Follow-up of intracranial aneurysms treated with detachable coils: comparison of plain radiographs, 3D time-of-flight MRA and digital subtraction angiography

Abstract

All patients with aneurysms treated with Guglielmi detachable coils (GDC) are undergo angiography to assess long-term stability of aneurysm exclusion or to show recurrence of the aneurysm sac, which may require further treatment. We prospectively compared the plain-film appearance of the coil-mass, 3D time-of-flight MR angiography (TOF MRA) and digital subtraction angiography (DSA) for the detection of aneurysm recanalisation during follow-up. We studied 60 patients with 74 intracranial aneurysms treated with Guglielmi detachable coils. We used the unsubtracted image of the angiograms performed at the completion of any embolisation procedure and at follow-up as the plain radiographs. Recanalisation was considered if loosening, compaction or reorientation of the coil mass was apparent. TOF MRA was performed to assess the presence and size of a neck remnant. DSA was regarded as the definitive investigation. Comparison of the techniques showed good agreement as regards aneurysm recanalisation. MRA was more accurate than plain radiography and could replace DSA for long term follow- up. The initial follow-up examination should, however, include both modalities. In cases of contraindications or limitations to MRA, the interval between follow-up angiographic examinations could be increased if there is no change in the plain-film coil-mass appearances.

Efficacy of Skull Plain Films in Follow-up Evaluation of Cerebral Aneurysms Treated with Detachable Coils: Quantitative Assessment of Coil Mass

“…[14][15][16] They focused mainly on the morphologic changes of coil mass and did not provide the quantitative information for coiled aneurysms. Although Hwang et al 16 first reported the usefulness of skull plain films in the prediction of aneurysm recurrence, they did not suggest the detailed morphologic criteria.…”

“…[21][22][23] Cottier et al 15 proposed that the diagnostic performance of skull plain films was less accurate than TOF-MRA. This study also showed that P Lat and L Lat have relatively low sensitivities (62.5% and 50.0%, respectively), which means that these parameters might not be appropriate as screening tools.…”

“…[8][9][10][11][12][13] In contrast, skull plain films have been conventional imaging tools because they are simple, inexpensive, less invasive, and applicable to every patient under any circumstances. However, the efficacy of skull plain films has been infrequently reported in the follow-up imaging of coiled aneurysms, [14][15][16] in which the detailed methods used for analysis were obscure and their reliability questionable. We aimed to evaluate the efficacy of skull plain films as follow-up imaging tools of coiled aneurysms by using quantitative assessment and to compare the subgroups by clinical parameters.…”

Evaluation of angiographic computed tomography in the follow-up after endovascular treatment of cerebral aneurysms—a comparative study with DSA and TOF-MRA

“…A long-term follow-up is mandatory because there is a relevant rate of aneurysm recurrence of up to 30%, which does not always need retreatment, but, however, can be associated with a risk of rebleeding [3][4][5][6]. Many neurovascular centers perform a follow-up digital subtraction angiography (DSA) and a time-of-flight magnetic resonance angiography (TOF-MRA) at 3 to 6 months after treatment in order to continue with TOF-MRA alone, which has been shown to be sufficient in detecting recurrent aneurysms in the majority of the patients [7][8][9].…”

Long-term follow-up of endovascular coil embolization for cerebral aneurysms using three-dimensional time-of-flight magnetic resonance angiography

“…Although an MIP image is superior to show the location of the aneurysm, the resolution is not sufficient to reveal minor residual flow 15 . The relatively long acquisition time and the presence of flow-related artifacts are the limiting factors of this method 16 . In addition, there may be high-signal artifacts from intraluminal thrombus or perianeurysmal hemorrhage, which can be mistaken for flow signal ( Figure 6).…”