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Mishra D, Kannath SK, Er J, Thomas B, Kesavadas C. Evaluating the diagnostic performance of non-contrast magnetic resonance angiography sequences in the pre-procedural comprehensive analysis of direct carotid cavernous fistula. Neuroradiology 2024; 66:1203-1212. [PMID: 38581636 DOI: 10.1007/s00234-024-03342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Endovascular treatment of direct carotid cavernous fistula (DCCF) requires invasive diagnostic cerebral angiography for diagnosis and planning; however, a less invasive modality like magnetic resonance angiography (MRA) can be useful, especially in high-risk cases. This single-centre study evaluated a newer MR angiography (MRA) sequence, silent MRA and the traditional time of flight (TOF) MRA for pre-procedural treatment planning of DCCF. METHODS All consecutive DCCF patients who underwent TOF, silent MRA and diagnostic cerebral angiography were included in the study. Angiographic features like rent size, location, draining veins and collateral communicating arteries were analysed and compared between the two MRA sequences, with digital subtraction angiography (DSA) as the gold standard. RESULTS Fifteen patients were included in the study. TOF MRA exhibited better sensitivity (76.9% vs 69.2%) in identifying the rent location, correctly pinpointing the location in 93.3% compared to 73.3% with silent MRA. Both MRA sequences showed good agreement with DSA for primary sac and rent size. TOF MRA correctly identified 86.2% of 210 total venous structures compared to 96% by silent MRA. Silent MRA demonstrated higher sensitivity (90% vs 76%) and accuracy (87.69 vs 94.36) in visualisation of involved veins compared to TOF MRA. CONCLUSION Arterial characteristics of DCCF like rent location and rent size were better assessed by TOF MRA. Although both MRA identified venous features, silent MRA correlated better with DSA irrespective of the size and proximity to the site of the fistula. Combining both sequences can evaluate various angioarchitectural features of DCCF useful for therapeutic planning.
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Affiliation(s)
- Dewansh Mishra
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Santhosh Kumar Kannath
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India.
| | - Jayadevan Er
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Bejoy Thomas
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - C Kesavadas
- Imaging Sciences and Interventional Radiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
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Satoh T, Sugiu K, Hiramatsu M, Haruma J, Date I. Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE24141. [PMID: 38621304 PMCID: PMC11023012 DOI: 10.3171/case24141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. OBSERVATIONS The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm's neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant's reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. LESSONS Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.
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Affiliation(s)
- Toru Satoh
- Departments of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan
| | - Kenji Sugiu
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Masafumi Hiramatsu
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Jun Haruma
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Isao Date
- Okayama Rosai Hospital, Okayama, Japan
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Ebiko Y, Wakabayashi H, Okada T, Mizoue T, Wakabayashi S. Usefulness of PETRA-MRA for Postoperative Follow-Up of Stent-Assisted Coil Embolization of Cerebral Aneurysms. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:188-195. [PMID: 37731465 PMCID: PMC10508989 DOI: 10.5797/jnet.oa.2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/19/2023] [Indexed: 09/22/2023]
Abstract
Objective Image evaluation after stent-assisted coil embolization (SAC) for a cerebral aneurysm is difficult with conventional MRA or CTA because of metal artifacts. Pointwise encoding time reduction with radial acquisition (PETRA)-MRA is a noninvasive imaging examination that can reduce metal artifacts. This study aimed to examine whether PETRA-MRA can be used as a follow-up imaging after SAC. Methods Twelve patients (eight women and four men; mean age, 66.9 ± 13.2 years) underwent SAC for unruptured aneurysms and were retrospectively evaluated using time-of-flight (TOF)- and PETRA-MRA data from the same follow-up session. Two neurosurgeons independently compared the aneurysm occlusion status and flow visualization score in the stented parent artery (4-point scale, where 4 points represented excellent visualization) between TOF- and PETRA-MRA images. If DSA was performed within 3 months before or after PETRA-MRA, the aneurysm assessment was compared between MRA and DSA. The interobserver agreement for each MRA was evaluated. Results Nine of the 12 patients underwent DSA within 3 months before and after TOF- and PETRA-MRA. The aneurysm occlusion status on DSA was more consistent with PETRA-MRA (eight of nine cases) than with TOF-MRA (one of nine cases; P = 0.023). The median visualization score of the stented parent artery was significantly higher for PETRA-MRA (4 [interquartile range {IQR} 3-4]) than for TOF-MRA (1 [IQR 1-1], P = 0.003). The interobserver agreement for evaluation of the aneurysm occlusion status and visualization score of the parent artery for PETRA-MRA were excellent (κ = 0.98 and 0.93, respectively). In one case, PETRA-MRA was able to detect aneurysm recurrence, leading to subsequent retreatment. Conclusion PETRA-MRA is a noninvasive examination that can be used to evaluate the occlusion status of aneurysms after SAC and visualize the stented parent artery. PETRA-MRA is useful for repeated follow-up examinations after SAC.
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Affiliation(s)
- Yusuke Ebiko
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Hiroshima, Japan
| | - Hikaru Wakabayashi
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Hiroshima, Japan
| | - Tomoaki Okada
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Hiroshima, Japan
| | - Shinichi Wakabayashi
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Hiroshima, Japan
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Satoh T, Sato Y, Sugiu K, Hishikawa T, Hiramatsu M, Haruma J, Date I. Hemifacial spasm due to vertebral artery dissecting aneurysm treated with stent-in-stent placement; Pre- and post-treatment evaluation by 3D multifusion imaging using silent MR angiography. Surg Neurol Int 2022; 13:232. [PMID: 35855151 PMCID: PMC9282821 DOI: 10.25259/sni_253_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Hemifacial spasm (HFS) due to vertebral artery (VA) dissecting aneurysm (VADA) is rare and endovascular treatment has been performed in selected cases. Case Description: We encountered a case of HFS caused by VADA that was managed with endovascular stent placement and additional stent-in-stent placement. Therapeutic strategies and benefits based on pre- and post-treatment evaluation by 3D multifusion imaging using silent MRA were discussed. Conclusion: This is the first case report of stent-in-stent placement in successful treatment of HFS caused by VADA, in which relief of neurovascular contact was demonstrated by multifusion imaging.
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Affiliation(s)
- Toru Satoh
- Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Fukuyama,
| | - Yu Sato
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Jun Haruma
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
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Chen PR, Lopez-Rivera V, Conner CR, Sanzgiri A, Sheth SA, Erkmen K, Kim DH, Day AL. Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2021; 23:108-116. [PMID: 33902273 PMCID: PMC8256019 DOI: 10.7461/jcen.2021.e2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized. METHODS Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence. RESULTS A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence. CONCLUSIONS The findings of our study suggest that skull x-rays may represent a lowcost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.
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Affiliation(s)
- Peng Roc Chen
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Victor Lopez-Rivera
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Christopher R Conner
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Aditya Sanzgiri
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Sunil A Sheth
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Kadir Erkmen
- Department of Neurosurgery, Temple University, Philadelphia, PA, USA
| | - Dong H Kim
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Arthur L Day
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
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Sato K, Asano A, Kobayashi T, Aoki H, Jinguji S, Seto H, Demachi H, Hasegawa H, Fujii Y. Validity of PETRA-MRA for Stent-Assisted Coil Embolization of Intracranial Aneurysms. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:352-359. [PMID: 37502413 PMCID: PMC10370957 DOI: 10.5797/jnet.oa.2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/15/2020] [Indexed: 07/29/2023]
Abstract
Objective Pointwise encoding time reduction with radial acquisition (PETRA) using magnetic resonance angiography (MRA) is a non-enhanced MRA technique employing an ultrashort echo time, and is known to significantly reduce the magnetic susceptibility of coils and stents during post-embolization imaging. We evaluated the quality of PETRA-MRA images for use at the follow-up assessment of stent-assisted coil embolization procedures performed to treat aneurysms. Methods A total of six aneurysm patients who were treated by stent-assisted coil embolization were included. All patients underwent PETRA-MRA, time-of-flight (TOF)-MRA performed with MAGNETOM Skyra (Siemens), and digital subtraction angiography (DSA) performed with Infinix Celeve-i INFX-8000V (Canon Medical Systems) and Allura Clarity FD20/15 (Philips). The PETRA-MRA images were compared with those from DSA and TOF-MRA to validate the aneurysm occlusion status and visually assess the blood flow within the stent. Four independent specialists graded occlusion status and flow visualization through the stent using a four-point scale, where 4 points represented excellent visualization of flow within the stent. Results The aneurysm was located in the internal carotid artery in two patients, the middle cerebral artery in two patients, the top of the basilar artery in one patient, and the vertebral artery-posterior inferior cerebellar artery (VA-PICA) in one patient. Three patients were treated using a Neuroform Atlas Stent system, one using an Enterprise2 VRD, one using two Neuroform Atlas stents for Y-stenting, and the remaining patient using a Neuroform Atlas and an Enterprise2 VRD for Y-stenting. With DSA, the postoperative aneurysm occlusion status was neck remnant (NR) in five cases and complete obliteration (CO) in one case. DSA and PETRA-MRA evaluations demonstrated an equal occlusion status in five of six cases, whereas DSA and TOF-MRA were equal in two of six cases. The mean visualization score for PETRA-MRA was 3.33 ± 0.82, whereas that for TOF-MRA was 2.17 ± 1.33. On the PETRA-MRA images, blood flow through the stent was well-visualized and produced an aneurysm occlusion status score comparable to DSA, especially in the three cases using the Neuroform Atlas Stent System where the visualization was scored 4 points. In the case of the VA-PICA aneurysm, for which an Enterprise2 VRD was used, PETRA-MRA images were insufficient for postoperative assessment. Conclusion PETRA-MRA can provide good visualization of the blood flow within a stent and displays a clear blood signal near the coils, barring small magnetic susceptibility artifacts. Therefore, PETRA-MRA may be an effective option for follow-up imaging after stent-assisted coil embolization.
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Affiliation(s)
- Keisuke Sato
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Akihiro Asano
- Department of Medical Technology, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Tsutomu Kobayashi
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hiroshi Aoki
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Shinya Jinguji
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hiroki Seto
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hiroshi Demachi
- Department of Diagnostic Radiology, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
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