Ultrashort Echo Time Magnetic Resonance Angiography in Follow-up of Intracranial Aneurysms Treated With Endovascular Coiling: Comparison of Time-of-Flight, Pointwise Encoding Time Reduction With Radial Acquisition, and Contrast-Enhanced Magnetic Resonance Angiography

You, Sung-Hye; Kim, Byung Jun; Yang, Kyung-Sook; Kim, Bo Kyu; Ryu, Joo-Hyung

doi:10.1093/neuros/nyaa467

Cited by 15 publications

(25 citation statements)

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“…Therefore, noninvasive imaging techniques are frequently preferred because procedure-related risks may accumulate when procedures are repeated over the follow-up period [ 5 ]. In previous studies, non-contrast-enhanced (CE) MRA using the Silent Scan algorithm (Silent MRA) or pointwise encoding time reduction with radial acquisition with subtraction-based MRA has been introduced as an imaging modality for the follow-up of treated intracranial aneurysms that can overcome the disadvantages of TOF MRA [ 7 8 9 10 11 12 13 ].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization

et al. 2022

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Objective To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. Materials and Methods Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. Results The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively ( p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). Conclusion Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.

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Section: Introductionmentioning

confidence: 99%

Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization

et al. 2022

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“…Computed tomography angiography is limited for post-stenting evaluation due to metal beam hardening artifact obscuring luminal evaluation ( 14 ). Traditional MRA methods including CE-MRA and 3D-TOF-MRA are limited due to susceptibility artifacts that create signal voids around the stent, overestimating the degree of stenosis ( 15 , 32 ). To the best of our knowledge, no studies have been published evaluating PETRA-MRA for post-stenting evaluation of intracranial stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, no studies have been published evaluating PETRA-MRA for post-stenting evaluation of intracranial stenosis. However, there have been a few studies evaluating PETRA-MRA for stent-assistant coiling for intracranial aneurysms ( 15 , 20 ). You et al evaluated 61 patients who underwent stent-assisted coiling of an intracranial aneurysm with zero-TE MRA (a technique comparable to PETRA-MRA), CE-MRA, 3D-TOF-MRA, and DSA ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been a few studies evaluating PETRA-MRA for stent-assistant coiling for intracranial aneurysms ( 15 , 20 ). You et al evaluated 61 patients who underwent stent-assisted coiling of an intracranial aneurysm with zero-TE MRA (a technique comparable to PETRA-MRA), CE-MRA, 3D-TOF-MRA, and DSA ( 15 ). They found zero-TE MRA had the best visualization of in-stent flow and performed better than CE-MRA and 3D-TOF-MRA.…”

Section: Discussionmentioning

confidence: 99%

“…Post-stenting arterial segment evaluation is also important considering the re-stenosis rate after stenting is 11.9-17.9% (12). This evaluation, however, is challenging for CTA, CE-MRA, and 3D-TOF-MRA due to beam hardening artifacts or magnetic susceptibility artifacts (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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The Use of Pointwise Encoding Time Reduction With Radial Acquisition MRA to Assess Middle Cerebral Artery Stenosis Pre- and Post-stent Angioplasty: Comparison With 3D Time-of-Flight MRA and DSA

Zhang

Ran

Zhu

et al. 2021

Front. Cardiovasc. Med.

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Background and Purpose: 3D pointwise encoding time reduction magnetic resonance angiography (PETRA-MRA) is a promising non-contrast magnetic resonance angiography (MRA) technique for intracranial stenosis assessment but it has not been adequately validated against digital subtraction angiography (DSA) relative to 3D-time-of-flight (3D-TOF) MRA. The aim of this study was to compare PETRA-MRA and 3D-TOF-MRA using DSA as the reference standard for intracranial stenosis assessment before and after angioplasty and stenting in patients with middle cerebral artery (MCA) stenosis.Materials and Methods: Sixty-two patients with MCA stenosis (age 53 ± 12 years, 43 males) underwent MRA and DSA within a week for pre-intervention evaluation and 32 of them had intracranial angioplasty and stenting performed. The MRAs' image quality, flow visualization within the stents, and susceptibility artifact were graded on a 1–4 scale (1 = poor, 4 = excellent) independently by three radiologists. The degree of stenosis was measured by two radiologists independently on DSA and MRAs.Results: There was an excellent inter-observer agreement for stenosis assessment on PETRA-MRA, 3D-TOF-MRA, and DSA (ICCs > 0.90). For pre-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA (3.87 ± 0.34 vs. 3.38 ± 0.65, P < 0.001), and PETRA-MRA had better agreement with DSA for stenosis measurements compared to 3D-TOF-MRA (r = 0.96 vs. r = 0.85). For post-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA for in-stent flow visualization and susceptibility artifacts (3.34 ± 0.60 vs. 1.50 ± 0.76, P < 0.001; 3.31 ± 0.64 vs. 1.41 ± 0.61, P < 0.001, respectively), and better agreement with DSA for stenosis measurements than 3D-TOF-MRA (r = 0.90 vs. r = 0.26). 3D-TOF-MRA significantly overestimated the stenosis post-stenting compared to DSA (84.9 ± 19.7 vs. 39.3 ± 13.6%, p < 0.001) while PETRA-MRA didn't (40.6 ± 13.7 vs. 39.3 ± 13.6%, p = 0.18).Conclusions: PETRA-MRA is accurate and reproducible for quantifying MCA stenosis both pre- and post-stenting compared with DSA and performs better than 3D-TOF-MRA.

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Synthetic Time of Flight Magnetic Resonance Angiography Generation Model Based on Cycle‐Consistent Generative Adversarial Network Using PETRA‐MRA in the Patients With Treated Intracranial Aneurysm

You

Cho

Kim

et al. 2022

Magnetic Resonance Imaging

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Background Pointwise encoding time reduction with radial acquisition (PETRA) magnetic resonance angiography (MRA) is useful for evaluating intracranial aneurysm recurrence, but the problem of severe background noise and low peripheral signal‐to‐noise ratio (SNR) remain. Deep learning could reduce noise using high‐ and low‐quality images. Purpose To develop a cycle‐consistent generative adversarial network (cycleGAN)‐based deep learning model to generate synthetic TOF (synTOF) using PETRA. Study type Retrospective. Population A total of 377 patients (mean age: 60 ± 11; 293 females) with treated intracranial aneurysms who underwent both PETRA and TOF from October 2017 to January 2021. Data were randomly divided into training (49.9%, 188/377) and validation (50.1%, 189/377) groups. Field Strength/Sequence Ultra‐short echo time and TOF‐MRA on a 3‐T MR system. Assessment For the cycleGAN model, the peak SNR (PSNR) and structural similarity (SSIM) were evaluated. Image quality was compared qualitatively (5‐point Likert scale) and quantitatively (SNR). A multireader diagnostic optimality evaluation was performed with 17 radiologists (experience of 1–18 years). Statistical Tests Generalized estimating equation analysis, Friedman's test, McNemar test, and Spearman's rank correlation. P < 0.05 indicated statistical significance. Results The PSNR and SSIM between synTOF and TOF were 17.51 [16.76; 18.31] dB and 0.71 ± 0.02. The median values of overall image quality, noise, sharpness, and vascular conspicuity were significantly higher for synTOF than for PETRA (4.00 [4.00; 5.00] vs. 4.00 [3.00; 4.00]; 5.00 [4.00; 5.00] vs. 3.00 [2.00; 4.00]; 4.00 [4.00; 4.00] vs. 4.00 [3.00; 4.00]; 3.00 [3.00; 4.00] vs. 3.00 [2.00; 3.00]). The SNRs of the middle cerebral arteries were the highest for synTOF (synTOF vs. TOF vs. PETRA; 63.67 [43.25; 105.00] vs. 52.42 [32.88; 74.67] vs. 21.05 [12.34; 37.88]). In the multireader evaluation, there was no significant difference in diagnostic optimality or preference between synTOF and TOF (19.00 [18.00; 19.00] vs. 20.00 [18.00; 20.00], P = 0.510; 8.00 [6.00; 11.00] vs. 11.00 [9.00, 14.00], P = 1.000). Data Conclusion The cycleGAN‐based deep learning model provided synTOF free from background artifact. The synTOF could be a versatile alternative to TOF in patients who have undergone PETRA for evaluating treated aneurysms. Evidence Level 4 Technical Efficacy Stage 1

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Ultrashort Echo Time Magnetic Resonance Angiography in Follow-up of Intracranial Aneurysms Treated With Endovascular Coiling: Comparison of Time-of-Flight, Pointwise Encoding Time Reduction With Radial Acquisition, and Contrast-Enhanced Magnetic Resonance Angiography

Cited by 15 publications

References 25 publications

Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization

Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization

The Use of Pointwise Encoding Time Reduction With Radial Acquisition MRA to Assess Middle Cerebral Artery Stenosis Pre- and Post-stent Angioplasty: Comparison With 3D Time-of-Flight MRA and DSA

Synthetic Time of Flight Magnetic Resonance Angiography Generation Model Based on Cycle‐Consistent Generative Adversarial Network Using PETRA‐MRA in the Patients With Treated Intracranial Aneurysm

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