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Jagadeesan B, Tariq F, Nada A, Bhatti IA, Masood K, Siddiq F. Principles Behind 4D Time-Resolved MRA/Dynamic MRA in Neurovascular Imaging. Semin Roentgenol 2024; 59:191-202. [PMID: 38880517 DOI: 10.1053/j.ro.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Bharathi Jagadeesan
- Departments of Radiology, Neurology and Neurosurgery, University of Minnesota, Minneapolis, MN.
| | - Farzana Tariq
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Ayman Nada
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Ibrahim A Bhatti
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Kamran Masood
- Departments of Radiology, Neurology and Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Farhan Siddiq
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
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Quan T, Ren Y, Li J, Fu X, Jin Y, Ran Y, Guan S, Cheng J, Xu H. Enhanced vessel wall magnetic resonance imaging in the follow-up of intracranial aneurysms treated with flow diversion. Eur Radiol 2024; 34:833-841. [PMID: 37580600 DOI: 10.1007/s00330-023-10094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy of enhanced 3D T1-weighted black-blood fast-spin-echo vessel wall magnetic resonance imaging (eVW-MRI) and time-of-flight magnetic resonance angiography (TOF MRA) for follow-up evaluation of aneurysms treated with flow diversion (FD). METHODS Our study enrolled 77 patients harboring 84 aneurysms treated with FD. Follow-up was by MRI (eVW-MRI and TOF MRA) and digital subtraction angiography (DSA). Two radiologists, blinded to DSA examination results, independently evaluated the images of aneurysm occlusion and parent artery patency using the Kamran-Byrne Scale. Interobserver diagnostic agreement and intermodality diagnostic agreement were acquired. Pretreatment and follow-up aneurysm wall enhancement (AWE) patterns were collected. RESULTS Based on the Kamran-Byrne Scale, the intermodality agreement between eVW-MRI and DSA was better than TOF MRA versus DSA for aneurysm remnant detection (weighted ĸ = 0.891 v. 0.553) and parent artery patency (ĸ = 0.950 v. 0.221). Even with the coil artifact, the consistency of eVW-MRI with DSA for aneurysm remnant detection was better than that of TOF MRA (weighted ĸ = 0.891 v. 0.511). The artifact of adjunctive coils might be more likely to affect the accuracy in evaluating parent artery patency with TOF MRA than with eVW-MRI (ĸ = 0.077 v. 0.788). The follow-up AWE patterns were not significantly associated with pretreatment AWE patterns and aneurysm occlusion. CONCLUSIONS The eVW-MRI outperforms TOF MRA as a reliable noninvasive and nonionizing radioactive imaging method for evaluating aneurysm remnants and parent artery patency after FD. The significance of enhancement patterns on eVW-MRI sequences needs more exploration. CLINICAL RELEVANCE STATEMENT The application of enhanced vessel wall magnetic resonance imaging has proven to be a promising tool to depict aneurysm remnant and parent artery stenosis in order to tailor the antiplatelet therapy strategy in patients after flow diversion. KEY POINTS • Enhanced vessel wall magnetic resonance imaging has an emerging role in depicting aneurysm remnant and parent artery patency after flow diversion. • With or without the artifact from adjunctive coils, enhanced vessel wall magnetic resonance imaging was better than TOF MRA in detecting aneurysm residual and parent artery stenosis by using DSA imaging as the standard. • Enhanced vessel wall magnetic resonance imaging holds potential to be used as an alternative to DSA for routine aneurysm follow-up after flow diversion.
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Affiliation(s)
- Tao Quan
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Yanan Ren
- Departments of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jinyi Li
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xiaojie Fu
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yazhou Jin
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yuncai Ran
- Departments of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jingliang Cheng
- Departments of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Haowen Xu
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Li Y, Zhu Y, Liu Y, Li G, Qu X. Comparative Study of the Diagnostic Value of Zero-Echo-Time Magnetic Resonance Angiography With Time-of-Flight Magnetic Resonance Angiography for Intracranial Aneurysm. J Comput Assist Tomogr 2024; 48:169-174. [PMID: 37531630 DOI: 10.1097/rct.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Intracranial aneurysm (IAN) is a class of cerebrovascular diseases with a serious threat to patients, and an accurate diagnosis of IAN is very important for both selection of the appropriate therapy and prediction of the prognosis. This study aimed to evaluate the diagnostic values of zero-echo-time magnetic resonance angiography (ZTE-MRA) and time-of-flight magnetic resonance angiography (TOF-MRA) in patients with IAN. METHODS Digital subtraction angiography, ZTE-MRA, and TOF-MRA were performed in 18 patients diagnosed with IAN. The images of ZTE-MRA and TOF-MRA were compared for image quality, qualitative diagnosis, detailed diagnosis, number of thrombi, and residual aneurysm lumen, with digital subtraction angiography as the reference. RESULTS Zero-echo-time MRA and TOF-MRA did not show a significant difference in image quality or detailed information (including aneurysm size, growth direction, and angle with the aneurysm-carrying vessel) ( P > 0.05). However, ZTE-MRA showed advantages over TOF-MRA in terms of qualitative diagnosis (sensitivity and specificity), intra-aneurismal thrombus detection, and residual aneurysm lumen detection after embolization ( P < 0.05). CONCLUSIONS Compared with TOF-MRA, ZTE-MRA showed greater diagnostic value for IAN patients in terms of qualitative diagnosis, as well as the detection of intra-aneurysm thrombi and residual aneurysm lumen after embolization.
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Affiliation(s)
- Yushi Li
- From the Department of Radiology, The Second Hospital, Dalian Medical University, Dalian
| | - Yifeng Zhu
- From the Department of Radiology, The Second Hospital, Dalian Medical University, Dalian
| | - Yajie Liu
- From the Department of Radiology, The Second Hospital, Dalian Medical University, Dalian
| | - Ge Li
- Department of Oncology, Yankuang New Journey General Hospital, Jining, China
| | - Xiaofeng Qu
- From the Department of Radiology, The Second Hospital, Dalian Medical University, Dalian
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Senger S, Fischer G, Mühl-Benninghaus R, Backens M, Reisel JR, Fritz T, Brack A, Reith W, Oertel J. Development and Evaluation of an MRI Artifact-Free Aneurysm Clip. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-01002. [PMID: 38112448 DOI: 10.1227/ons.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The digital subtraction angiography is still the gold standard in the follow-up after aneurysm surgery, although it remains a repeating invasive technique with accumulating X-ray exposure. An alternative magnetic resonance angiography has the disadvantage of metal-related artifacts. A metal-free aneurysm clip could overcome this problem. Recent advances in manufacturing technologies of fiber-reinforced plastics might allow developing a prototype of a metal-free clip. METHODS The prototype was formed out of carbon fiber-reinforced polyetheretherketone (CF-PEEK) in accordance with the standard clip design. In vivo and in vitro studies were performed to analyze the central nervous system biocompatibility. The prototype was tested in a phantom in a 3 T MRI scanner and microtomography scanner. For in vivo assessment, the left renal artery of rats was either ligated with a suture, clipped with a regular titanium clip or with the CF-PEEK prototype clip. The animals underwent standard MRI sequences and magnetic resonance angiography and assessment by a blinded neuroradiologist. RESULTS Phantom studies showed no signs of artifacts. The prototype showed a reliable clamping and reopening after clip application, although the clamping force was reduced. In vivo studies showed a successful occlusion of the renal artery in all cases in the magnetic resonance angiography. Clip artifacts were statistically significant reduced in the prototype group (P < .01). CF-PEEK showed no signs of impaired biocompatibility compared with the titanium samples in vitro and in vivo. CONCLUSION Former attempts of metal-free aneurysm clips did not meet the criteria of the standard clip design. In this study, the practicability of this new CF-PEEK artifact-free aneurysm clip has been proven. The further fabrication developments should overcome the problem of a reduced clamping force in the future. After clinical approval, it will improve the magnetic resonance image quality and might help to reduce the amount of digital subtraction angiography in the follow-up.
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Affiliation(s)
- Sebastian Senger
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
| | - Gerrit Fischer
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
| | | | - Martin Backens
- Department of Neuroradiology, Medical School Saarland University, Homburg, Germany
| | - Jan René Reisel
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
| | - Tobias Fritz
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Homburg, Germany
| | - Alexander Brack
- Fraunhofer Institute for Production Technology IPT, Aachen, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Medical School Saarland University, Homburg, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
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Togao O, Obara M, Yamashita K, Kikuchi K, Wada T, Murazaki H, Arimura K, Nishimura A, Horie N, van de Ven K, Van Cauteren M, Ishigami K. Arterial Spin Labeling-Based MR Angiography for Cerebrovascular Diseases: Principles and Clinical Applications. J Magn Reson Imaging 2023. [PMID: 37937684 DOI: 10.1002/jmri.29119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
Arterial spin labeling (ASL) is a noninvasive imaging technique that labels the proton spins in arterial blood and uses them as endogenous tracers. Brain perfusion imaging with ASL is becoming increasingly common in clinical practice, and clinical applications of ASL for intracranial magnetic resonance angiography (MRA) have also been demonstrated. Unlike computed tomography (CT) angiography and cerebral angiography, ASL-based MRA does not require contrast agents. ASL-based MRA overcomes most of the disadvantages of time-of-flight (TOF) MRA. Several schemes have been developed for ASL-based MRA; the most common method has been pulsed ASL, but more recently pseudo-continuous ASL, which provides a higher signal-to-noise ratio (SNR), has been used more frequently. New methods that have been developed include direct intracranial labeling methods such as velocity-selective ASL and acceleration-selective ASL. MRA using an extremely short echo time (eg, silent MRA) or ultrashort echo-time (TE) MRA can suppress metal susceptibility artifacts and is ideal for patients with a metallic device implanted in a cerebral vessel. Vessel-selective 4D ASL MRA can provide digital subtraction angiography (DSA)-like images. This review highlights the principles, clinical applications, and characteristics of various ASL-based MRA techniques. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Osamu Togao
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazufumi Kikuchi
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuhiro Wada
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroo Murazaki
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tan S, Lu Y, Li B, Yang Q, Zhou X, Wang Y. Diagnostic performance of silent magnetic resonance angiography for endovascularly-treated intracranial aneurysm follow-up: a prospective study. J Neurointerv Surg 2023; 15:608-613. [PMID: 35478174 DOI: 10.1136/neurintsurg-2022-018726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple studies have reported the clinical usefulness of silent magnetic resonance angiography (MRA) in the follow-up of endovascularly-treated aneurysms. However, most previous studies were retrospective or with small sample sizes. The objective of this study was to prospectively evaluate the diagnostic performance of silent MRA in the follow-up of intracranial aneurysms treated by different interventional approaches. METHODS Patients with endovascularly-treated intracranial aneurysms and followed by silent MRA and digital subtraction angiography (DSA) were enrolled. The visualization of treated sites on silent MRA was rated on a 5-point scale. The aneurysm occlusion status was evaluated using the Raymond Scale and a simplified two-grade scale. RESULTS A total of 155 patients with 175 treated aneurysms were enrolled. The average score for the visualization of treated sites was 3.92±0.94, and 93.7% (164/175) had a score ≥3. In the subgroup analysis, except for the simple coiling group which had an obviously higher score (4.95±0.21), there was no significant difference among the stent-assisted coiling group (3.51±0.77), flow diversion group (3.74±0.80), and flow diversion with coiling group (3.40±1.17). Regarding aneurysm occlusion status, silent MRA and DSA were discordant for only one aneurysm using the Raymond Scale, and the inter-modality consistency was almost perfect (κ=0.992, 95% CI 0.977 to 1.000). CONCLUSIONS Silent MRA showed an excellent diagnostic performance in the follow-up of endovascularly-treated intracranial aneurysms, and may be an ideal option for repeated examinations.
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Affiliation(s)
- Song Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Beijing, China
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Heo YJ, Kim D, Jeong HW, Baek JW, Kim DS, Shin GW, Han JY, Kim ST, Jeong YG. Usefulness of Pointwise Encoding Time Reduction with Radial Acquisition-Magnetic Resonance Angiography after Endovascular Treatment for Intracranial Aneurysms. Interv Neuroradiol 2023; 29:20-29. [PMID: 34913378 PMCID: PMC9893233 DOI: 10.1177/15910199211065906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/19/2021] [Accepted: 11/18/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Imaging follow-up after endovascular treatment is important; however, time-of-flight magnetic resonance angiography (TOF-MRA) has limitations associated with magnetic susceptibility and radiofrequency shielding caused by the stent and coils. We evaluated the diagnostic performance of pointwise encoding time reduction with radial acquisition (PETRA)-MRA after endovascular treatment for intracranial aneurysms. MATERIAL AND METHODS A total of 186 patients with 211 aneurysms who underwent both pointwise encoding time reduction with radial acquisition- and time-of-flight magnetic resonance angiography in the same imaging session for follow-up after endovascular treatment. We subjectively graded the overall image quality, visualization of treated sites, and occlusion status. RESULTS Although the overall image quality scores of pointwise encoding time reduction with radial acquisition-magnetic resonance angiography were significantly lower than those of time-of-flight magnetic resonance angiography for both observers (4.04 ± 0.81 vs. 4.85 ± 0.35 [observer 1], 4.60 ± 0.69 vs. 4.94 ± 0.24 [observer 2]) (both P < .001), the visibility of treated sites using pointwise encoding time reduction with radial acquisition-magnetic resonance angiography was significantly better than that of time-of-flight magnetic resonance angiography overall (4.27 ± 0.97 vs. 3.42 ± 1.01; P < .001), in the distal internal carotid artery (4.46 ± 0.79 vs. 3.40 ± 1.00; P < .001), and in the middle cerebral artery (4.19 ± 0.93 vs. 3.08 ± 0.53, P = 0.007). Pointwise encoding time reduction with radial acquisition-magnetic resonance angiography showed a higher area under the curve than time-of-flight magnetic resonance angiography for the evaluation of treated aneurysm occlusion, except for posterior circulation aneurysms. CONCLUSIONS Pointwise encoding time reduction with radial acquisition-magnetic resonance angiography showed better visualization of treated sites and better diagnostic performance than time-of-flight magnetic resonance angiography for anterior circulation aneurysms. However, Pointwise encoding time reduction with radial acquisition-magnetic resonance angiography showed limitations in the follow-up evaluation of posterior circulation aneurysms.
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Affiliation(s)
- Young Jin Heo
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Donghyun Kim
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Jin Wook Baek
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Da Som Kim
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Gi Won Shin
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Ji-yeon Han
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Inje University Busan Paik
Hospital, Busan, Korea
| | - Young Gyun Jeong
- Department of Neurosurgery, Inje University Busan Paik
Hospital, Busan, Korea
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Marazzi TBM, Mendes PV. Updates on aneurysmal subarachnoid hemorrhage: is there anything really new? ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:80-87. [PMID: 35976291 PMCID: PMC9491434 DOI: 10.1590/0004-282x-anp-2022-s101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a severe disease, with systemic involvement and complex diagnosis and treatment. Since the current guidelines were published by the AHA/ASA, Neurocritical Care Society and the European Stroke Organization in 2012-2013,there has been an evolution in the comprehension of SAH-associated brain injury and its multiple underlying mechanisms. As a result, several clinical and translational trials were developed or are underway. Objective: The aim of this article is to review some updates in the diagnosis and treatment of neurological complications of SAH. Methods: A review of PubMed (May, 2010 to February, 2022) was performed. Data was summarized. Results: Content of five meta-analyses, nine review articles and 23 new clinical trials, including pilots, were summarized. Conclusions:Advances in the comprehension of pathophysiology and improvements in critical care have been reflected in the reduction of mortality in SAH. However, despite the number of publications, the only treatments shown to be effective in adequate, well-controlled clinical trials are nimodipine and repair of the ruptured aneurysm. Thus, doubts about the optimal management of SAH still persist.
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Affiliation(s)
| | - Pedro Vitale Mendes
- Universidade de São Paulo, Departamento de Emergências Clínicas, São Paulo SP, Brazil
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Li R, Jin S, Wu T, Zang X, Li M, Li J. Usefulness of silent magnetic resonance angiography (MRA) for the diagnosis of atherosclerosis of the internal carotid artery siphon in comparison with time-of-flight MRA. Eur J Med Res 2022; 27:44. [PMID: 35314001 PMCID: PMC8935786 DOI: 10.1186/s40001-022-00673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background and purpose Flow visualization in 3D time-of-flight MRA (3D-TOF MRA) may be limited for internal carotid artery siphon owing to turbulent artifact. The purpose of this study was to compare the usefulness of Silent MRA and 3D-TOF MRA to assess atherosclerosis of the internal carotid artery siphon. Material and methods A total of 106 patients with suspected cerebrovascular disease were included. All patients were scanned with Silent MRA and 3D-TOF MRA sequences and also underwent DSA examination. Two observers independently assessed the TOF MRA and Silent MRA images of atherosclerosis of the internal carotid artery siphon. The diagnostic efficacy of two MRA methods in evaluating atherosclerosis of the carotid siphon was performed by using receiver operating characteristic (ROC) curve analysis. Interobserver reliability was also assessed using weighted kappa statistics. Results Image of Silent MRA sequence had higher subjective evaluation scores and significantly high CNR between the carotid siphon and the background tissues than the image of 3D-TOF MRA sequence (P < 0.05). The AUC was 0.928 (95% CI 0.909–0.986) for Silent MRA, which was significantly higher than that of 3D-TOF MRA (0.671, 95% CI 0.610–0.801, P < 0.05). Silent MRA had high sensitivity, specificity and accuracy than 3D-TOF MRA for visualization of the carotid siphon. Conclusions Silent MRA as a new angiographic modality is superior to 3D-TOF MRA for visualization of the carotid siphon, and maybe an alternative to 3D-TOF MRA in the diagnosis of atherosclerosis of the carotid siphon.
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Affiliation(s)
- Rui Li
- Department of Medical Imaging, Tianjin Huanhu Hospital, 6 Jizhao Road, Tianjin, 300350, China.,Department of Medical Imaging, Affiliated Huanhu Hospital of Nankai University, 6 Jizhao Road, Tianjin, 300350, China
| | - Song Jin
- Department of Medical Imaging, Tianjin Huanhu Hospital, 6 Jizhao Road, Tianjin, 300350, China.,Department of Medical Imaging, Affiliated Huanhu Hospital of Nankai University, 6 Jizhao Road, Tianjin, 300350, China
| | - Tao Wu
- GE Healthcare MR Enhanced Application Team, 1 Tongji South Road, Beijing, 100176, China
| | - Xiao Zang
- Department of Radiology, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Meng Li
- Department of Radiology, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jinfeng Li
- Department of Radiology, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Kim YN, Choi JW, Lim YC, Song J, Park JH, Jung WS. Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization. Korean J Radiol 2022; 23:246-255. [PMID: 35029075 PMCID: PMC8814699 DOI: 10.3348/kjr.2021.0332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/15/2022] Open
Abstract
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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Affiliation(s)
- You Na Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jihye Song
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Hyun Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.,Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea.
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Tan S, Lu Y, Li B, Wu Q, Zhou X, Wang Y. Usefulness of Silent Magnetic Resonance Angiography in the Follow-Up of Endovascular-Treated Intracranial Aneurysm: A Prospective Study. J Stroke Cerebrovasc Dis 2021; 31:106256. [PMID: 34923434 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To prospectively evaluate the clinical usefulness of Silent magnetic resonance angiography (Silent MRA) in the follow-up of endovascular-treated intracranial aneurysms by comparing it with time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA). METHODS Patients with endovascular-treated saccular aneurysms and followed with Silent MRA, TOF MRA, and DSA in our center were included. The visualization of the treated sites in the two MRA sequences was assessed using a 5-point scale. The aneurysm occlusion status according to each of the three imaging modalities was assessed using a 3-point scale. RESULTS Forty-one patients with 46 saccular aneurysms were recruited. The image quality score of Silent MRA was significantly higher than that of TOF MRA (4.32 ± 0.87 vs. 3.08 ± 1.48, P < 0.001). In the aneurysms treated by simple coiling, the maximal aneurysm diameter showed a strong negative correlation with image quality score in TOF MRA (Spearman's r = -0.519, P = 0.033), while it showed no significant correlation in Silent MRA (r = -0.037, P = 0.887). For the aneurysm occlusion status, inter-modality agreement was excellent (κ = 0.845) between DSA and Silent MRA, but poor (κ = 0.185) between DSA and TOF MRA. CONCLUSIONS Silent MRA was superior to TOF MRA in the follow-up of endovascular-treated intracranial aneurysms and showed excellent consistency with DSA in the evaluation of aneurysm occlusion. Therefore, Silent MRA is useful for the follow-up of endovascular-treated aneurysms.
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Affiliation(s)
- Song Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Bin Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Qin Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China; Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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12
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Hwang ZA, Li CW, Lin CYE, Chen JH, Chen CY, Chan WP. Intensity of arterial structure acquired by Silent MRA estimates cerebral blood flow. Insights Imaging 2021; 12:185. [PMID: 34894298 PMCID: PMC8665965 DOI: 10.1186/s13244-021-01132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral blood flow (CBF) and the morphology of the cerebral arteries are important for characterizing cerebrovascular disease. Silent magnetic resonance angiography (Silent MRA) is a MRA technique focusing on arterial structural delineation. This study was conducted to investigate the correlation between Silent MRA and CBF quantification, which has not yet been reported. METHODS Both the Silent MRA and time-of-flight magnetic resonance angiography scans were applied in seventeen healthy participants to acquire the arterial structure and to find arterial intensities. Phase-contrast MRA (PC-MRA) was then used to perform the quantitative CBF measurement of 13 cerebral arteries. Due to different dataset baseline signal level of Silent MRA, the signal intensities of the selected 13 cerebral arteries were normalized to the selected ROIs of bilateral internal carotid arteries. The normalized signal intensities were used to determine the relationship between Silent MRA and CBF. RESULTS The image intensity distribution of arterial regions generated by Silent MRA showed similar laminar shape as the phase distribution by PC-MRA (correlation coefficient > 0.62). Moreover, in both the results of individual and group-leveled analysis, the intensity value of arterial regions by Silent MRA showed positively correlation with the CBF by PC-MRA. The coefficient of determination (R2) of individual trends ranged from 0.242 to 0.956, and the R2 of group-leveled result was 0.550. CONCLUSIONS This study demonstrates that Silent MRA provides valuable CBF information despite arterial structure, rendering it a potential tool for screening for cerebrovascular disease.
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Affiliation(s)
- Zhen-An Hwang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Wei Li
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,GE Healthcare, Taipei, Taiwan
| | | | - Jyh-Horng Chen
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Chia-Yuen Chen
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan. .,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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13
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Zhang F, Ran Y, Zhu M, Lei X, Niu J, Wang X, Zhang Y, Li S, Zhu J, Gao X, Mossa-Basha M, Cheng J, Zhu C. 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. Front Cardiovasc Med 2021; 8:739332. [PMID: 34568466 PMCID: PMC8458737 DOI: 10.3389/fcvm.2021.739332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/18/2021] [Indexed: 01/25/2023] Open
Abstract
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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Affiliation(s)
- Feifei Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming Zhu
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaowen Lei
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxia Niu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shujian Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare, Ltd., Beijing, China
| | - Xuemei Gao
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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14
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Heo YJ, Jeong HW, Kim D, Baek JW, Han JY, Choo HJ, Kim ST, Jeong YG, Jin SC. Usefulness of pointwise encoding time reduction with radial acquisition sequence in subtraction-based magnetic resonance angiography for follow-up of the Neuroform Atlas stent-assisted coil embolization for cerebral aneurysms. Acta Radiol 2021; 62:1193-1199. [PMID: 32867507 DOI: 10.1177/0284185120952784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although time-of-flight magnetic resonance angiography (TOF-MRA) is widely used, it has limited usefulness for follow-up after stent-assisted coil embolization. Contrast-enhanced MRA (CE-MRA) and ultrashort echo time MRA have been suggested as alternative methods for visualization after this procedure. PURPOSE To compare efficacy and usefulness of pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA (qMRA), TOF-MRA, and CE-MRA during the follow-up after Neuroform Atlas stent-assisted coil embolization for intracranial aneurysms. MATERIAL AND METHODS This retrospective study included 23 patients with 24 aneurysms who underwent Neuroform Atlas stent-assisted coil embolization for intracranial aneurysms. All patients were evaluated with PETRA qMRA, TOF-MRA, and CE-MRA at the same follow-up session. The flow within stents, occlusion status, and presence of pseudo-stenosis were evaluated; inter-observer and intermodality agreements for the three methods were also graded. RESULTS The mean score for flow visualization within the stents was significantly higher for PETRA qMRA and CE-MRA than for TOF-MRA (although no significant difference was found between PETRA qMRA and CE-MRA). Good inter-observer agreement was observed for each modality. PETRA qMRA and CE-MRA were more consistent with digital subtraction angiography (DSA) than TOF-MRA for aneurysm occlusion status. The intermodality agreement was better between PETRA qMRA and DSA, and between CE-MRA and DSA, than between DSA and TOF-MRA. Pseudo-stenosis was most frequently observed in TOF-MRA, followed by CE-MRA and PETRA qMRA. CONCLUSION PETRA qMRA is useful for evaluating the parent artery patency and occlusion status of aneurysms after Neuroform Atlas stent-assisted coil embolization.
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Affiliation(s)
- Young Jin Heo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hae Woong Jeong
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Donghyun Kim
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jin Wook Baek
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Ji-yeon Han
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hye Jung Choo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Young Gyun Jeong
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
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15
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Zhang C, Dou W, Yu K, Ji Y, Wang W, Sami MU, Shen Y, Xu K. The feasibility of non-contrast-enhanced zero echo time magnetic resonance angiography for characterization of intracranial atherosclerotic disease. Quant Imaging Med Surg 2021; 11:2442-2452. [PMID: 34079714 DOI: 10.21037/qims-20-696] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Accurate and non-invasive assessment of intracranial atherosclerotic disease (ICAD) is important because of its effect on treatment planning. The aim of this study is to investigate if zero echo time (zTE) magnetic resonance angiography (zTE-MRA) is feasible in the characterization of ICAD. Methods A total of 175 patients with ICAD were recruited. ZTE-MRA and time-of-flight (TOF)-MRA sequences were conducted for all participants using a 3T clinical MR system. Forty-one patients also underwent digital subtraction angiography (DSA), and were confirmed to have intracranial arterial stenosis (ICAS). Weighted kappa (κ) statistics were used to assess the inter-observer agreement and diagnostic consistency of both zTE- and TOF-MRA, using DSA as a reference. The Wilcoxon signed-rank test was used to evaluate differences in image quality between zTE- and TOF-MRA images. The nonparametric test of multiple paired samples was used to compare the results of vascular stenosis diagnosis between zTE-, TOF-MRA and DSA. Results Supported by high inter-observer agreement (weighted κ=0.78), zTE-MRA generated significantly higher scores than TOF-MRA for susceptibility artifact signal (mean: 3.03±0.98 vs. 2.72±1.09; P=0.017) and flow signal in parent artery (mean: 3.63±0.49 vs. 3.07±0.82; P<0.001). Additionally, zTE-MRA showed more robust diagnostic performance than TOF-MRA for patients with ICAD and degree of vascular stenosis (P<0.05), and was highly consistent with reference DSA images (weighted κ=0.80). Conclusions ZTE-MRA has potential for use as a routine clinical method for patients with ICAD.
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Affiliation(s)
- Chao Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Ke Yu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Ji
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Radiology, Traditional Chinese Medical Hospital of Yixing, Yixing, China
| | - Wenliang Wang
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Muhammad Umair Sami
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Shen
- GE Healthcare, MR Enhanced Application China, Beijing, China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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16
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Shang S, Wang L, Ye J, Luo X, Zhang H, Dou W, Wu J, Li D. Can Hybrid Arterial Spin Labeling-Tagged Zero-Echo-Time Magnetic Resonance Angiography Be an Effective Candidate in the Evaluation of Intracranial Artery Diseases? A Clinical Feasibility Study. J Magn Reson Imaging 2021; 54:938-949. [PMID: 34014010 DOI: 10.1002/jmri.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flow related artifacts in continuous arterial spin labeling (cASL) zero-echo-time (ZTE) magnetic resonance angiography (MRA) could influence the vasculature visualization. PURPOSE To investigate the clinical feasibility for the intracranial artery diseases assessment by utilizing hybrid ASL-ZTE-MRA (hASL-ZTE-MRA). STUDY TYPE Prospective, technical development. POPULATION Sixty-seven subjects with known/suspected cerebrovascular diseases. FIELD STRENGTH/SEQUENCE Gradient echo based cASL-/hASL- ZTE-MRA at 3.0 T. ASSESSMENT Subjective/objective evaluation for sound-levels. Image quality (IQ), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed within artery segments. Stenotic grading, aneurysm measurement, and signal intensity of lesions were further analyzed. STATISTICAL TESTS Kolmogorov-Smirnov test for data normality check. Between two MRAs: Wilcoxon signed-rank test for sound experience/IQ ratings analysis; Paired t test for SNR/CNR comparison. One-way analysis of variance for sound intensity comparison. For stenosis grading/aneurysm measurement: Kendall's W test/intraclass correlation coefficient (ICC) for interobserver agreement test within each modality, weighted kappa statistics/ICC for intermodality agreement test between each MRA and computed tomography angiography. RESULTS Sound-level perception/intensity was similar (P = 0.86, P = 0.55) between MRAs. The mean IQ score for hASL-ZTE-MRA was on diagnostic scale and slightly higher (P < 0.05) than that of cASL-ZTE-MRA. hASL-ZTE-MRA provided higher (P < 0.05) SNR/CNR than that of cASL-ZTE-MRA. Signal uniformity was improved on hASL-ZTE-MRA, particularly among the anterior circulation (P < 0.05). Comparing to cASL-ZTE-MRA, on hASL-ZTE-MRA, stenotic lesions were accurately assessed; flow in the stent or aneurysm remnant was better depicted (P < 0.05); AVM nidus was preferred with increased SNR (P < 0.05). No significant differences for the aneurysm measurement were found between MRAs (P = 0.95), in addition to the slightly higher SNR (P < 0.05) on hASL-ZTE-MRA. DATA CONCLUSION Comparing to cASL-ZTE-MRA, hASL-ZTE-MRA is robust and feasible for the evaluation of intracranial artery diseases with diagnostic IQ, improved vessel contrast, and better signal heterogeneity. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Song'an Shang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lijuan Wang
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jing Ye
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xianfu Luo
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hongying Zhang
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Weiqiang Dou
- Department of MR Research China, GE Healthcare, Beijing, China
| | - Jingtao Wu
- Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daixin Li
- Department of Radiology, Nanjing Second Hospital, Nanjing University of Chinese Medicine, Nanjing, China
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17
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Kawai T. Editorial for "Can Hybrid Arterial Spin Labeling-Tagged Zero-Echo-Time Magnetic Resonance Angiography Be an Effective Candidate in the Evaluation of Intracranial Artery Diseases? A Clinical Feasibility Study". J Magn Reson Imaging 2021; 54:950-951. [PMID: 33963793 DOI: 10.1002/jmri.27671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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18
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Ljungberg E, Damestani NL, Wood TC, Lythgoe DJ, Zelaya F, Williams SCR, Solana AB, Barker GJ, Wiesinger F. Silent zero TE MR neuroimaging: Current state-of-the-art and future directions. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2021; 123:73-93. [PMID: 34078538 DOI: 10.1016/j.pnmrs.2021.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Magnetic Resonance Imaging (MRI) scanners produce loud acoustic noise originating from vibrational Lorentz forces induced by rapidly changing currents in the magnetic field gradient coils. Using zero echo time (ZTE) MRI pulse sequences, gradient switching can be reduced to a minimum, which enables near silent operation.Besides silent MRI, ZTE offers further interesting characteristics, including a nominal echo time of TE = 0 (thus capturing short-lived signals from MR tissues which are otherwise MR-invisible), 3D radial sampling (providing motion robustness), and ultra-short repetition times (providing fast and efficient scanning).In this work we describe the main concepts behind ZTE imaging with a focus on conceptual understanding of the imaging sequences, relevant acquisition parameters, commonly observed image artefacts, and image contrasts. We will further describe a range of methods for anatomical and functional neuroimaging, together with recommendations for successful implementation.
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Affiliation(s)
- Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Nikou L Damestani
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - David J Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Steven C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Florian Wiesinger
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; ASL Europe, GE Healthcare, Munich, Germany
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19
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Fu Q, Liu DX, Zhang XY, Deng XB, Zheng CS. Pointwise encoding time reduction with radial acquisition in subtraction-based magnetic resonance angiography to assess saccular unruptured intracranial aneurysms at 3 Tesla. Neuroradiology 2020; 63:189-199. [PMID: 32794074 DOI: 10.1007/s00234-020-02512-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the clinical utility of pointwise encoding time reduction with radial acquisition in subtraction-based magnetic resonance angiography (PETRA-MRA) and time-of-flight magnetic resonance angiography (TOF-MRA) to evaluate saccular unruptured intracranial aneurysms (UIAs). METHODS A total of 49 patients with 54 TOF-MRA-identified saccular UIAs were enrolled. The morphologic parameters, contrast-to-noise-ratios (CNRs), and sharpness of aneurysms were measured using PETRA-MRA and TOF-MRA. Two radiologists independently evaluated subjective image scores, focusing on aneurysm signal homogeneities and sharpness depictions using a 4-point scale: 4, excellent; 3, good; 2, poor; 1, not assessable. PETRA-MRA and TOF-MRA acoustic noises were measured. RESULTS All aneurysms were detected with PETRA-MRA. The morphologic parameters of 15 patients evaluated with PETRA-MRA were more closely correlated with those receiving computed tomography angiography over those receiving TOF-MRA. No significant differences between PETRA-MRA and TOF-MRA parameters were seen in the 54 UIAs (p > 0.10), excluding those with inflow angles (p < 0.05). In four patients with inflow angles on PETRA-MRA, the angles were more closely related to those of digital subtraction angiography than those of TOF-MRA. CNRs between TOF-MRA and PETRA-MRA were comparable (p = 0.068), and PETRA-MRA sharpness values and subjective image scores were significantly higher than those of TOF-MRA (p < 0.001). Inter-observer agreements were excellent for both PETRA-MRA and TOF-MRA (intraclass correlation coefficients were 0.90 and 0.97, respectively). The acoustic noise levels of PETRA-MRA were much lower than those of TOF-MRA (59 vs.73 dB, p < 0.01). CONCLUSIONS PETRA-MRA, with better visualization of aneurysms and lower acoustic noise levels than TOF-MRA, showed a superior diagnostic performance for depicting saccular UIAs.
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Affiliation(s)
- Qing Fu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People's Republic of China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Ding-Xi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People's Republic of China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Xiao-Yong Zhang
- MR Collaborations, Siemens Healthcare Ltd, Shenzhen, 518000, People's Republic of China
| | - Xian-Bo Deng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People's Republic of China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People's Republic of China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China.
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20
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Tanoue S, Uchiyama Y, Hirohata M, Takeuchi Y, Orito K, Koganemaru M, Nagata S, Tanaka N, Abe T. Follow-up non-contrast MRA after treatment of intracranial aneurysms using microcoils with prominent metallic artifact: a comparative study of TOF-MRA and Silent MRA. Jpn J Radiol 2020; 38:853-859. [PMID: 32377927 DOI: 10.1007/s11604-020-00981-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Some of the detachable microcoils are associated with the prominent metallic artifact. We have applied Silent MRA to reduce the artifact. In this study, we present a retrospective study in which Silent MRA is used for cases showing prominent metallic artifact on conventional TOF-MRA due to a detachable bare platinum microcoil (Barricade coil). MATERIALS AND METHODS Fifteen patients, who had undergone endosaccular embolization using Barricade coil and other detachable microcoils up to 3 days previously, were scanned with TOF-MRA and silent MRA at the same time. The treatment DSA and follow-up MRA images were graded by two experienced neuroradiologists, focusing on the visibility of residual aneurysm and parent arterial lumen. RESULTS DSA images showed residual aneurysm (RA) in four, residual neck (RN) in six, and complete occlusion (CO) in five patients. TOF-MRA images showed RN in five, CO in four, mild defect (MD) in one, severe defect (SD) in three, and complete defect in two. In contrast, on Silent MRA, the grades were RA in two, RN in five, CO in five, and MD in three. CONCLUSION Barricade coils are associated with prominent metallic artifact on TOF-MRA. Silent MRA is useful for follow-up MRA after embolization using Barricade coils. The metallic artifacts were compared between TOF-MRA and Silent MRA in patients treated by using Barricade coils. Barricade coils are associated with more metallic artifact on TOF-MRA than Silent MRA. Silent MRA is useful for follow-up MRA after embolization using Barricade coils.
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Affiliation(s)
- Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan.
| | - Yusuke Uchiyama
- Department of Radiology, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Yasuharu Takeuchi
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Kimihiko Orito
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Masamichi Koganemaru
- Department of Radiology, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Asahi-machi, 67, Kurume-shi, Fukuoka, 830-0011, Japan
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Song Y, Qi P, Huang J, Jiao S, Zhang J, Wang D, Chen M. Application of zero echo time MR angiography in follow-up of intracranial aneurysm remnant and in-stent lumen after embolization: a comparison study with digital subtraction angiography. Acta Radiol 2020; 61:480-486. [PMID: 31357872 DOI: 10.1177/0284185119865721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Intracranial aneurysm with endovascular treatment needs to be followed-up with a proper imaging method. Purpose To evaluate the performance of magnetic resonance angiography (MRA) with zero echo time at 1.5-T in assessing the intracranial aneurysm remnant and in-stent lumen as compared with time-of-flight MRA, with digital subtraction angiography as the gold standard. Material and Methods A total of 46 patients (17 men; mean age = 56.6±13.7 years) with 54 aneurysms who underwent coil embolization with or without stent were enrolled in this study. The presence of aneurysm remnant and the visualization of in-stent lumen were evaluated. The agreement of remnant identification between MRA with zero echo time and time-of-flight MRA with digital subtraction angiography was evaluated using Cohen’s kappa analysis. The performance of in-stent lumen visualization between MRA with zero echo time and time-of-flight MR angiography was compared with Chi-square test. Results Of 54 aneurysms, 27 were found to have remnants by digital subtraction angiography. The kappa value in identification of remnant of aneurysm was 0.852 between MRA with zero echo time and digital subtraction angiography and 0.741 between time-of-flight MRA and digital subtraction angiography. In detecting remnant of aneurysm, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.3%, 88.9%, 89.7%, and 96.0% for MRA with zero echo time and 91.7%, 83.3%, 81.5%, and 92.6% for time-of-flight MRA, respectively. In visualizing in-stent lumen, MRA with zero echo time had better performance than time-of-flight MRA ( P < 0.001). Conclusion MR angiography with zero echo time might be a better non-invasive approach in assessing remnant of aneurysms and in-stent lumen as compared with time-of-flight MRA.
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Affiliation(s)
- Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, PR China
| | - Juan Huang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, PR China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
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Comparison of Time-of-Flight-Magnetic Resonance Angiography From Silent Scan Magnetic Resonance Angiography in Depiction of Arteriovenous Malformation of the Brain. J Comput Assist Tomogr 2019; 43:943-947. [PMID: 31738210 DOI: 10.1097/rct.0000000000000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Silent magnetic resonance angiography (MRA) was compared with time-of-flight (TOF)-MRA in imaging of arteriovenous malformations (AVMs) of the brain. METHODS Thirty-five consecutive patients with AVMs of the brain were included. Quantitative analyses were performed by measuring both signal-to-noise ratio and contrast-to-noise ratio of the nidus. Qualitative analysis (scores 1-4) was performed by evaluating depictions of feeding arteries and draining veins independently by 2 reviewers. RESULTS Both signal-to-noise ratio and contrast-to-noise ratio in TOF-MRA were significantly higher than those in silent MRA. For both feeders and drainers, scores were significantly higher in silent MRA than in TOF-MRA for both reviewers. Interrater agreement was higher in silent MRA than in TOF-MRA. CONCLUSIONS Silent MRA visualized feeders and drainers in AVMs significantly better than did TOF-MRA. Interrater agreement was also better in silent MRA.
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Ryu KH, Baek HJ, Moon JI, Choi BH, Park SE, Ha JY, Park H, Kim SS, Kim JS, Cho SB, Carl M. Usefulness of Noncontrast-Enhanced Silent Magnetic Resonance Angiography (MRA) for Treated Intracranial Aneurysm Follow-up in Comparison with Time-of-Flight MRA. Neurosurgery 2019; 87:220-228. [DOI: 10.1093/neuros/nyz421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Flow visualization in time-of-flight magnetic resonance angiography (TOF MRA) is limited for treated intracranial aneurysms owing to magnetic susceptibility and radiofrequency shielding.
OBJECTIVE
To assess the clinical usefulness of noncontrast-enhanced magnetic resonance angiography (MRA) using a silent scan (silent MRA) as a follow-up imaging modality in patients with treated intracranial aneurysms.
METHODS
A total of 119 patients with 126 treated aneurysms underwent silent MRA and TOF MRA during the same scan session. Two neuroradiologists independently assessed overall image quality and visualization of the treated site using a 5-point Likert scale to compare the 2 image sets. We used receiver operating characteristic (ROC) curve analysis to investigate the diagnostic performance of the 2 MRA methods in evaluating aneurysm occlusion. Interobserver reliability was also assessed using weighted kappa statistics.
RESULTS
The overall image quality scores of silent MRA and TOF MRA were 4.04 ± 0.22 and 4.64 ± 0.48, respectively (P < .001), and interobserver agreement was substantial (P < .001). For the treated site, the score of flow visualization on silent MRA was higher than that on TOF MRA, 3.94 ± 0.94 vs 2.59 ± 1.37 (P < .001), with substantial interobserver agreement (P < .001). ROC curve analysis showed that silent MRA was superior to TOF MRA in diagnostic performance (area under the curve [AUC] = 0.962; 95% CI: 0.931-0.982 vs AUC = 0.843; 95% CI: 0.792-0.886; P < .001).
CONCLUSION
Silent MRA can be useful to evaluate treated intracranial aneurysms during follow-up without radiation exposure and use of contrast material. It is characterized by higher diagnostic performance and superior visualization for the treated site.
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Affiliation(s)
- Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seung Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jung-Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Michael Carl
- Applied Science Lab, GE Healthcare, San Diego, CA, United States
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Magnetic Resonance Imaging in Aneurysmal Subarachnoid Hemorrhage: Current Evidence and Future Directions. Neurocrit Care 2019; 29:241-252. [PMID: 29633155 DOI: 10.1007/s12028-018-0534-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is associated with an unacceptably high mortality and chronic disability in survivors, underscoring a need to validate new approaches for treatment and prognosis. The use of advanced imaging, magnetic resonance imaging (MRI) in particular, could help address this gap given its versatile capacity to quantitatively evaluate and map changes in brain anatomy, physiology and functional activation. Yet there is uncertainty about the real value of brain MRI in the clinical setting of aSAH. METHODS In this review, we discuss current and emerging MRI research in aSAH. PubMed was searched from inception to June 2017, and additional studies were then chosen on the basis of relevance to the topics covered in this review. RESULTS Available studies suggest that brain MRI is a feasible, safe, and valuable testing modality. MRI detects brain abnormalities associated with neurologic examination, outcomes, and aneurysm treatment and thus has the potential to increase knowledge of aSAH pathophysiology as well as to guide management and outcome prediction. Newer pulse sequences have the potential to reveal structural and physiological changes that could also improve management of aSAH. CONCLUSION Research is needed to confirm the value of MRI-based biomarkers in clinical practice and as endpoints in clinical trials, with the goal of improving outcome for patients with aSAH.
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Tomura N, Kokubun M, Horiuchi K, Watanabe Z. Comparison of TOF-MRA and silent scan-MRA in depicting cerebral arteries in patients with Moyamoya disease. Acta Radiol 2019; 60:1321-1328. [PMID: 30682891 DOI: 10.1177/0284185118824782] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Noriaki Tomura
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Mika Kokubun
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Kazuomi Horiuchi
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Zenichiro Watanabe
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
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Shang S, Ye J, Dou W, Luo X, Qu J, Zhu Q, Zhang H, Wu J. Validation of Zero TE-MRA in the Characterization of Cerebrovascular Diseases: A Feasibility Study. AJNR Am J Neuroradiol 2019; 40:1484-1490. [PMID: 31467242 DOI: 10.3174/ajnr.a6173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Zero TE-MRA is less sensitive to field heterogeneity, complex flow, and acquisition noise. This study aimed to prospectively validate the feasibility of zero TE-MRA for cerebrovascular diseases assessment, compared with TOF-MRA. MATERIALS AND METHODS Seventy patients suspected of having cerebrovascular disorders were recruited. Sound levels were estimated for each MRA subjectively and objectively in different modes. MRA image quality was estimated by 2 neuroradiologists. The degree of stenosis (grades 0-4) and the z-diameter of aneurysms (tiny group ≤3 mm and large group >3 mm) were measured for further quantitative analysis. CTA was used as the criterion standard. RESULTS Zero TE-MRA achieved significantly lower subjective perception and objective noise reduction (37.53%). Zero TE-MRA images showed higher signal homogeneity (3.29 ± 0.59 versus 3.04 ± 0.43) and quality of venous signal suppression (3.67 ± 0.47 versus 2.75 ± 0.46). The intermodality agreement was higher for zero TE-MRA than for TOF-MRA (zero TE, 0.90; TOF, 0.81) in the grading of stenosis. Zero TE-MRA had a higher correlation than TOF-MRA (zero TE, 0.84; TOF, 0.74) in the tiny group and a higher consistency with CTA (intraclass correlation coefficient, 0.83; intercept, -0.5084-1.1794; slope -0.4952 to -0.2093) than TOF-MRA (intraclass correlation coefficient, 0.64; intercept, 0.7000-2.6133; slope -1.0344 to -0.1923). Zero TE-MRA and TOF-MRA were comparable in the large group. Zero TE-MRA had more accurate details than TOF-MRA of AVM and Moyamoya lesions. CONCLUSIONS Compared with TOF-MRA, zero TE-MRA achieved more robust performance in depicting cerebrovascular diseases. Therefore, zero TE-MRA was shown to be a promising MRA technique for further routine application in the clinic in patients with cerebrovascular diseases.
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Affiliation(s)
- S Shang
- From the Department of Radiology (S.S., J.Y., X.L., Q.Z., H.Z., J.W.), Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - J Ye
- From the Department of Radiology (S.S., J.Y., X.L., Q.Z., H.Z., J.W.), Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - W Dou
- MR Research China (W.D., J.Q.), GE Healthcare, Beijing China
| | - X Luo
- From the Department of Radiology (S.S., J.Y., X.L., Q.Z., H.Z., J.W.), Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - J Qu
- MR Research China (W.D., J.Q.), GE Healthcare, Beijing China
| | - Q Zhu
- From the Department of Radiology (S.S., J.Y., X.L., Q.Z., H.Z., J.W.), Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - H Zhang
- From the Department of Radiology (S.S., J.Y., X.L., Q.Z., H.Z., J.W.), Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - J Wu
- From the Department of Radiology (S.S., J.Y., X.L., Q.Z., H.Z., J.W.), Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
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27
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Ahmed SU, Mocco J, Zhang X, Kelly M, Doshi A, Nael K, De Leacy R. MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis. J Neurointerv Surg 2019; 11:1009-1014. [PMID: 31048457 DOI: 10.1136/neurintsurg-2019-014936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. METHODS Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. RESULTS The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. CONCLUSION MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.
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Affiliation(s)
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Xiangnan Zhang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Kelly
- Royal University Hospital, University of Saskatchewan, Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Amish Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kambiz Nael
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Satoh T, Hishikawa T, Hiramatsu M, Sugiu K, Date I. Visualization of Aneurysmal Neck and Dome after Coiling with 3D Multifusion Imaging of Silent MRA and FSE-MR Cisternography. AJNR Am J Neuroradiol 2019; 40:802-807. [PMID: 30948372 DOI: 10.3174/ajnr.a6026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to visualize the precise configuration of the aneurysmal neck and dome with/without remnants combined with a coiled dome after coiling treatment for cerebral aneurysms. We developed 3D multifusion imaging of silent MRA and FSE-MR cisternography. MATERIALS AND METHODS We examined 12 patients with 3D multifusion imaging by composing 3D images reconstructed from TOF-MRA, silent MRA, and FSE-MR cisternography. The influence of magnetic susceptibility artifacts caused by metal materials affecting the configuration of the aneurysmal complex with coiling was assessed in a single 3D image. RESULTS In all cases, TOF-MRA failed to depict the aneurysmal neck complex precisely due to metal artifacts, whereas silent MRA delineated the neck and parent arteries at the coiled regions without serious metal artifacts. FSE-MR cisternography depicted the shape of the coiled aneurysmal dome and parent artery complex together with the brain parenchyma. With the 3D multifusion images of silent MRA and FSE-MR cisternography, the morphologic status of the coiled neck and parent arteries was clearly visualized with the shape of the dome in a single 3D image. CONCLUSIONS Silent MRA is a non-contrast-enhanced form of MRA. It depicts the coiled neck complex without serious metal artifacts. FSE-MR cisternography can delineate the shape of the coiled dome. In this small feasibility study, 3D multifusion imaging of silent MRA and FSE-MR cisternography allowed good visualization of key features of coiled aneurysms. This technique may be useful in the follow-up of coiled aneurysms.
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Affiliation(s)
- T Satoh
- From the Department of Neurological Surgery (T.S.), Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan
| | - T Hishikawa
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
| | - M Hiramatsu
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
| | - K Sugiu
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
| | - I Date
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
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Heo YJ, Jeong HW, Baek JW, Kim ST, Jeong YG, Lee JY, Jin SC. Pointwise Encoding Time Reduction with Radial Acquisition with Subtraction-Based MRA during the Follow-Up of Stent-Assisted Coil Embolization of Anterior Circulation Aneurysms. AJNR Am J Neuroradiol 2019; 40:815-819. [PMID: 30975655 DOI: 10.3174/ajnr.a6035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Time-of-flight MR angiography, though widely used after coil embolization, is associated with limitations owing to magnetic susceptibility and radiofrequency shielding following stent-assisted coil embolization. We evaluated the pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA (qMRA) using an ultrashort TE relative to TOF-MRA during the follow-up of stent-assisted coil embolization for anterior circulation aneurysms. MATERIALS AND METHODS Twenty-five patients (3 men and 22 women; mean age, 59.1 ± 14.0 years) underwent stent-assisted coil embolization for anterior circulation aneurysms and were retrospectively evaluated using TOF-MRA and PETRA qMRA data from the same follow-up session. Two neuroradiologists independently reviewed both MRA findings and subjectively graded flow within the stents (relative to the latest DSA findings) and occlusion status (complete occlusion or neck/aneurysm remnant). Interobserver and intermodality agreement for TOF-MRA and PETRA qMRA were evaluated. RESULTS The mean score for flow visualization within the stents was significantly higher in PETRA qMRA than in TOF-MRA (P < .001 for both observers), and good interobserver agreement was reported (κ = 0.63). The aneurysm occlusion status of PETRA qMRA (observer 1, 92.0%; observer 2, 88.0%) was more consistent with DSA than with TOF-MRA (observer 1, 76.0%; observer 2, 80.0%), and there was a better intermodality agreement between DSA and PETRA qMRA than between DSA and TOF-MRA. CONCLUSIONS These findings indicate that PETRA qMRA is a useful follow-up technique for patients who have undergone stent-assisted coil embolization for anterior circulation aneurysms.
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Affiliation(s)
- Y J Heo
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - H W Jeong
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - J W Baek
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - S T Kim
- Neurosurgery (S.T.K., Y.G.J.)
| | | | - J Y Lee
- Internal Medicine (J.Y.L.), Inje University Busan Paik Hospital, Busan, Korea
| | - S-C Jin
- Department of Neurosurgery (S.-C.J.), Inje University Haeundae Paik Hospital, Busan, Korea
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Takano K, Hida K, Iwaasa M, Inoue T, Yoshimitsu K. Three-dimensional spin-echo-based black-blood MRA in the detection of vasospasm following subarachnoid hemorrhage. J Magn Reson Imaging 2018; 49:800-807. [PMID: 30284331 DOI: 10.1002/jmri.26231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/05/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Black-blood MR angiography (BBMRA), which utilizes a non-T1 contrast spin-echo type technique, has been expected to overcome several issues associated with time-of-flight (TOF) MRA. PURPOSE To investigate the efficacy of BBMRA to detect vasospasms following subarachnoid hemorrhage (SAH). STUDY TYPE Retrospective. SUBJECTS Seventeen patients with SAH in their early posttreatment period. FIELD STRENGTH/SEQUENCE BBMRA, which uses a volumetric isotropic turbo spin-echo acquisition (VISTA), and TOF-MRA on 1.5T scanners. ASSESSMENT Visualization of supratentorial arteries and veins in BBMRA was rated on a 4-point scale by two neuroradiologists. Another neuroradiologist independently assessed TOF-MRA. The degree of the vasospasm was then evaluated using a 3-point scale by the same readers. The diagnostic performance of the MRAs was evaluated using computed tomography angiography (CTA) or digital subtraction angiography (DSA) as the standard of reference. STATISTICAL TESTS Wilcoxon signed rank test, McNemar test, and Cohen's kappa coefficient. RESULTS BBMRA provided superior visualization of the anterior and middle cerebral arteries than TOF-MRA (P < 0.05). The depiction of the veins was more pronounced on BBMRA (P < 0.01). Of the 166 arterial segments evaluated by CTA or DSA, 23 (13.9%) could not be assessed using TOF-MRA because of high signal hemorrhage, whereas BBMRA enabled visualization of all the segments. Vasospasm was confirmed in 30 segments by CTA or DSA. The sensitivity, specificity, and positive and negative predictive values were 73, 96, 76, and 95 for TOF-MRA and 91, 100, 100, and 98 for BBMRA, respectively (P = 0.13 for sensitivity, P = 0.06 for specificity). The agreement of the degree of vasospasm between MRA and the standard of reference, as indicated by kappa value, was 0.71 (95% confidence interval [CI], 0.55-0.87) for TOF-MRA and 0.91 (95% CI, 0.82-0.99) for BBMRA. DATA CONCLUSION BBMRA, owing to its contrast properties, may be superior to TOF-MRA for the evaluation of intracranial arteries after SAH. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:800-807.
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Affiliation(s)
- Koichi Takano
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kosuke Hida
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Mitsutoshi Iwaasa
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kengo Yoshimitsu
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Li K, Guo Y, Zhao Y, Xu B, Xu K, Yu J. Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review. Interv Neuroradiol 2017; 24:117-124. [PMID: 29231793 DOI: 10.1177/1591019917747245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute rerupture after coil embolization is defined as rerupture within three days after treatment; its prognosis is worse than that of rebleeding at other time periods. However, to date, little is known about complications during the acute phase. Therefore, we used the PubMed database to perform a review of acute rerupture after coil embolization of ruptured intracranial saccular aneurysms and increase our understanding. After reviewing the complications, we found that the cause of acute rerupture is unclear, but the following risk factors are involved: incomplete occlusion of the initial aneurysm, the presence of a hematoma adjacent to a ruptured aneurysm, an aneurysmal outpouching, poor Hunt-Hess grade at the time of treatment, and the location of the aneurysm in an anterior communicating artery. In addition, intraoperative rupture is a non-negligible cause. Acute rerupture after coil embolization mainly occurs within the first 24 hours after the procedure. Brain computed tomography is the gold standard for diagnosing acute rebleeding of a coiled aneurysm. For acute rerupture after coil embolization, prevention is critical, and complete occlusion of the aneurysm in the first session is the best protection against acute rebleeding. In addition, a restricted postembolization anticoagulation strategy is recommended for patients with high-risk aneurysms. For patients with an adjacent hematoma, surgical clipping is recommended. Most patients present no changes immediately after acute rebleeding because of their poor condition. However, surgical or endovascular treatments can be attempted if the patient is in an acceptable condition. Even so, the outcomes are typically unsatisfactory.
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Affiliation(s)
- Kailing Li
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yunbao Guo
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Ying Zhao
- 2 Department of Training, The First Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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