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Abstract

Purpose: The purpose of this study was to measure sensitivity of virtual reality (VR) in detecting biomarkers of neurovascular remodeling suboptimally evaluated in digital subtraction angiography (DSA) of treated unruptured, intracranial aneurysms. Methods: The sensitivity of virtual reality and digital subtraction angiography in detection of neurovascular biomarkers in aneurysms treated with flow diversion, coiling, and clipping were evaluated. Validated grading scales were integrated into a standardized rating platform. The respective novel and conceptual measures of minimal imaging important difference (MIID) and number needed to image (NNI) were calculated for each biomarker. Results: In flow diversion, coiling, and clipping, minimal imaging important difference and number needed to image were associated with virtual reality in detection of abnormal biomarkers, with the exception of stasis phase associated with digital subtraction angiography. Number needed to image was associated with flow diversion stent stenosis (RR: 7.00, 95% CI 0.37 to 131.97; OR: 7.46, 95% CI 0.38 to 148.49). Minimal imaging important difference was greatest in residual aneurysm filling (25%±8.66, 95% CI) in flow diversion and Meyer score in coiling (42.5%±17.69, 95% CI) and clipping (22.2%±13.58, 95% CI). Regression models demonstrated minimal imaging important difference and number needed to image shared a significant correlation (R 2 0.99, 95% CI, p<0.001). Conclusion: Virtual reality adds value to digital subtraction angiography in evaluation of aneurysms treated with flow diversion, coiling, and clipping. Larger, prospective studies are warranted to increase statistical power and validate clinical significance.