segmentation models.

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Section: Introductionmentioning

confidence: 99%

Deep Learning–Assisted Diagnosis of Cerebral Aneurysms Using the HeadXNet Model

et al. 2019

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“…2,27,28 The sensitivity of CTA and MRA in detecting small (,3mm) aneurysms is inferior to that of DSA. 29 The accuracy of these noninvasive imaging modalities in determining ,1-mm caliber changes in the middle and distal branches is insufficient compared with DSA. The objective DSA quantification of changes in the diameter of vascular segments after the administration of IA verapamil demonstrated high accuracy in detecting RCVS (Fig 3).…”

Section: Discussionmentioning

confidence: 99%

Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome

Sequeiros

Roa

Sabotin

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: There is mounting evidence supporting the benefit of intra-arterial administration of vasodilators in diagnosing reversible cerebral vasoconstriction syndrome. We prospectively quantified the degree of luminal diameter dilation after intra-arterial administration of verapamil and its accuracy in diagnosing reversible cerebral vasoconstriction syndrome. MATERIALS AND METHODS:Patients suspected of having intracranial arteriopathy on noninvasive imaging and referred for digital subtraction angiography were enrolled in a prospective registry. Intra-arterial verapamil was administered in vascular territories with segmental irregularities. The caliber difference (Caliber post À Caliber pre ) and the proportion of caliber change ([(Caliber post À Caliber pre )/Caliber pre ] Â 100%) were used to determine the response to verapamil. The diagnosis of reversible cerebral vasoconstriction syndrome was made on the basis of clinical and imaging features at a follow-up appointment, independent of the reversibility of verapamil. Receiver operating characteristic curve analysis was performed to determine the best threshold.RESULTS: Twenty-six patients were included, and 9 (34.6%) were diagnosed with reversible cerebral vasoconstriction syndrome. A total of 213 vascular segments were assessed on diagnostic angiography. Every patient with a final diagnosis of reversible cerebral vasoconstriction syndrome responded to intra-arterial verapamil. The maximal proportion of change (P , .001), mean proportion of change (P ¼ .002), maximal caliber difference (P ¼ .004), and mean caliber difference (P ¼ .001) were statistically different between patients with reversible cerebral vasoconstriction syndrome and other vasculopathies. A maximal proportion of change $32% showed a sensitivity of 100% and a specificity of 88.2% to detect reversible cerebral vasoconstriction syndrome (area under the curve ¼ 0.951). The Reversible Cerebral Vasoconstriction Syndrome-2 score of $5 points achieved a lower area under the curve (0.908), with a sensitivity of 77.8% and a specificity of 94.1%. CONCLUSIONS:Objective measurement of the change in the arterial calibers after intra-arterial verapamil is accurate in distinguishing reversible cerebral vasoconstriction syndrome from other vasculopathies. A proportion of change $32% has the best diagnostic performance.ABBREVIATIONS: AUC ¼ area under the curve; CD ¼ caliber difference; IA ¼ intra-arterial; ICAD ¼ intracranial atherosclerotic disease; DSA ¼ digital subtraction angiography; PACNS ¼ primary angiitis of the central nervous system; PC ¼ proportion of change; RCVS ¼ reversible cerebral vasoconstriction syndrome; ROC ¼ receiver operating characteristic; TCH ¼ thunderclap headache

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“…To alleviate this issue, gadolinium-enhanced MRA (GE-MRA) can be performed as it is flow-independent (18)(19)(20). Both TOF-and GE-MRA have 95% sensitivity compared to DSA (6). Recently, 7T MRA has been evaluated in the study of IA.…”

Section: Morphological Imagingmentioning

confidence: 99%

Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye

Maupu

Lebas

Boulaftali

2022

Front. Cardiovasc. Med.

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Intracranial aneurysms (IA) are often asymptomatic and have a prevalence of 3 to 5% in the adult population. The risk of IA rupture is low, however when it occurs half of the patients dies from subarachnoid hemorrhage (SAH). To avoid this fatal evolution, the main treatment is an invasive surgical procedure, which is considered to be at high risk of rupture. This risk score of IA rupture is evaluated mainly according to its size and location. Therefore, angiography and anatomic imaging of the intracranial aneurysm are crucial for its diagnosis. Moreover, it has become obvious in recent years that several other factors are implied in this complication, such as the blood flow complexity or inflammation. These recent findings lead to the development of new IA imaging tools such as vessel wall imaging, 4D-MRI, or molecular MRI to visualize inflammation at the site of IA in human and animal models. In this review, we will summarize IA imaging techniques used for the patients and those currently in development.

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Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review

Cited by 32 publications

References 84 publications

Deep Learning–Assisted Diagnosis of Cerebral Aneurysms Using the HeadXNet Model

Deep Learning–Assisted Diagnosis of Cerebral Aneurysms Using the HeadXNet Model

Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome

Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye

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