1
|
Veeturi SS, Hall S, Fujimura S, Mossa-Basha M, Sagues E, Samaniego EA, Tutino VM. Imaging of Intracranial Aneurysms: A Review of Standard and Advanced Imaging Techniques. Transl Stroke Res 2024:10.1007/s12975-024-01261-w. [PMID: 38856829 DOI: 10.1007/s12975-024-01261-w] [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: 04/16/2024] [Revised: 04/16/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024]
Abstract
The treatment of intracranial aneurysms is dictated by its risk of rupture in the future. Several clinical and radiological risk factors for aneurysm rupture have been described and incorporated into prediction models. Despite the recent technological advancements in aneurysm imaging, linear length and visible irregularity with a bleb are the only radiological measure used in clinical prediction models. The purpose of this article is to summarize both the standard imaging techniques, including their limitations, and the advanced techniques being used experimentally to image aneurysms. It is expected that as our understanding of advanced techniques improves, and their ability to predict clinical events is demonstrated, they become an increasingly routine part of aneurysm assessment. It is important that neurovascular specialists understand the spectrum of imaging techniques available.
Collapse
Affiliation(s)
- Sricharan S Veeturi
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Samuel Hall
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Soichiro Fujimura
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- Division of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Elena Sagues
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | | | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA.
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
2
|
Konovalov A, Gadzhiagaev V, Artemyev A, Okishev D, Pilipenko Y, Grebenev F, Eliava S. A Systematic Review and Case Illustrations of Misdiagnosing Intracranial Aneurysms. Cureus 2024; 16:e59185. [PMID: 38807799 PMCID: PMC11130603 DOI: 10.7759/cureus.59185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
Modern neuroimaging methods do not completely rule out false diagnoses of intracranial aneurysms which can lead to an unwarranted operation associated with risks of complications. However, surgical interventions for falsely diagnosed aneurysms are quite rare. The purpose of this study is to demonstrate two clinical cases of false-positive aneurysms and a systematic review of the literature dedicated to the incidence and etiology of false-positive aneurysms, identifying risk factors associated with false-positive aneurysms. A literature search in two databases (PubMed and Web of Science) using keywords "mimicking an intracranial aneurysm", "presenting as an intracranial aneurysm", "false positive intracranial aneurysms", and "neurosurgery" was conducted. A total of 243 papers were found in the initial search in two databases. Sixteen papers (including 20 patients) were included in the final analysis. There were 10 women and 10 men. The most common location of false-positive aneurysms was the bifurcation of the middle cerebral artery (MCA). In the posterior circulation, false-positive aneurysms were identified either on the basilar artery, or at the vertebro-basilar junction. The main causes of false intracranial aneurysm diagnosis included artery occlusion with vascular stump formation, infundibular widening, fenestration, arterial dissection, contrast extravasation, and venous varix. In conclusion, summarizing the results of our analysis, we can say that surgical interventions for false-positive aneurysms are an underestimated problem in vascular neurosurgery. Despite extremely rare published clinical observations, the actual frequency of erroneous surgical interventions for false-positive aneurysms is unknown.
Collapse
Affiliation(s)
- Anton Konovalov
- Cerebrovascular Surgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS
| | - Vadim Gadzhiagaev
- Neurosurgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS
- Neurosurgery, Moscow Regional Clinical Research Institute Named After M. F. Vladimirsky, Moscow, RUS
| | - Anton Artemyev
- Neurosurgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS
| | - Dmitry Okishev
- Vascular Surgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS
| | - Yuri Pilipenko
- Neurosurgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS
| | - Fyodor Grebenev
- Neurosurgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS
| | - Shalva Eliava
- Vascular Surgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS
| |
Collapse
|
3
|
Gulati A, Watnick T. Vascular Complications in Autosomal Dominant Polycystic Kidney Disease: Perspectives, Paradigms, and Current State of Play. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:429-439. [PMID: 38097333 DOI: 10.1053/j.akdh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the leading cause of inherited kidney disease with significant contributions to CKD and end-stage kidney disease. The underlying polycystin proteins (PC1 and PC2) have widespread tissue expression and complex functional roles making ADPKD a systemic disease. Vascular complications, particularly intracranial aneurysms (ICA) are the most feared due to their potential for devastating neurological complications and sudden death. Intracranial aneurysms occur in 8-12% of all patients with ADPKD, but the risk is intensified 4-5-fold in those with a positive family history. The basis for this genetic risk is not well understood and could conceivably be due to features of the germline mutation with a significant contribution of other genetic modifiers and/or environmental factors. Here we review what is known about the natural history and genetics of unruptured ICA in ADPKD including the prevalence and risk factors for aneurysm formation and subarachnoid hemorrhage. We discuss two alternative screening strategies and recommend a practical algorithm that targets those at highest risk for ICA with a positive family history for screening.
Collapse
Affiliation(s)
- Ashima Gulati
- Division of Nephrology, Children's National Hospital and Children's National Research Institute, Washington, DC
| | - Terry Watnick
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
| |
Collapse
|
4
|
Walker EYX, Marlais M. Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? Pediatr Nephrol 2023; 38:77-85. [PMID: 35106642 PMCID: PMC8807382 DOI: 10.1007/s00467-022-05432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 01/10/2023]
Abstract
This is an overview of the challenges associated with screening for asymptomatic intracranial aneurysms (ICA) in children with autosomal dominant polycystic kidney disease (ADPKD). ADPKD is the most common inherited kidney disease affecting 1 in 1,000 people. ICAs are an extra-kidney manifestation of ADPKD, and while the exact pathophysiology of how they develop is unknown, we know that they more commonly occur in the adult rather than paediatric population. ICAs can be found in up to 9-11.5% of adults with ADPKD, but ICA rupture remains a rare event in adults with an incidence of 0.04 per 100 patient years. ICA size is an important factor in determining the risk of aneurysm rupture and therefore affects the decision on intervention in asymptomatic adults. For some, unruptured aneurysms cause no clinical significance, but those that rupture can be associated with devastating morbidity and mortality. Therefore, if detected, the treatment for unruptured ICAs is usually endovascular coiling, alongside recognising the importance of preventative interventions such as hypertension management. There are, however, no current guidelines for either adult or paediatric patients with ADPKD supporting regular screening for asymptomatic ICAs, although there is a suggestion for individualised practice, for example, with those with a positive family history. The UK clinical guidelines for ADPKD in children make research recommendations due to a lack of published literature, which in itself indicates that ICA rupture is an extremely rare phenomenon in children.
Collapse
Affiliation(s)
- Emma Y. X. Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute for Child Health, London, UK.
| |
Collapse
|
5
|
Prevalence and risk factors of unruptured intracranial saccular aneurysms in hospital population by 3D-TOF-MRA with VR reconstruction. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
6
|
He G, Wang J, Zhang Y, Li M, Lu H, Cheng Y, Zhu Y. Diagnostic Performance of MRA for UnrupturedAneurysms at the Distal ICA. Clin Neuroradiol 2022; 32:507-515. [DOI: 10.1007/s00062-021-01076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/21/2021] [Indexed: 11/03/2022]
|
7
|
Joo B, Choi HS, Ahn SS, Cha J, Won SY, Sohn B, Kim H, Han K, Kim HP, Choi JM, Lee SM, Kim TG, Lee SK. A Deep Learning Model with High Standalone Performance for Diagnosis of Unruptured Intracranial Aneurysm. Yonsei Med J 2021; 62:1052-1061. [PMID: 34672139 PMCID: PMC8542476 DOI: 10.3349/ymj.2021.62.11.1052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study aimed to investigate whether a deep learning model for automated detection of unruptured intracranial aneurysms on time-of-flight (TOF) magnetic resonance angiography (MRA) can achieve a target diagnostic performance comparable to that of human radiologists for approval from the Korean Ministry of Food and Drug Safety as an artificial intelligence-applied software. MATERIALS AND METHODS In this single-center, retrospective, confirmatory clinical trial, the diagnostic performance of the model was evaluated in a predetermined test set. After sample size estimation, the test set consisted of 135 aneurysm-containing examinations with 168 intracranial aneurysms and 197 aneurysm-free examinations. The target sensitivity and specificity were set as 87% and 92%, respectively. The patient-wise sensitivity and specificity of the model were analyzed. Moreover, the lesion-wise sensitivity and false-positive detection rate per case were also investigated. RESULTS The sensitivity and specificity of the model were 91.11% [95% confidence interval (CI): 84.99, 95.32] and 93.91% (95% CI: 89.60, 96.81), respectively, which met the target performance values. The lesion-wise sensitivity was 92.26%. The overall false-positive detection rate per case was 0.123. Of the 168 aneurysms, 13 aneurysms from 12 examinations were missed by the model. CONCLUSION The present deep learning model for automated detection of unruptured intracranial aneurysms on TOF MRA achieved the target diagnostic performance comparable to that of human radiologists. With high standalone performance, this model may be useful for accurate and efficient diagnosis of intracranial aneurysm.
Collapse
Affiliation(s)
- Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Seok Choi
- Department of Radiology, Seoul Medical Center, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Sung Soo Ahn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jihoon Cha
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - So Yeon Won
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Beomseok Sohn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hwiyoung Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Kwak Y, Son W, Kim YS, Park J, Kang DH. Discrepancy between MRA and DSA in identifying the shape of small intracranial aneurysms. J Neurosurg 2021; 134:1887-1893. [DOI: 10.3171/2020.4.jns20128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The authors evaluated the sensitivity and accuracy of MRA in identifying the shape of small-sized unruptured intracranial aneurysms.
METHODS
Small (< 7 mm) unruptured intracranial aneurysms initially detected by MRA and confirmed by DSA between January 2017 and December 2018 were morphologically reviewed by neuroradiologists. Regularity or irregularity of aneurysm shape was analyzed by two independent reviewers using MRA without DSA results. DSA findings served as the reference standard for aneurysm shape. Irregular shape, which in small aneurysms is associated with a higher likelihood of rupture, was defined as positive, and MRA sensitivity, specificity, and accuracy were determined by using evaluations based on location, size, and MRA magnetic strength (1.5T vs 3T MRA). Multivariate analysis was performed to determine risk factors for false-negative MRA results for irregularly shaped aneurysms.
RESULTS
In total, 652 unruptured intracranial aneurysms in 530 patients were reviewed for this study. For detecting aneurysm shape irregularity, the overall MRA sensitivity was 60.4% for reviewer 1 and 60.9% for reviewer 2. Anterior cerebral artery aneurysms had the lowest sensitivity for location (36.7% for reviewer 1, 46.9% for reviewer 2); aneurysms sized < 3 mm had the lowest sensitivity for size (26.7% for both reviewers); and 1.5T MRA had lower sensitivity and accuracy than 3T MRA. In multivariate analysis, location, size, and magnetic strength of MRA were independent risk factors for false-negative MRA results for irregularly shaped aneurysms.
CONCLUSIONS
MRA had a low sensitivity for detecting the irregular shape of small intracranial aneurysms. In particular, anterior cerebral artery location, aneurysm size < 3 mm, and detection with 1.5T MRA were associated with a higher risk of irregularly shaped aneurysms being misjudged as regular.
Collapse
Affiliation(s)
- Youngseok Kwak
- Department of Neurosurgery, School of Medicine, Catholic University of Daegu; and
| | | | - Yong-Sun Kim
- Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | | | | |
Collapse
|
9
|
Jang M, Kim JH, Park JW, Roh H, Lee HJ, Seo J, Hwang SH, Yoon JH, Yoon SH, Cho BK. Features of "false positive" unruptured intracranial aneurysms on screening magnetic resonance angiography. PLoS One 2020; 15:e0238597. [PMID: 32881975 PMCID: PMC7470380 DOI: 10.1371/journal.pone.0238597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physicians can find it challenging to decide whether confirmative digital subtraction angiography (DSA) should be performed in patients who present with "suspicious small aneurysm-like structures" on magnetic resonance angiography (MRA). Factors associated with "false positive aneurysms on MRA" (FPAMs)," which are finally confirmed as negative on DSA, have rarely been reported. This study aimed to identify the clinical or radiologic clues indicative of FPAM on DSA. METHODS Patients who had undergone DSA between 2016 and 2019 for suspicious aneurysm-like structures < 5 mm in size on MRA were enrolled. Patient demographics and the details regarding the geometry of the structures were retrospectively reviewed. Univariate and multivariate logistic regression analyses were conducted to identify the associated factors. Receiver operating characteristic curve analysis was performed to assess the clinical implications. RESULTS Of the 107 suspicious structures, 46 were indicated as being false positive on DSA (42.96%). Location (positive on C7 and negative on C5-6 ICA) and lower dome to neck ratio were found to be significant parameters in the multivariate analysis. The dome to neck ratio threshold value was 0.99. CONCLUSION Suspicious aneurysm-like structures located not on C5-6 but on C7 ICA and having wide neck morphologies (dome to neck ratio < 0.99) are highly likely to be negative on DSA.
Collapse
Affiliation(s)
- Minsu Jang
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jang Hun Kim
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Trauma Center, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- * E-mail:
| | - Jin Woo Park
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Haewon Roh
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Han-Joo Lee
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Junghan Seo
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sung Hwan Hwang
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joon Ho Yoon
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| |
Collapse
|
10
|
Zeng Y, Liu X, Xiao N, Li Y, Jiang Y, Feng J, Guo S. Automatic Diagnosis Based on Spatial Information Fusion Feature for Intracranial Aneurysm. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1448-1458. [PMID: 31689186 DOI: 10.1109/tmi.2019.2951439] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Timely and accurate auxiliary diagnosis of intracranial aneurysm can help radiologist make treatment plans quickly, saving lives and cutting costs at the same time. At present, Digital Subtraction Angiography (DSA) is the gold standard for the diagnosis of intracranial aneurysm, but as radiologists interpret those imaging sequences frame by frame, misdiagnosis might occur. The utilization of computer-aided diagnosis (CAD) can ease the burdens of radiologists and improve the detection accuracy of aneurysms. In this article, a deep learning method is applied to detect the intracranial aneurysm in 3D Rotational Angiography (3D-RA) based on a spatial information fusion (SIF) method, and instead of a 3D vascular model, 2D image sequences are used. Given the intracranial aneurysm and vascular overlap having similar feature in the most time, rather than focusing on distinguishing them in one frame, the morphological differences between frames are considered as major feature. In the training data, consecutive frames of every imaging time series are extracted and concatenated in a specific way, so that the spatial contextual information could be embedded into a single two-dimensional image. This method enables the time series with obvious correlation between frames be directly trained on 2D convolutional neural network (CNN), instead of 3D-CNN with huge computational cost. Finally, we got an accuracy of 98.89%, with sensitivity and specificity of 99.38% and 98.19%, respectively, which proves the feasibility and availability of the SIF feature.
Collapse
|
11
|
Falk Delgado A, Van Westen D, Nilsson M, Knutsson L, Sundgren PC, Larsson EM, Falk Delgado A. Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging 2019; 10:84. [PMID: 31444580 PMCID: PMC6708018 DOI: 10.1186/s13244-019-0771-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) increase lesion detection and improve disease characterization for many cerebral pathologies investigated with MRI. These agents, introduced in the late 1980s, are in wide use today. However, some non-ionic linear GBCAs have been associated with the development of nephrogenic systemic fibrosis in patients with kidney failure. Gadolinium deposition has also been found in deep brain structures, although it is of unclear clinical relevance. Hence, new guidelines from the International Society for Magnetic Resonance in Medicine advocate cautious use of GBCA in clinical and research practice. Some linear GBCAs were restricted from use by the European Medicines Agency (EMA) in 2017. This review focuses on non-contrast-enhanced MRI techniques that can serve as alternatives for the use of GBCAs. Clinical studies on the diagnostic performance of non-contrast-enhanced as well as contrast-enhanced MRI methods, both well established and newly proposed, were included. Advantages and disadvantages together with the diagnostic performance of each method are detailed. Non-contrast-enhanced MRIs discussed in this review are arterial spin labeling (ASL), time of flight (TOF), phase contrast (PC), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), and amide proton transfer (APT) imaging. Ten common diseases were identified for which studies reported comparisons of non-contrast-enhanced and contrast-enhanced MRI. These specific diseases include primary brain tumors, metastases, abscess, multiple sclerosis, and vascular conditions such as aneurysm, arteriovenous malformation, arteriovenous fistula, intracranial carotid artery occlusive disease, hemorrhagic, and ischemic stroke. In general, non-contrast-enhanced techniques showed comparable diagnostic performance to contrast-enhanced MRI for specific diagnostic questions. However, some diagnoses still require contrast-enhanced imaging for a complete examination.
Collapse
Affiliation(s)
- Anna Falk Delgado
- Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, Solna, Stockholm, Sweden.
| | - Danielle Van Westen
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Markus Nilsson
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Pia C Sundgren
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
12
|
Takeda R, Ooigawa H, Uchino A, Kurita H. Is MRA at 3.0 Tesla sufficient for preoperative planning for aneurysmal clipping in patients with contraindicated condition of contrast media? INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
13
|
Zhang W, Blumenfeld JD, Prince MR. MRI in autosomal dominant polycystic kidney disease. J Magn Reson Imaging 2019; 50:41-51. [PMID: 30637853 DOI: 10.1002/jmri.26627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Weiguo Zhang
- Department of Radiology, Weill Cornell Medicine New York New York USA
| | - Jon D. Blumenfeld
- Rogosin Institute, and Department of MedicineWeill Cornell Medicine New York New York USA
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medicine New York New York USA
- Columbia College of Physicians and Surgeons New York New York USA
| |
Collapse
|
14
|
Raza HK, Chen H, Chansysouphanthong T, Cui G. The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature. Somatosens Mot Res 2018; 35:229-239. [PMID: 30592440 DOI: 10.1080/08990220.2018.1547697] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oculomotor nerve palsy (ONP) is an important and common clinical diagnosis. Its main features are diplopia and ptosis. Its aetiologies are various and complex. A number of different conditions have been reported to cause ONP, such as diabetes mellitus, aneurysm, tumours, painful ophthalmoplegia, pituitary lesions, cavernous sinus lesions, central nervous system infections, and subarachnoid haemorrhage. A patients needs to undergo several tests in order to establish the correct underlying pathology. In this review, we have summarized the aetiologies of the unilateral ONP, and discussed their relative clinical features, pathogenesis, diagnostic criteria, treatment options, and prognosis. We searched PubMed for papers related to ONP and its aetiologies, and selected the publications, which seemed appropriate.
Collapse
Affiliation(s)
- Hafiz Khuram Raza
- a School of International Education , Xuzhou Medical University , Xuzhou , China
| | - Hao Chen
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | | | - Guiyun Cui
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| |
Collapse
|
15
|
Advanced Neuroimaging of Acute Ischemic Stroke: Penumbra and Collateral Assessment. Neuroimaging Clin N Am 2018; 28:585-597. [PMID: 30322595 DOI: 10.1016/j.nic.2018.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute ischemic stroke (AIS) occurs when there is a sudden loss in cerebral blood flow due to embolic or thromboembolic occlusion of a cerebral or cervical artery. Patients with AIS require emergent neuroimaging to guide treatment, which includes intravenous thrombolysis and endovascular mechanical thrombectomy (EMT). Recent advances in AIS treatment by EMT has been driven in part by advances in computed tomography (CT) and MR imaging neuroimaging evaluation of ischemic penumbra and pial collateral vessels. The authors review advanced noninvasive brain imaging by CT and MR imaging for the evaluation of AIS focusing on penumbral and collateral imaging.
Collapse
|
16
|
Yan R, Zhang B, Wang L, Li Q, Zhou F, Ren J, Zhai Z, Li Z, Cui H. A comparison of contrast-free MRA at 3.0 T in cases of intracranial aneurysms with or without subarachnoid hemorrhage. Clin Imaging 2018; 49:131-135. [DOI: 10.1016/j.clinimag.2017.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 10/03/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
|
17
|
Chen X, Liu Y, Tong H, Dong Y, Ma D, Xu L, Yang C. Meta-analysis of computed tomography angiography versus magnetic resonance angiography for intracranial aneurysm. Medicine (Baltimore) 2018; 97:e10771. [PMID: 29768368 PMCID: PMC5976319 DOI: 10.1097/md.0000000000010771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Whether the diagnosis value of computed tomography angiography (CTA) for intracranial aneurysm is in accordance with magnetic resonance angiography (MRA) remains inconclusive. This meta-analysis aims to synthesize relevant studies to compare the diagnostic efficacies of the 2 methods. METHODS Potentially relevant studies were selected through PubMed, Embase, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure databases by using the core terms "computer tomography angiography" (CTA) and "magnetic resonance angiography" (MRA) and "intracranial aneurysm*" in the titles, abstracts, and keywords of the articles. Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2) was utilized to evaluate the quality. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were count. Summary receiver operating characteristic curves (SROC) and area under the curve (AUC) were used to summarize the overall diagnostic performance. Statistical analyses were performed by Stata version 12.0 and MetaDisc 1.4 software. RESULTS Ten articles were identified in this current paper. For CTA, the pooled estimates of diagnostic parameters for intracranial aneurysm were as follows: sensitivity, 0.84 (95%CI = 0.81-0.86); specificity, 0.85 (95%CI = 0.79-0.89); PLR, 4.09 (95%CI = 2.45-6.81); NLR, 0.18 (95%CI = 0.11-0.28); DOR, 23.74 (95%CI = 10.49-53.74); AUC, 0.90, respectively. For MRA, the pooled estimates of diagnostic parameters for intracranial aneurysm were as follows: sensitivity, 0.80 (95%CI = 0.77-0.83); specificity, 0.87 (95%CI = 0.82-0.91); PLR, 3.61 (95%CI = 1.72-7.55); NLR; 0.27 (95%CI = 0.21-0.35); DOR, 16.77 (95%CI = 7.38-38.11); AUC, 0.87, respectively. No significant difference was found the AUC value between CTA and MRA for intracranial aneurysm (Z = 0.828, P > .05). CONCLUSION This comprehensive meta-analysis demonstrated that the diagnosis value of CTA was in accordance with MRA for intracranial aneurysm. However, considering the limitation of sample size, the results should be treated with caution.
Collapse
Affiliation(s)
- Xiaodan Chen
- Department of Science and Education, Jiangxi Provincial Cancer Hospital
| | - Yun Liu
- Cadre Wards of Neurology Medicine
| | - Huazhang Tong
- Department of Cancer Radiotherapy, Jiangxi Provincial People's Hospital
| | - Yonghai Dong
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang
| | - Dongyang Ma
- Nanhui Mental Health Center, Pudong New Area, Shanghai, China
| | - Lei Xu
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang
| | - Cheng Yang
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang
| |
Collapse
|
18
|
Herzberg M, Forbrig R, Schichor C, Brückmann H, Dorn F. Preoperative Digital Subtraction Angiography in Incidental Unruptured Intracranial Aneurysms. Clin Neuroradiol 2018; 28:429-435. [DOI: 10.1007/s00062-018-0689-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
|
19
|
Cho SH, Lee JY, Ryu KH, Suh DC. Diagnosis of Cerebral Aneurysm Via Magnetic Resonance Angiography Screening: Emphasis on Legal Responsibility Increases False Positive Rate. Neurointervention 2018. [PMID: 29535898 PMCID: PMC5847890 DOI: 10.5469/neuroint.2018.13.1.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose False positive diagnoses of cerebral aneurysm via magnetic resonance angiography (MRA) screening may increase unnecessary cerebral catheter angiography. The purpose of this study was to investigate the effects of medical liability on medical decision-making during radiologic interpretation. Materials and Methods We included 56 consecutive patients who were referred with suspected aneurysm based on MRA or computed tomography angiography (CTA) and showed no aneurysm on subsequent digital subtraction angiography (DSA). MRA and CTA were reviewed twice by two neuroradiology fellows who were blind as to whether the suspected lesions were true aneurysms or not. The second review was repeated after proposing that their decision was subject to legal liability and they would be responsible for medico-legal problems related to their diagnoses. Diagnostic differences based on each review were analyzed, focusing on changes in false positive diagnosis rates. Results A total of 63 suspected aneurysmal lesions detected via MRA or CTA were found to be negative based on DSA. At first review, 32 lesions were diagnosed as true aneurysms by observer 1 and 27 by observer 2, corresponding to false positive rates of 51% and 43% respectively. At the second review, 39 lesions (62%) were diagnosed by observer 1, and 30 (48%) by observer 2. Thus, there was an overall increase in false positive aneurysm diagnosis of 11% for observer 1 and 5% for observer 2, after emphasizing their responsibilities in the context of medical litigation. Conclusion Concerns about medical liability could result in increased false positive diagnoses of cerebral aneurysms via MRA screening. Whether repeated follow-up of the suspected lesion or catheter angiographic confirmation is better with regard to long-term patient outcomes requires further study.
Collapse
Affiliation(s)
- Su-Hee Cho
- Department of Neurosurgery, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Korea
| | - Kyeong-Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
20
|
Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review. World Neurosurg 2018; 113:280-292. [PMID: 29360591 DOI: 10.1016/j.wneu.2018.01.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are pathologic dilatations of cerebral arteries. This systematic review summarizes and compares imaging techniques for assessing unruptured IAs (UIAs). This review also addresses their uses in different scopes of practice. Pathophysiologic mechanisms are reviewed to better understand the clinical usefulness of each imaging modality. METHODS A literature review was performed using PubMed with these search terms: "intracranial aneurysm," "cerebral aneurysm," "magnetic resonance angiography (MRA)," computed tomography angiography (CTA)," "catheter angiography," "digital subtraction angiography," "molecular imaging," "ferumoxytol," and "myeloperoxidase". Only studies in English were cited. RESULTS Since the development and improvement of noninvasive diagnostic imaging (computed tomography angiography and magnetic resonance angiography), many prospective studies and meta-analyses have compared these tests with gold standard digital subtraction angiography (DSA). Although computed tomography angiography and magnetic resonance angiography have lower detection rates for UIAs, they are vital in the treatment and follow-up of UIAs. The reduction in ionizing radiation and lack of endovascular instrumentation with these modalities provide benefits compared with DSA. Novel molecular imaging techniques to detect inflammation within the aneurysmal wall with the goal of stratifying risk based on level of inflammation are under investigation. CONCLUSIONS DSA remains the gold standard for preoperative planning and follow-up for patients with IA. Newer imaging modalities such as ferumoxytol-enhanced magnetic resonance imaging are emerging techniques that provide critical in vivo information about the inflammatory milieu within aneurysm walls. With further study, these techniques may provide aneurysm rupture risk and prediction models for individualized patient care.
Collapse
|
21
|
Flahault A, Trystram D, Nataf F, Fouchard M, Knebelmann B, Grünfeld JP, Joly D. Screening for intracranial aneurysms in autosomal dominant polycystic kidney disease is cost-effective. Kidney Int 2017; 93:716-726. [PMID: 29061331 DOI: 10.1016/j.kint.2017.08.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/16/2017] [Accepted: 08/24/2017] [Indexed: 12/16/2022]
Abstract
Intracranial aneurysm rupture is a dramatic complication of autosomal dominant polycystic kidney disease (ADPKD). It remains uncertain whether screening should be widespread or only target patients with risk factors (personal or familial history of intracranial aneurysm), with an at-risk profession, or those who request screening. We evaluated this in a single-center cohort of 495 consecutive patients with ADPKD submitted to targeted intracranial aneurysm screening. Cerebral magnetic resonance angiography was proposed to 110 patients with a familial history of intracranial aneurysm (group 1), whereas it was not our intention to propose it to 385 patients without familial risk (group 2). Magnetic resonance angiography results, intracranial aneurysm prophylactic repair, rupture events, and cost-effectiveness of intracranial aneurysm screening strategies were retrospectively analyzed. During a median follow up of 5.9 years, five non-fatal intracranial aneurysm ruptures occurred (incidence rate 2.0 (0.87-4.6)/1000 patients-year). In group 1, 90% of patients were screened and an intracranial aneurysm was detected in 14, treated preventively in five, and ruptured in one patient despite surveillance. In group 2, 21% of patients were screened and an intracranial aneurysm was detected in five, and treated preventively in one. Intracranial aneurysm rupture occurred in four patients in group 2. Systematic screening was deemed cost-effective and provides a gain of 0.68 quality-adjusted life years compared to targeted screening. Thus, the intracranial aneurysm rupture rate is high in ADPKD despite targeted screening, and involves mostly patients without familial risk factors. Hence, cost-utility analysis suggests that intracranial aneurysm screening could be proposed to all ADPKD patients.
Collapse
Affiliation(s)
- Adrien Flahault
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France; College de France, Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis and Cardiovascular Functions, CIRB, INSERM U1050, Paris, France
| | - Denis Trystram
- Université Paris-Descartes, INSERM UMR 894, Service de Neuroradiologie, Centre Hospitalier Sainte-Anne, Paris, France
| | - François Nataf
- Université Paris-Descartes, INSERM UMR 894, Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Paris, France
| | - Marie Fouchard
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Bertrand Knebelmann
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Jean-Pierre Grünfeld
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Dominique Joly
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France; Investigation Network Initiative, Cardiovascular and Renal Clinical Trialists, Paris, France.
| |
Collapse
|
22
|
HaiFeng L, YongSheng X, YangQin X, Yu D, ShuaiWen W, XingRu L, JunQiang L. Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis. Neuroradiology 2017; 59:1083-1092. [DOI: 10.1007/s00234-017-1905-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022]
|
23
|
Flahault A, Knebelmann B, Nataf F, Trystram D, Grünfeld JP, Joly D. [Screening and management of intracranial aneurisms in patients with autosomal dominant polycystic kidney disease]. Nephrol Ther 2017; 13 Suppl 1:S147-S153. [PMID: 28577737 DOI: 10.1016/j.nephro.2017.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/21/2017] [Indexed: 12/17/2022]
Abstract
Autosomal dominant polycystic kidney disease is the most frequent hereditary kidney disease. Intracranial aneurysm prevalence in this population is four to five times higher than the prevalence in the general population. The most frequent complication of intracranial aneurysms is rupture with subarachnoidal hemorrhage, which is associated with a high morbidity and mortality. The only identified risk factor for unruptured intracranial aneurysm is a family history of intracranial aneurysm. However, most cases of aneurysm rupture occur without any family history of intracranial aneurysm. Magnetic resonance angiography without contrast medium injection facilitates screening, and progress have been made in preventive (endovascular or neurosurgical) treatment of intracranial aneurysm. Recommendations have recently been published concerning intracranial aneurysm screening, and suggest screening patients with autosomal dominant polycystic kidney disease and a family history of intracranial aneurysm, those who have an at-risk activity and those who request screening despite adequate information. Conflicting opinions exist, however, in the literature. Furthermore, a study of practice was conducted among French-speaking nephrologists in Europe and showed that approximately a third of the participants were in favor of systematic screening for intracranial aneurysm in all patients with autosomal dominant polycystic kidney disease. Beyond intracranial aneurysm prevalence, it is necessary to better define rupture rates in the autosomal dominant polycystic kidney disease population, with and without familial history of intracranial aneurysm. This would allow optimizing intracranial aneurysm screening practices in autosomal dominant polycystic kidney disease.
Collapse
Affiliation(s)
- Adrien Flahault
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France; Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis and Cardiovascular Functions, Center of Interdisciplinary Research in Biology (CIRB), collège de France, 11, place Marcelin-Berthelot, 75231 Paris cedex 05, France; Inserm U1050, 11, place Marcelin-Berthelot, 75231 Paris cedex 05, France
| | - Bertrand Knebelmann
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - François Nataf
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Inserm UMR 894, 2, ter rue d'Alésia, 75014 Paris, France; Service de neurochirurgie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14, France
| | - Denis Trystram
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Inserm UMR 894, 2, ter rue d'Alésia, 75014 Paris, France; Service de neuroradiologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14, France
| | - Jean-Pierre Grünfeld
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - Dominique Joly
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France.
| |
Collapse
|
24
|
320-Row Multidetector CT Angiography in the Detection of Critical Cerebrovascular Anomalies. Can J Neurol Sci 2016; 43:543-8. [PMID: 26963444 DOI: 10.1017/cjn.2016.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The acquisition of a new 320-row multidetector computed tomography angiography (CTA) scanner at the Montreal Neurological Institute and Hospital has provided higher quality imaging with less radiation exposure and shorter time of acquisition. However, its reliability has not been fully proven in critical vascular lesions when it comes to replacing a more invasive examination such as cerebral angiography. We wished to validate the accuracy of this equipment to investigate four common indications for patients to undergo conventional digital subtraction angiography: subarachnoid hemorrhage, vasospasm, unusual intracerebral hemorrhage, and unruptured aneurysm. METHODS Radiological reports and relevant imaging from 82 consecutive subjects who underwent a 320-row multidetector CTA followed by cerebral angiography from February 2010 to February 2014 were retrospectively analysed. A total of 102 cerebrovascular anomalies were found. Reports from both imaging modalities were compared to determine the diagnostic accuracy of CTA. RESULTS The overall sensitivity and specificity of 320-row multidetector CTA for detecting cerebrovascular abnormalities were, respectively, 97.60% and 63.20%. Similar results were obtained for all four categories of clinical indications. CONCLUSION Results obtained from CTA were consistent with those obtained on digital subtraction angiography regardless of the vascular pathology. To our knowledge, this study is the first validating the accuracy of 320-row CTA in diagnosing critical cerebrovascular lesions.
Collapse
|
25
|
Lee HJ, Yang PS, Lee SB, Yi JS, Ryu SY, Kim TW, Lee TJ, Yang JH, Lee IW, Kim JK, Kim HJ. The Influence of Flush Methods on Transfemoral Catheter Cerebral Angiography: Continuous Flush versus Intermittent Flush. J Vasc Interv Radiol 2016; 27:651-7. [PMID: 26952125 DOI: 10.1016/j.jvir.2015.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the influence of different flush methods on transfemoral cerebral angiography (TFCA). MATERIALS AND METHODS This single-blind randomized controlled trial included 50 patients who had undergone TFCA. Balanced block randomization was used to allocate participants into intermittent-flush (n = 25) and continuous-flush (n = 25) groups. Differences in procedure duration, amounts of contrast medium and heparinized saline used, heparin dose, blood loss, fluoroscopy time, radiation dose, and occurrence of new embolic signal (NES) on diffusion-weighted imaging (DWI) were compared between the two groups. RESULTS The procedure duration was shorter in the continuous-flush group (mean 26.5 min ± 3.7) than in the intermittent-flush group (mean 29.6 min ± 2.8) (P = .004). Amounts of injected contrast medium (mean 20.2 mL ± 4.4 vs 57.1 mL ± 9.0), wasted heparinized saline (mean 19.8 mL ± 9.6 vs 92.3 mL ± 16.7), and aspirated blood (mean 4.7 mL ± 1.3 vs 13.2 mL ± 2.9) were lower in the continuous-flush group than in the intermittent-flush group (P < .001). The amount of injected (or infused) heparinized saline, heparin dose, fluoroscopy time, radiation dose, and occurrence of NES on DWI did not differ between the groups (P > .05). CONCLUSIONS The use of continuous flushing during TFCA reduced the procedure time, amount of contrast medium needed, amount of wasted heparinized saline, and blood loss, but no difference in the occurrence of NES on DWI was noted between the groups.
Collapse
Affiliation(s)
- Hyung Jin Lee
- Departments of Neurosurgery, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Po Song Yang
- Radiology, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Sang Bong Lee
- Neurology, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Jin Seok Yi
- Departments of Neurosurgery, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Seon-Young Ryu
- Neurology, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Tae Woo Kim
- Neurology, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Taek-Jun Lee
- Neurology, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Ji Ho Yang
- Departments of Neurosurgery, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Il Woo Lee
- Departments of Neurosurgery, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea
| | - Jae Kyun Kim
- Departments of Neurosurgery, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea; Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Kim
- Radiology, Daejeon St. Mary's Hospital, Medical School, Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon 301-723, Korea.
| |
Collapse
|
26
|
Aneurismi arteriosi intracranici. Neurologia 2016. [DOI: 10.1016/s1634-7072(15)76145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
27
|
Akasaka T, Fujimoto K, Yamamoto T, Okada T, Fushumi Y, Yamamoto A, Tanaka T, Togashi K. Optimization of Regularization Parameters in Compressed Sensing of Magnetic Resonance Angiography: Can Statistical Image Metrics Mimic Radiologists' Perception? PLoS One 2016; 11:e0146548. [PMID: 26744843 PMCID: PMC4706324 DOI: 10.1371/journal.pone.0146548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/19/2015] [Indexed: 11/24/2022] Open
Abstract
In Compressed Sensing (CS) of MRI, optimization of the regularization parameters is not a trivial task. We aimed to establish a method that could determine the optimal weights for regularization parameters in CS of time-of-flight MR angiography (TOF-MRA) by comparing various image metrics with radiologists' visual evaluation. TOF-MRA of a healthy volunteer was scanned using a 3T-MR system. Images were reconstructed by CS from retrospectively under-sampled data by varying the weights for the L1 norm of wavelet coefficients and that of total variation. The reconstructed images were evaluated both quantitatively by statistical image metrics including structural similarity (SSIM), scale invariant feature transform (SIFT) and contrast-to-noise ratio (CNR), and qualitatively by radiologists' scoring. The results of quantitative metrics and qualitative scorings were compared. SSIM and SIFT in conjunction with brain masks and CNR of artery-to-parenchyma correlated very well with radiologists' visual evaluation. By carefully selecting a region to measure, we have shown that statistical image metrics can reflect radiologists' visual evaluation, thus enabling an appropriate optimization of regularization parameters for CS.
Collapse
Affiliation(s)
- Thai Akasaka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Fujimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Okada
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasutaka Fushumi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Tanaka
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
28
|
Perrone RD, Malek AM, Watnick T. Vascular complications in autosomal dominant polycystic kidney disease. Nat Rev Nephrol 2015; 11:589-98. [PMID: 26260542 PMCID: PMC4904833 DOI: 10.1038/nrneph.2015.128] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Relentless cyst growth substantially enlarges both kidneys and culminates in renal failure. Patients with ADPKD also have vascular abnormalities; intracranial aneurysms (IAs) are found in ∼10% of asymptomatic patients during screening and in up to 25% of those with a family history of IA or subarachnoid haemorrhage. As the genes responsible for ADPKD—PKD1 and PKD2—have complex integrative roles in mechanotransduction and intracellular calcium signalling, the molecular basis of IA formation might involve focal haemodynamic conditions exacerbated by hypertension and altered flow sensing. IA rupture results in substantial mortality, morbidity and poor long-term outcomes. In this Review, we focus mainly on strategies for screening, diagnosis and treatment of IAs in patients with ADPKD. Other vascular aneurysms and anomalies—including aneurysms of the aorta and coronary arteries, cervicocephalic and thoracic aortic dissections, aortic root dilatation and cerebral dolichoectasia—are less common in this population, and the available data are insufficient to recommend screening strategies. Treatment decisions should be made with expert consultation and be based on a risk-benefit analysis that takes into account aneurysm location and morphology as well as patient age and comorbidities.
Collapse
Affiliation(s)
- Ronald D Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Adel M Malek
- Department of Neurosurgery, Cerebrovascular and Endovascular Division, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Terry Watnick
- Department of Medicine, Division of Nephrology, University of Maryland, 720 Rutland Avenue, Baltimore, MD 21205, USA
| |
Collapse
|
29
|
Abstract
Many noncontrast magnetic resonance angiography techniques have recently been developed in response to concerns about gadolinium in patients with renal impairment. This article describes the theory behind established and recently described techniques and how and where they can be performed in clinical practice.
Collapse
|
30
|
Meshaal MS, Kassem HH, Samir A, Zakaria A, Baghdady Y, Rizk HH. Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis. PLoS One 2015; 10:e0118616. [PMID: 25823006 PMCID: PMC4379076 DOI: 10.1371/journal.pone.0118616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 01/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs). These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA) is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE. METHODS From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention. RESULTS The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%). Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32%) had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%). The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture. CONCLUSIONS Routine brain CT/CTA resulted in changes in the treatment plan in a significant proportion of patients with IE, even those without clinically evident neurological disease. Routine brain CT/CTA may be indicated in all hospitalized patients with IE.
Collapse
Affiliation(s)
| | | | - Ahmad Samir
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Ayman Zakaria
- Department of Radiology, Cairo University, Cairo, Egypt
| | - Yasser Baghdady
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | | |
Collapse
|
31
|
Detection and characterization of unruptured intracranial aneurysms: Comparison of 3T MRA and DSA. J Neuroradiol 2014; 42:162-8. [PMID: 25454398 DOI: 10.1016/j.neurad.2014.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/18/2014] [Accepted: 08/30/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare magnetic resonance angiography (MRA) at 3 Tesla (3T) and digital subtraction angiography (DSA) for the detection and characterization of unruptured intracranial aneurysms (UIA). MATERIALS AND METHODS This study has been approved by our local ethical committee. From February to August 2010, 40 consecutive patients with UIA contemporarily underwent MRA at 3T including time-of-flight (TOF-MRA) and contrast enhanced (CE-MRA) techniques and DSA. MR images were independently reviewed by 3 radiologists and DSA images were reviewed by 2 radiologists together. Interobserver and intertechnique agreements were assessed for aneurysm detection and characterization including maximal diameter, neck width and the presence of a bleb or a branch arising from the sac. RESULTS DS angiography revealed 56 aneurysms. Mean sensitivity and positive predictive value of MRA were 91.4% and 93.4% respectively. For UIA < 3 mm and those ≥ 3 mm, MRA had a mean sensitivity of 74.1% and 100% respectively. Intertechnique and interobserver agreements were substantial for the measurement of UIA maximal diameter (mean κ, 0.607 and 0.601 respectively) and were moderate and fair for neck width measurement respectively (mean κ, 0.456 and 0.285 respectively). For bleb detection, intertechnique and interobserver agreements were fair and slight respectively (mean κ, 0.312 and 0.116 respectively) whereas both were slight for detection of branches arising from the sac (mean κ, 0.151 and 0.070 respectively). CONCLUSION MR angiography at 3T has a high sensitivity for the detection of UIA. However, it remains significantly inferior to DSA for morphological characterization of UIA.
Collapse
|
32
|
Li MH, Li YD, Gu BX, Cheng YS, Wang W, Tan HQ, Chen YC. Accurate Diagnosis of Small Cerebral Aneurysms ≤5 mm in Diameter with 3.0-T MR Angiography. Radiology 2014; 271:553-60. [DOI: 10.1148/radiol.14122770] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
33
|
Inoue S, Hosoda K, Fujita A, Ohno Y, Fujii M, Sugimura K, Kohmura E. Utility of 320-detector row CT for diagnosis and therapeutic strategy for paraclinoid and intracavernous aneurysms. Acta Neurochir (Wien) 2014; 156:505-14. [PMID: 24445734 DOI: 10.1007/s00701-014-1996-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was (1) to assess the diagnostic accuracy of 320-detector row computed tomography (CT) for paraclinoid and intracavernous aneurysms, and (2) to investigate whether this method provides sufficient information for surgery. METHODS A total of 14 patients with 16 unruptured proximal ICA aneurysms underwent three-dimensional CT angiography (3D-CTA) fusion imaging, which was created by superimposing 3D-CT venography data and/or 3D-bone data onto 3D-CTA data using 320-detector row CT, magnetic resonance imaging (MRI), and 3D digital subtraction angiography (DSA). The images of each modality were assessed using intraoperative findings as the reference standard. RESULTS All aneurysms were clearly visualized on 320-detector row CT. Bone subtraction and arterio-venous discrimination were accurate. On 3D-CTA fusion images, 11 aneurysms were diagnosed as "extracavernous" and five as "intracavernous". No discordance in aneurysm location between the 3D-CTA fusion images and the intraoperative findings was found. In contrast, discordance between MRI and intraoperative findings were found in five of the 16 cases (31%), which was significantly more frequent than with 3D-CTA (p = 0.043). The findings DSA, which was performed in nine patients, were also in excellent agreement with the intraoperative findings. However, 3D-CTA fusion imaging provided more comprehensive information, including venous and osseous structures, than 3D-DSA. The 320-detector row CTA after surgery demonstrated a clear relationship between the clip and aneurysmal neck with notably few artifacts, which suggested the utility of this modality for postoperative assessment. CONCLUSIONS The 320-detector row CT provided high accuracy for the diagnosis of paraclinoid and intracavernous aneurysms. This technique also provided comprehensive depiction of the aneurysms and surrounding structures. Therefore, this modality might be useful for the diagnosis of the paraclinoid and intracavernous aneurysms and for developing a surgical treatment plan.
Collapse
|
34
|
Sailer AM, Wagemans BA, Nelemans PJ, de Graaf R, van Zwam WH. Diagnosing Intracranial Aneurysms With MR Angiography. Stroke 2014; 45:119-26. [PMID: 24326447 DOI: 10.1161/strokeaha.113.003133] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna M.H. Sailer
- From the Department of Radiology (A.M.H.S., B.A.J.M.W., R.d.G., W.H.v.Z.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bart A.J.M. Wagemans
- From the Department of Radiology (A.M.H.S., B.A.J.M.W., R.d.G., W.H.v.Z.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia J. Nelemans
- From the Department of Radiology (A.M.H.S., B.A.J.M.W., R.d.G., W.H.v.Z.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rick de Graaf
- From the Department of Radiology (A.M.H.S., B.A.J.M.W., R.d.G., W.H.v.Z.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Willem H. van Zwam
- From the Department of Radiology (A.M.H.S., B.A.J.M.W., R.d.G., W.H.v.Z.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
35
|
Pradilla G, Wicks RT, Hadelsberg U, Gailloud P, Coon AL, Huang J, Tamargo RJ. Accuracy of Computed Tomography Angiography in the Diagnosis of Intracranial Aneurysms. World Neurosurg 2013; 80:845-52. [DOI: 10.1016/j.wneu.2012.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 06/06/2012] [Accepted: 12/03/2012] [Indexed: 11/17/2022]
|
36
|
van Amerongen MJ, Boogaarts HD, de Vries J, Verbeek ALM, Meijer FJA, Prokop M, Bartels RHMA. MRA versus DSA for follow-up of coiled intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol 2013; 35:1655-61. [PMID: 24008171 DOI: 10.3174/ajnr.a3700] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
MR angiography is proposed as a safer and less expensive alternative to the reference standard, DSA, in the follow-up of intracranial aneurysms treated with endovascular coil occlusion. We performed a systematic review and meta-analysis to evaluate the accuracy of TOF-MRA and contrast-enhanced MRA in detecting residual flow in the follow-up of coiled intracranial aneurysms. Literature was reviewed through the PubMed, Cochrane, and EMBASE data bases. In comparison with DSA, the sensitivity of TOF-MRA was 86% (95% CI: 82-89%), with a specificity of 84% (95% CI: 81-88%), for the detection of any recurrent flow. For contrast-enhanced MRA, the sensitivity and specificity were 86% (95% CI: 82-89%) and 89% (95% CI: 85-92%), respectively. Both TOF-MRA and contrast-enhanced MRA are shown to be highly accurate for detection of any recanalization in intracranial aneurysms treated with endovascular coil occlusion.
Collapse
Affiliation(s)
- M J van Amerongen
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
| | - H D Boogaarts
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
| | - J de Vries
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
| | | | - F J A Meijer
- Radiology/Neuroradiology (F.J.A.M., M.P.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - M Prokop
- Radiology/Neuroradiology (F.J.A.M., M.P.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R H M A Bartels
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
| |
Collapse
|
37
|
Chen H, Li MH. A1 segment hypoplasia accompanied by AcomA aneurysms assessed with magnetic resonance angiography. Surg Radiol Anat 2013; 36:353-7. [PMID: 23912562 DOI: 10.1007/s00276-013-1182-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/26/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE This study is to evaluate the use of three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) at 3.0 T for the detection and classification of A1 segment hypoplasia based on a large case series and investigates the potential links with AcomA aneurysm occurrence. METHODS Between January 2009 and June 2012, 8,013 patients underwent MRA examination at 3.0 T in our hospital. MRA was performed using 3D-TOF with volume rendering technique. The presence and location of A1 segment hypoplasia and AcomA aneurysm was reviewed. RESULTS Among the 8,013 patients examined, 138 patients were identified with AcomA aneurysms. 425 patients were defined with A1 segment hypoplasia, among whom 303 right-sided A1 hypoplasia and 122 left-sided A1 hypoplasia. 60 of these 425 patients were confirmed with AcomA aneurysms, among them were 49 right-sided A1 hypoplasia. The prevalence of AcomA aneurysm with A1 segment hypoplasia was 14.1 %, which was much higher compared with that (1.0 %) of AcomA aneurysm without A1 segment hypoplasia (P < 0.001). CONCLUSIONS The incidence of right-sided A1 segment hypoplasia either accompanied with AcomA aneurysm or not was much greater than that of left-sided. Intracranial AcomA aneurysm development appeared to be associated with A1 segment hypoplasia.
Collapse
Affiliation(s)
- Hao Chen
- Institute of Diagnostic and Interventional Radiology, The Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, 200233, ShangHai, China,
| | | |
Collapse
|
38
|
Yanamadala V, Sheth SA, Walcott BP, Buchbinder BR, Buckley D, Ogilvy CS. Non-contrast 3D time-of-flight magnetic resonance angiography for visualization of intracranial aneurysms in patients with absolute contraindications to CT or MRI contrast. J Clin Neurosci 2013; 20:1122-6. [PMID: 23685107 DOI: 10.1016/j.jocn.2012.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
Abstract
The preoperative evaluation of patients with intracranial aneurysms typically includes a contrast-enhanced vascular study, such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography. However, there are numerous absolute and relative contraindications to the administration of imaging contrast agents, including pregnancy, severe contrast allergy, and renal insufficiency. Evaluation of patients with contrast contraindications thus presents a unique challenge. We identified three patients with absolute contrast contraindications who presented with intracranial aneurysms. One patient was pregnant, while the other two had previous severe anaphylactic reactions to iodinated contrast. Because of these contraindications to intravenous contrast, we performed non-contrast time-of-flight MRA with 3D reconstruction (TOF MRA with 3DR) with maximum intensity projections and volume renderings as part of the preoperative evaluation prior to successful open surgical clipping of the aneurysms. In the case of one paraclinoid aneurysm, a high-resolution non-contrast CT scan was also performed to assess the relationship of the aneurysm to the anterior clinoid process. TOF MRA with 3DR successfully identified the intracranial aneurysms and adequately depicted the surrounding microanatomy. Intraoperative findings were as predicted by the preoperative imaging studies. The aneurysms were successfully clip-obliterated, and the patients had uneventful post-operative courses. These cases demonstrate that non-contrast imaging is a viable modality to assess intracranial aneurysms as part of the surgical planning process in patients with contrast contraindications. TOF MRA with 3DR, in conjunction with high-resolution non-contrast CT when indicated, provides adequate visualization of the microanatomy of the aneurysm and surrounding structures.
Collapse
Affiliation(s)
- Vijay Yanamadala
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | | | | |
Collapse
|
39
|
Pierot L, Portefaix C, Rodriguez-Régent C, Gallas S, Meder JF, Oppenheim C. Role of MRA in the detection of intracranial aneurysm in the acute phase of subarachnoid hemorrhage. J Neuroradiol 2013; 40:204-10. [PMID: 23664329 DOI: 10.1016/j.neurad.2013.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/27/2013] [Accepted: 03/30/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Magnetic resonance angiography (MRA) has been evaluated for the detection of unruptured intracranial aneurysms with favorable results at 3 Tesla (3T) and with similar diagnostic accuracy as both 3D time-of-flight (3D-TOF) and contrast-enhanced (CE-MRA) MRA. However, the diagnostic value and place of MRA in the detection of ruptured aneurysms has been little evaluated. Thus, the goal of this prospective single-center series was to assess the feasibility and diagnostic value of 3T 3D-TOF MRA and CE-MRA for aneurysm detection in acute non-traumatic subarachnoid hemorrhage (SAH). METHODS From March 2006 to December 2007, all consecutive patients admitted to our hospital with acute non-traumatic SAH (≤10 days) were prospectively included in this study evaluating MRA in the diagnostic workup of SAH. Feasibility of MRA and sensitivity/specificity of 3D-TOF and CE-MRA were assessed compared with gold standard DSA. RESULTS In all, 84 consecutive patients (45 women, 39 men; age 23-86 years) were included. The feasibility of MRA was low (43/84, 51.2%). The reasons given for patients not undergoing magnetic resonance imaging (MRI) examination were clinical status (27 patients), potential delay in aneurysm treatment (11 patients) and contraindications to MRI (three patients). In patients explored by MRA, the sensitivity of CE-MRA (95%) was higher compared with 3D-TOF (86%) with similar specificity (80%). Also, 3D-TOF missed five aneurysms while CE-MRA missed two. CONCLUSION The value of MRA in the diagnostic workup of ruptured aneurysms is limited due to its low feasibility during the acute phase of bleeding. Sensitivity for aneurysm detection was good for both MRA techniques, but tended to be better with CE-MRA.
Collapse
Affiliation(s)
- Laurent Pierot
- Department of Radiology, Maison Blanche Hospital, Université Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims, France.
| | | | | | | | | | | |
Collapse
|
40
|
Stamm AC, Wright CL, Knopp MV, Schmalbrock P, Heverhagen JT. Phase contrast and time-of-flight magnetic resonance angiography of the intracerebral arteries at 1.5, 3 and 7 T. Magn Reson Imaging 2013; 31:545-9. [DOI: 10.1016/j.mri.2012.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/22/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
|
41
|
Normal anatomical features and variations of the vertebrobasilar circulation and its branches: an analysis with 64-detector row CT and 3T MR angiographies. ScientificWorldJournal 2013; 2013:620162. [PMID: 24023533 PMCID: PMC3759058 DOI: 10.1155/2013/620162] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/09/2013] [Indexed: 12/02/2022] Open
Abstract
Purpose. To determine the normal anatomical features and variations of the vertebrobasilar circulation and its branches in patients who underwent multidetector computed tomography (CT) or magnetic resonance (MR) angiographies of the brain. Methods. 135 patients (male, 83 and female, 52; mean age, 50.1 years) who underwent CT (n = 71) or MR (n = 64) angiographies of the vertebrobasilar vasculature for various reasons were analyzed retrospectively. The right and left distal vertebral arteries (VAs), posterior inferior cerebellar arteries (PICAs), anterior inferior cerebellar arteries (AICAs), superior cerebellar arteries (SCAs), posterior cerebral arteries (PCAs), and posterior communicating arteries (PCoAs) were analyzed individually. Results. In 24.4% of the cases (33/135) right PICA, in 19.3% of the cases (26/135) left PICA, in 17.8% of the cases (24/135) right AICA, and in 18.5% of the cases (25/135) left AICA were absent. In cases without PICA or AICA, there was a statistically significant, moderately or well-developed AICA or PICA on the same side, respectively (P < 0.001). The most common variation was isolated absence of right PICA and was seen in 17.8% of the cases. Conclusions. The anatomic features of the branches of the vertebrobasilar circulation may be different from well-known normal anatomy. CT and MR angiographies allow a precise and detailed evaluation of vertebrobasilar circulation.
Collapse
|
42
|
McLaughlin N, Villablanca PJ, Jahan R, Martin NA. An infundibulum of thalamoperforator arteries: Importance of angiographic images for appropriate diagnosis. Surg Neurol Int 2013; 4:44. [PMID: 23607066 PMCID: PMC3622354 DOI: 10.4103/2152-7806.109811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/22/2013] [Indexed: 11/27/2022] Open
Abstract
Background: The identification of infundibula on noninvasive imaging modalities may be challenging. Because these lesions have generally been viewed as nonpathological, distinguishing them from small or micro-aneurysms is important. Case Description: A 39-year-old male was diagnosed with recurrence of typical orgasmic headache. An outpoutching arising from the distal part of the right P1 at the take-off of thalamoperforator arteries was visualized on noninvasive investigations. The patient was referred to neurosurgery for surgical management of a right P1 aneurysm. Its unusual location and morphology led to be suspicious of an infundibular dilatation. Catheter angiography with 2D projections and 3D rotational reconstruction revealed an infundibulum at the common origin of two thalamoperforators, giving rise to a double-peaked shape, mimicking a true aneurysm, rather than the more characteristic conical shape of an infundibulum. Conclusion: Although noninvasive modalities may identify typical infundibula, the catheter angiogram with 2D projections was critical to establishing the diagnosis. The 3D rotational reconstruction enabled a straightforward understanding of the 3D vascular anatomy. This pyramidal variant of infundibular dilatation should be included in the differential diagnosis of a wide-based nonsaccular arterial contour deformities located in an area of multiple perforators.
Collapse
Affiliation(s)
- Nancy McLaughlin
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, CA, USA
| | | | | | | |
Collapse
|
43
|
Incidence of growth and rupture of unruptured intracranial aneurysms followed by serial MRA. Acta Neurochir (Wien) 2013. [PMID: 23196925 DOI: 10.1007/s00701-012-1566-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The natural history, including growth and rupture, of unruptured intracranial aneurysms (UIAs) remains unknown. Here, we present the results of serial magnetic resonance angiography (MRA) follow-up study in 111 patients with 136 UIAs. METHOD A total of 111 patients with 136 UIAs were followed annually over the past 12 years, using 1.5-Tesla MRA. Follow-up was ended when UIAs were treated surgically, or the patients died of subarachnoid hemorrhage or other causes. Various factors influencing aneurysm rupture or growth were examined statistically. RESULTS Aneurysm rupture and growth occurred in six and 13 of the 111 patients, respectively. Annual rupture rate was 1.8 % per year and annual growth rate was 3.9 % per year. Aneurysm size was the sole factor influencing rupture(H.R. 1.214, 95 % CI, 1.078-1.368) and multiplicity was the sole factor influencing aneurysm growth (H.R. 5.174, 95 % CI 1.81-14.80). CONCLUSIONS Serial MRA study showed that the incidence of UIA growth was twice as high as that of UIA rupture. As four patients showed aneurysm rupture or growth within 1 year, further investigations are necessary to determine the optimum interval of radiological investigation and to identify which UIAs grow or rupture within a short time.
Collapse
|
44
|
Agarwal N, Gala NB, Choudhry OJ, Assina R, Prestigiacomo CJ, Duffis EJ, Gandhi CD. Prevalence of asymptomatic incidental aneurysms: a review of 2,685 computed tomographic angiograms. World Neurosurg 2013; 82:1086-90. [PMID: 23336985 DOI: 10.1016/j.wneu.2013.01.082] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 10/17/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Intracranial aneurysms are a public health issue with a potential for rupturing, causing significant morbidity/mortality. The prevalence of unruptured intracranial aneurysms, including those that are asymptomatic, varies widely, as it has been determined through autopsy studies as well as conventional angiography. However, computed tomography angiography, a less invasive procedure, has replaced the use of conventional angiography in the recent decades. The objective of the present study is to determine the prevalence of incidental aneurysms. METHODS The present study reviews all computed tomography angiography cases within the past decade at a single institution. RESULTS Of 2195 cases included in the study, 39 (1.8%) were found to have asymptomatic unruptured aneurysms. CONCLUSIONS The numbers of asymptomatic incidental aneurysms have increased.
Collapse
Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Nihar B Gala
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Osamah J Choudhry
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Rachid Assina
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Charles J Prestigiacomo
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA; Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA; Department of Neurology and Neuroscience, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Ennis J Duffis
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Chirag D Gandhi
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA; Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
| |
Collapse
|
45
|
Rozenfeld MN, Ansari SA, Shaibani A, Russell EJ, Mohan P, Hurley MC. Should patients with autosomal dominant polycystic kidney disease be screened for cerebral aneurysms? AJNR Am J Neuroradiol 2013; 35:3-9. [PMID: 23292526 DOI: 10.3174/ajnr.a3437] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Autosomal dominant polycystic kidney disease is a genetic disorder affecting 1 in 1000 people worldwide and is associated with an increased risk of intracranial aneurysms. It remains unclear whether there is sufficient net benefit to screening this patient population for IA, considering recent developments in imaging and treatment and our evolving understanding of the natural history of unruptured aneurysms. There is currently no standardized screening protocol for IA in patients with ADPCKD. Our review of the literature focused on the above issues and presents our appraisal of the estimated value of screening for IA in the setting of ADPCKD.
Collapse
Affiliation(s)
- M N Rozenfeld
- Department of Radiology, St. Francis Hospital, Evanston, Illinois
| | | | | | | | | | | |
Collapse
|
46
|
Igase M, Igase K, Kohara K, Yamashita S, Fujisawa M, Katagi R, Miki T. Visit-To-Visit Variability in Systolic Blood Pressure Is a Novel Risk Factor for the Growth of Intracranial Aneurysms. Cerebrovasc Dis 2013; 36:401-6. [DOI: 10.1159/000356217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022] Open
|
47
|
Zhang H, Hou C, Zhou Z, Zhang H, Zhou G, Zhang G. Evaluating of small intracranial aneurysms by 64-detector CT Angiography: a comparison with 3-dimensional rotation DSA or surgical findings. J Neuroimaging 2012; 24:137-43. [PMID: 23228080 DOI: 10.1111/j.1552-6569.2012.00747.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 06/17/2012] [Accepted: 07/01/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE The diagnostic performance of 64-detector computed tomographic angiography (CTA) for detection of small intracranial aneurysms (SIAs) was evaluated. METHODS In this prospective study, 112 consecutive patients underwent 64-detector CTA before volume-rendering rotation digital subtraction angiography (VR-RDSA) or surgery. VR-RDSA or intraoperative findings or both were used as the gold standards. The accuracy, sensitivity, specificity, and positive predictive values (PPV) and negative predictive values (NPV), as measures to detect or rule out SIAs, were determined by patient-based and aneurysm size-based evaluations. RESULTS The reference standard methods revealed 84 small aneurysms in 71 patients. The results of patient-based 64-detector CTA evaluation for SIAs were: accuracy, 98.2%; sensitivity, 98.6%; specificity, 97.6%; PPV, 98.6%; and NPV, 97.6%. The aneurysm-based evaluation results were: accuracy, 96.8%; sensitivity, 97.6%; specificity, 95.1%; PPV, 97.6%; and NPV, 95.1%. Two false-positive and two false-negative findings for aneurysms <3 mm in size occurred in the 64-detector CTA analysis. CONCLUSION The diagnostic performance of 64-detector CTA did not improve much compared with 16-detector CTA for detecting SIAs, especially for very small aneurysms. VR-RDSA is still necessary for patients with a history of subarachnoid hemorrhage if the CTA findings are negative.
Collapse
Affiliation(s)
- He Zhang
- Department of Radiology, Shanghai First People's Hospital, Medical College, Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | | | | |
Collapse
|
48
|
The clinical value of MRA at 3.0 T for the diagnosis and therapeutic planning of patients with subarachnoid haemorrhage. Eur Radiol 2012; 22:1404-12. [DOI: 10.1007/s00330-012-2390-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 11/30/2011] [Accepted: 01/12/2012] [Indexed: 11/25/2022]
|
49
|
The Role of 3 Tesla MRA in the Detection of Intracranial Aneurysms. Int J Vasc Med 2012; 2012:792834. [PMID: 22292121 PMCID: PMC3265088 DOI: 10.1155/2012/792834] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 10/09/2011] [Indexed: 12/01/2022] Open
Abstract
Intracranial aneurysms constitute a common pathological entity, affecting approximately 1–8% of the general population. Their early detection is essential for their prompt treatment. Digital subtraction angiography is considered the imaging method of choice. However, other noninvasive methodologies such as CTA and MRA have been employed in the investigation of patients with suspected aneurysms. MRA is a noninvasive angiographic modality requiring no radiation exposure. However, its sensitivity and diagnostic accuracy were initially inadequate. Several MRA techniques have been developed for overcoming all these drawbacks and for improving its sensitivity. 3D TOF MRA and contrast-enhanced MRA are the most commonly employed techniques. The introduction of 3 T magnetic field further increased MRA's sensitivity, allowing detection of aneurysms smaller than 3 mm. The development of newer MRA techniques may provide valuable information regarding the flow characteristics of an aneurysm. Meticulous knowledge of MRA's limitations and pitfalls is of paramount importance for avoiding any erroneous interpretation of its findings.
Collapse
|
50
|
Kin T, Shin M, Oyama H, Kamada K, Kunimatsu A, Momose T, Saito N. Impact of multiorgan fusion imaging and interactive 3-dimensional visualization for intraventricular neuroendoscopic surgery. Neurosurgery 2011; 69:ons40-8; discussion ons48. [PMID: 21336214 DOI: 10.1227/neu.0b013e318211019a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Imaging technologies have evolved to meet the demand for improved presurgical simulations, particularly with the introduction of endoscopic surgery in the neurosurgical field. OBJECTIVE To evaluate the effectiveness of a 3-dimensional interactive visualization method with a computer graphics model, which was created using hybrid rendering and multimodal fusion methods for neuroendoscopic surgery, and to assess whether the 2-dimensional interactive visualization method could effectively represent the microsurgical anatomical information necessary for endoscopic surgery compared with conventional 3-dimensional computer graphics models. METHODS Ten patients scheduled for neuroendoscopic surgery for intraventricular lesions were included in the study. For the 3-dimensional interactive visualization method, a hybrid model of volume and surface rendering was created from magnetic resonance images combined with computed tomography and positron emission tomography. Preoperative radiographic images were fused with the normalized mutual information method. Visibility of anatomic structures was compared between the multifusion models and nonfusion models created from only heavy-T2-weighted images that rely solely on the surface rendering method. RESULTS The average visibility score of the multifusion models was 97.5% (range, 95.6% to 100%), which was significantly higher than that for nonfusion models (35.9% to 64.1%; P = .002). The multifusion model represents an improved visualization method for preoperative virtual simulation for neuroendoscopic intraventricular surgery. CONCLUSION Our 3-dimensional imaging method is superior to conventional methods and will greatly improve the safety and effectiveness of neuroendoscopic surgical procedures for complex intraventricular lesions.
Collapse
Affiliation(s)
- Taichi Kin
- Department of Neurosurgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|