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Iwata N, Sakamoto M, Sakou T, Uno T, Kurosaki M. Image Follow-Up After Flow Diverter Treatment Using Only Ultra-High Resolution CT Angiography with Model-Based Iterative Reconstruction: A Case Report. Yonago Acta Med 2024; 67:254-258. [PMID: 39176194 PMCID: PMC11335917 DOI: 10.33160/yam.2024.08.006] [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: 05/24/2024] [Accepted: 07/09/2024] [Indexed: 08/24/2024]
Abstract
Follow-up examinations using magnetic resonance imaging or digital subtraction angiography are mandatory after flow diverter treatment of cerebral aneurysms. However, flow diverter features metal artifacts on magnetic resonance imaging and ischemic complications with digital subtraction angiography. Ultra-high-resolution computed tomography systems have recently become available in clinical practice. The combined use of ultra-high-resolution computed tomography and a reconstruction technique called model-based iterative reconstruction is expected to replace follow-up magnetic resonance imaging and digital subtraction angiography of flow diverter placement. Here, we report a case of ultra-high-resolution computed tomography with model-based iterative reconstruction after flow diverter treatment.
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Affiliation(s)
- Naoki Iwata
- Department of Clinical Radiology, Tottori University Hospital, Yonago 683-8503, Japan
| | - Makoto Sakamoto
- Division of Neurosurgery, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Toshio Sakou
- Department of Clinical Radiology, Tottori University Hospital, Yonago 683-8503, Japan
| | - Tetsuji Uno
- Division of Neurosurgery, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Masamichi Kurosaki
- Division of Neurosurgery, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Ozpeynirci Y, Gorodezky M, Sanches AF, Mandava S, Solana AB, Liebig T. Impact of Various Non-Contrast-Enhanced MRA Techniques on Lumen Visibility in Vascular Flow Models with a Surpass Evolve Flow Diverter. Diagnostics (Basel) 2024; 14:1146. [PMID: 38893675 PMCID: PMC11171646 DOI: 10.3390/diagnostics14111146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Silent MRA has shown promising results in evaluating the stents used for intracranial aneurysm treatment. A deep learning-based denoising and deranging algorithm was recently introduced by GE HealthCare. The purpose of this study was to compare the performance of several MRA techniques regarding lumen visibility in silicone models with flow diverter stents. METHODS Two Surpass Evolve stents of different sizes were implanted in two silicone tubes. The tubes were placed in separate boxes in the straight position and in two different curve configurations and connected to a pulsatile pump to construct a flow loop. Using a 3.0T MRI scanner, TOF and silent MRA images were acquired, and deep learning reconstruction was applied to the silent MRA dataset. The intraluminal signal intensity in the stent (SIin-stent), in the tube outside the stent (SIvessel), and of the background (SIbg) were measured for each scan. RESULTS The SIin-stent/SIbg and SIin-stent/SIv ratios were higher in the silent scans and DL-based reconstructions than in the TOF images. The stent tips created severe artefacts in the TOF images, which could not be observed in the silent scans. CONCLUSIONS Our study demonstrates that the DL reconstruction algorithm improves the quality of the silent MRA technique in evaluating the flow diverter stent patency.
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Affiliation(s)
- Yigit Ozpeynirci
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany; (A.F.S.); (T.L.)
| | | | - Augusto Fava Sanches
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany; (A.F.S.); (T.L.)
| | | | - Ana Beatriz Solana
- GE HealthCare, 80807 Munich, Germany; (M.G.); (A.B.S.)
- Center for Neuroimaging Sciences, King’s College London, London SE1 7EH, UK
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany; (A.F.S.); (T.L.)
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Wada A, Akatsu T, Ikenouchi Y, Suzuki M, Akashi T, Hagiwara A, Nishizawa M, Sano K, Kamagata K, Aoki S. Synthesizing 4D Magnetic Resonance Angiography From 3D Time-of-Flight Using Deep Learning: A Feasibility Study. Cureus 2024; 16:e60803. [PMID: 38910733 PMCID: PMC11190969 DOI: 10.7759/cureus.60803] [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: 05/19/2024] [Indexed: 06/25/2024] Open
Abstract
Objective and background This study aimed to develop a deep convolutional neural network (DCNN) model capable of generating synthetic 4D magnetic resonance angiography (MRA) from 3D time-of-flight (TOF) images, allowing estimation of temporal changes in arterial flow. TOF MRA provides static information about arterial structures through maximum intensity projection (MIP) processing, but it does not capture the dynamic information of contrast agent circulation, which is lost during MIP processing. Considering the principles of TOF, it is hypothesized that dynamic information about arterial blood flow is latent within TOF signals. Although arterial spin labeling (ASL) can extract dynamic arterial information, ASL MRA has drawbacks, such as longer imaging times and lower spatial resolution than TOF MRA. This study's primary aim is to extend the utility of TOF MRA by training a machine-learning model on paired TOF and ASL data to extract latent dynamic information from TOF signals. Methods A DCNN combining a modified U-Net and a long-short-term memory (LSTM) network was trained on a dataset of 13 subjects (11 men and two women, aged 42-77 years) using paired 3D TOF MRA and 4D ASL MRA images. Subjects had no history of cerebral vessel occlusion or significant stenosis. The dataset was acquired using a 3T MRI system with a 32-channel head coil. Preprocessing involved resampling and intensity normalization of TOF and ASL images, followed by data augmentation and arterial mask generation. The model learned to extract flow information from TOF images and generate 8-phase 4D MRA images. The precision of flow estimation was evaluated using the coefficient of determination (R²) and Bland-Altman analysis. A board-certified neuroradiologist validated the quality of the images and the absence of significant stenosis in the major cerebral arteries. Results The generated 4D MRA images closely resembled the ground-truth ASL MRA data, with R² values of 0.92, 0.85, and 0.84 for the internal carotid artery (ICA), proximal middle cerebral artery (MCA), and distal MCA, respectively. Bland-Altman analysis revealed a systematic error of -0.06, with 95% agreement limits ranging from -0.18 to 0.12. Additionally, the model successfully identified flow abnormalities in a subject with left MCA stenosis, displaying a delayed peak and subsequent flattening distal to the stenosis, indicative of reduced blood flow. Visualization of the predicted arterial flow overlaid on the original TOF MRA images highlighted the spatial progression and dynamics of the flow. Conclusions The DCNN model effectively generated synthetic 4D MRA images from TOF images, demonstrating its potential to estimate temporal changes in arterial flow accurately. This non-invasive technique offers a promising alternative to conventional methods for visualizing and evaluating healthy and pathological flow dynamics. It has significant potential to improve the diagnosis and treatment of cerebrovascular diseases by providing detailed temporal flow information without the need for contrast agents or invasive procedures. The practical implementation of this model could enable the extraction of dynamic cerebral blood flow information from routine brain MRI examinations, contributing to the early diagnosis and management of cerebrovascular disorders.
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Affiliation(s)
- Akihiko Wada
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Toshiya Akatsu
- Department of Radiology, Juntendo University Hospital, Tokyo, JPN
| | - Yutaka Ikenouchi
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University Urayasu Hospital, Chiba, JPN
| | - Toshiaki Akashi
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Mitsuo Nishizawa
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Katsuhiro Sano
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
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Quan T, Ren Y, Li J, Fu X, Jin Y, Ran Y, Guan S, Cheng J, Xu H. Enhanced vessel wall magnetic resonance imaging in the follow-up of intracranial aneurysms treated with flow diversion. Eur Radiol 2024; 34:833-841. [PMID: 37580600 DOI: 10.1007/s00330-023-10094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy of enhanced 3D T1-weighted black-blood fast-spin-echo vessel wall magnetic resonance imaging (eVW-MRI) and time-of-flight magnetic resonance angiography (TOF MRA) for follow-up evaluation of aneurysms treated with flow diversion (FD). METHODS Our study enrolled 77 patients harboring 84 aneurysms treated with FD. Follow-up was by MRI (eVW-MRI and TOF MRA) and digital subtraction angiography (DSA). Two radiologists, blinded to DSA examination results, independently evaluated the images of aneurysm occlusion and parent artery patency using the Kamran-Byrne Scale. Interobserver diagnostic agreement and intermodality diagnostic agreement were acquired. Pretreatment and follow-up aneurysm wall enhancement (AWE) patterns were collected. RESULTS Based on the Kamran-Byrne Scale, the intermodality agreement between eVW-MRI and DSA was better than TOF MRA versus DSA for aneurysm remnant detection (weighted ĸ = 0.891 v. 0.553) and parent artery patency (ĸ = 0.950 v. 0.221). Even with the coil artifact, the consistency of eVW-MRI with DSA for aneurysm remnant detection was better than that of TOF MRA (weighted ĸ = 0.891 v. 0.511). The artifact of adjunctive coils might be more likely to affect the accuracy in evaluating parent artery patency with TOF MRA than with eVW-MRI (ĸ = 0.077 v. 0.788). The follow-up AWE patterns were not significantly associated with pretreatment AWE patterns and aneurysm occlusion. CONCLUSIONS The eVW-MRI outperforms TOF MRA as a reliable noninvasive and nonionizing radioactive imaging method for evaluating aneurysm remnants and parent artery patency after FD. The significance of enhancement patterns on eVW-MRI sequences needs more exploration. CLINICAL RELEVANCE STATEMENT The application of enhanced vessel wall magnetic resonance imaging has proven to be a promising tool to depict aneurysm remnant and parent artery stenosis in order to tailor the antiplatelet therapy strategy in patients after flow diversion. KEY POINTS • Enhanced vessel wall magnetic resonance imaging has an emerging role in depicting aneurysm remnant and parent artery patency after flow diversion. • With or without the artifact from adjunctive coils, enhanced vessel wall magnetic resonance imaging was better than TOF MRA in detecting aneurysm residual and parent artery stenosis by using DSA imaging as the standard. • Enhanced vessel wall magnetic resonance imaging holds potential to be used as an alternative to DSA for routine aneurysm follow-up after flow diversion.
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Affiliation(s)
- Tao Quan
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Yanan Ren
- Departments of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jinyi Li
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xiaojie Fu
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yazhou Jin
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yuncai Ran
- Departments of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jingliang Cheng
- Departments of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Haowen Xu
- Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Hamamoto K, Chiba E, Oyama-Manabe N, Yuzawa H, Edo H, Suyama Y, Shinmoto H. Ultra-short Echo-time MR Angiography Combined with a Modified Signal Targeting Alternating Radio Frequency with Asymmetric Inversion Slabs Technique to Assess Visceral Artery Aneurysm after Coil Embolization. Magn Reson Med Sci 2024; 23:110-121. [PMID: 36384909 PMCID: PMC10838713 DOI: 10.2463/mrms.tn.2022-0063] [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: 05/16/2022] [Accepted: 09/25/2022] [Indexed: 01/05/2024] Open
Abstract
Contrast-enhanced CT and MR angiography are widely used for follow-up of visceral artery aneurysms after coil embolization. However, potential adverse reactions to contrast agents and image deterioration due to susceptibility artifacts from the coils are major drawbacks of these modalities. Herein, we introduced a novel non-contrast-enhanced MR angiography technique using ultra-short TE combined with a modified signal targeting alternating radio frequency with asymmetric inversion slabs, which could provide a serial hemodynamic vascular image with fewer susceptibility artifacts for follow-up after coil embolization.
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Affiliation(s)
- Kohei Hamamoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Emiko Chiba
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Hironao Yuzawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Hiromi Edo
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yohsuke Suyama
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
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Iwata N, Sakamoto M, Sakou T, Uno T, Kurosaki M. Utility of follow-up ultra-high-resolution CT angiography with model-based iterative reconstruction after flow diverter treatment for cerebral aneurysms. LA RADIOLOGIA MEDICA 2023; 128:1262-1270. [PMID: 37658197 DOI: 10.1007/s11547-023-01692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE Follow-up examinations after flow diverter (FD) treatment for cerebral aneurysms typically involve magnetic resonance imaging (MRI) or digital subtraction angiography (DSA). However, MRI is prone to vascular defects due to metal artifacts from FD, and DSA carries a risk of ischemic complications. In the context of computed tomography angiography (CTA), this study compares the efficacy of ultra-high-resolution CT (UHRCT) and novel reconstruction techniques, such as model-based iterative reconstruction (MBIR), against conventional methods such as filtered back projection (FBP) and hybrid iterative reconstruction (IR), to determine if they are a viable alternative to DSA in clinical settings. MATERIALS AND METHODS A phantom study was conducted with the full-width half-maximum considered as the FD thickness. This study compared three reconstruction methods: MBIR, FBP, and hybrid IR. A clinical study was also conducted with 21 patients who underwent follow-up CTA after FD treatment. The FD's visibility was assessed using a 4-point scale in FBP, hybrid IR, and MBIR compared to cone-beam CT (CBCT) with angiographic systems. RESULTS In the phantom study, FBP, hybrid IR, and MBIR visualized thinner FD thicknesses and improved detail rendering in that order. MBIR proved to be significantly superior in both the phantom and clinical study. CONCLUSION UHRCT with MBIR is highly effective for follow-up evaluations after FD treatment and may become the first-choice modality in the future.
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Affiliation(s)
- Naoki Iwata
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan.
| | - Makoto Sakamoto
- Division of Neurosurgery, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Toshio Sakou
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| | - Tetsuji Uno
- Division of Neurosurgery, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Masamichi Kurosaki
- Division of Neurosurgery, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
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Suzuki Y, Toma N, Inoue K, Ichikawa T, Nishikawa H, Miura Y, Fujimoto M, Yasuda R, Maeda M, Suzuki H. Evaluation of Intra-Aneurysmal Residual Blood Flow with the iMSDE T1-Black Blood Imaging after Flow Diverter Treatment. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:159-166. [PMID: 37609573 PMCID: PMC10442175 DOI: 10.5797/jnet.oa.2023-0016] [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: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 08/24/2023]
Abstract
Objective We aimed to evaluate the efficacy of the "improved motion-sensitized driven-equilibrium (iMSDE)"-prepared T1-weighted black blood (T1-BB) MRI for monitoring treatment effect with a flow diverter (FD) for cerebral aneurysms. Methods Following the exclusion of concomitant coiling and retreatment cases from 60 consecutive cases of cerebral aneurysms treated with FDs at our institution, 32 with imaging data were included in the analysis. Detectability of residual blood flow within the aneurysms was validated as follows: 1) comparison of MRI sequences (iMSDE-prepared T1-BB images, T1-weighted images [ T1WI], and time-of-flight [ TOF]-MRA) in cases of incompletely occluded aneurysms and 2) comparison of angiography and MRI sequences in the same period. Results 1) The probability of diagnosing intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p <0.001). 2) The diagnostic accuracy of residual aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB than that with T1WI (p = 0.032). Furthermore, in cases of incomplete occlusion, the probability of detecting intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p = 0.023). Conclusion Our results demonstrated that iMSDE-prepared T1-BB could help distinguish between blood flow and thrombus within the aneurysms after FD treatment, especially in the early stages of FD treatment.
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Affiliation(s)
- Yume Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Naoki Toma
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Katsuhiro Inoue
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Tomonori Ichikawa
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hirofumi Nishikawa
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoichi Miura
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masashi Fujimoto
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ryuta Yasuda
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Tan S, Lu Y, Li B, Yang Q, Zhou X, Wang Y. Diagnostic performance of silent magnetic resonance angiography for endovascularly-treated intracranial aneurysm follow-up: a prospective study. J Neurointerv Surg 2023; 15:608-613. [PMID: 35478174 DOI: 10.1136/neurintsurg-2022-018726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple studies have reported the clinical usefulness of silent magnetic resonance angiography (MRA) in the follow-up of endovascularly-treated aneurysms. However, most previous studies were retrospective or with small sample sizes. The objective of this study was to prospectively evaluate the diagnostic performance of silent MRA in the follow-up of intracranial aneurysms treated by different interventional approaches. METHODS Patients with endovascularly-treated intracranial aneurysms and followed by silent MRA and digital subtraction angiography (DSA) were enrolled. The visualization of treated sites on silent MRA was rated on a 5-point scale. The aneurysm occlusion status was evaluated using the Raymond Scale and a simplified two-grade scale. RESULTS A total of 155 patients with 175 treated aneurysms were enrolled. The average score for the visualization of treated sites was 3.92±0.94, and 93.7% (164/175) had a score ≥3. In the subgroup analysis, except for the simple coiling group which had an obviously higher score (4.95±0.21), there was no significant difference among the stent-assisted coiling group (3.51±0.77), flow diversion group (3.74±0.80), and flow diversion with coiling group (3.40±1.17). Regarding aneurysm occlusion status, silent MRA and DSA were discordant for only one aneurysm using the Raymond Scale, and the inter-modality consistency was almost perfect (κ=0.992, 95% CI 0.977 to 1.000). CONCLUSIONS Silent MRA showed an excellent diagnostic performance in the follow-up of endovascularly-treated intracranial aneurysms, and may be an ideal option for repeated examinations.
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Affiliation(s)
- Song Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Beijing, China
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Tan S, Zhou X, Xu X, Lu Y, Zeng X, Wu Q, Wang Y. Diagnostic Performance of High-Resolution Vessel Wall MR Imaging Combined with TOF-MRA in the Follow-up of Intracranial Vertebrobasilar Dissecting Aneurysms after Reconstructive Endovascular Treatment. AJNR Am J Neuroradiol 2023; 44:453-459. [PMID: 36958804 PMCID: PMC10084898 DOI: 10.3174/ajnr.a7838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/14/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND PURPOSE Few studies have reported the utility of high-resolution vessel wall MR imaging in the follow-up of endovascularly treated vertebrobasilar dissecting aneurysms. This study aimed to evaluate the diagnostic performance of high-resolution vessel wall MR imaging combined with TOF-MRA in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment. MATERIALS AND METHODS Patients with intracranial vertebrobasilar dissecting aneurysms with reconstructive endovascular treatment and followed up with TOF-MRA, high-resolution vessel wall MR imaging, and DSA were included. With DSA as the criterion standard, the diagnostic performance of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA in the evaluation of aneurysm occlusion status and parent artery patency was assessed. Visualization of the stented artery on TOF-MRA and high-resolution vessel wall MR imaging was rated on a 5-point scale. RESULTS Twenty-seven patients with 29 aneurysms were included. The sensitivity, specificity, positive predictive value, and negative predictive value of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA for diagnosing aneurysm remnants were 80.0%, 100.0%, 100.0%, and 82.4%; 53.3%, 100.0%, 100.0%, and 66.7%; and 93.3%, 100.0%, 100.0%, and 93.3%, respectively. For the visualization of the stented artery, the mean score of high-resolution vessel wall MR imaging was significantly higher than that of TOF-MRA (4.88 [SD, 0.32] versus 2.53 [SD, 1.25], P < .001). In the evaluation of parent artery patency (normal or pathologic), whereas TOF-MRA had a sensitivity, specificity, positive predictive value, and negative predictive value of 100.0%, 8.0%, 14.8%, and 100.0%, respectively, high-resolution vessel wall MR imaging was completely consistent with the DSA. CONCLUSIONS High-resolution vessel wall MR imaging combined with TOF-MRA at 3T showed good diagnostic performance in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment.
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Affiliation(s)
- S Tan
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Zhou
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Xu
- Department of Neurosurgery (X.X.), The First People's Hospital of Zhaoqing City, Zhaoqing, Guangdong Province, China
| | - Y Lu
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Zeng
- Radiology (X. Zeng, Q.W.), The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Q Wu
- Radiology (X. Zeng, Q.W.), The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Y Wang
- Department of Neurosurgery (Y.W.), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
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Kitamura T, Fujii T, Yatomi K, Teranishi K, Mitome-Mishima Y, Oishi H. Safety and efficacy of pipeline embolization device treatments for intradural internal carotid artery aneurysms in a single center in a Japanese population. Surg Neurol Int 2023; 14:92. [PMID: 37025526 PMCID: PMC10070317 DOI: 10.25259/sni_1165_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/25/2023] [Indexed: 03/19/2023] Open
Abstract
Background:
The pipeline embolization device (PED) is the most common flow diverter device in the world. To date, there have been no reports of treatment outcomes specific to intradural internal carotid artery (ICA) aneurysms. The safety and efficacy of the PED treatments for intradural ICA aneurysms are reported.
Methods:
131 patients with 133 aneurysms underwent PED treatments for intradural ICA aneurysms. The mean aneurysm dome size and neck length were 12.7 ± 4.3 mm and 6.1 ± 2.2 mm, respectively. We used adjunctive endosaccular coil embolization for 88 aneurysms (66.2%). A total of 113 aneurysms (85%) were angiographically followed up 6 months following the procedure, and 93 aneurysms (69.9%) were followed up for 1 year.
Results:
The angiographic outcome at 6 months showed that 94 (83.2%) aneurysms had O’Kelly-Marotta (OKM) grade D, 6 (5.3%) had C, 10 (8.8%) had B, and 3 (2.7%) had A. At 1 year, 82 (88.2%) aneurysms had OKM grade D, 6 (6.5%) had C, 3 (3.2%) had B, and 2 (2.2%) had A. Multivariate analysis showed that aneurysm neck size and adjunctive coiling were statistically significant in aneurysm occlusion status. Major morbidity modified Rankin Scale >2 and mortality rates related to procedures were 3.0% and 0%, respectively. Delayed aneurysm ruptures were not observed.
Conclusion:
These results reveal that PED treatment of intradural ICA aneurysms is safe and efficacious. The combined use of adjunctive coil embolization not only prevents delayed aneurysm ruptures but also contributes to an increase in the rate of complete occlusion.
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Affiliation(s)
- Takayuki Kitamura
- Department of Neuroendovascular Therapy and Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takashi Fujii
- Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kohsuke Teranishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yumiko Mitome-Mishima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neuroendovascular Therapy and Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
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Umemura T, Hatano T, Ogura T, Miyata T, Agawa Y, Nakajima H, Sakamoto H, Nakazawa Y, Shiomi K, Koga N, Nagahori T, Shiraishi W, Nagata I. Ultrashort Echo Time Magnetic Resonance Angiography as an Alternative Tool to Digital Subtraction Angiography in the Follow-up of Stent-Assisted Coil Embolization Outcomes. Neurosurgery 2023; 92:574-580. [PMID: 36512845 DOI: 10.1227/neu.0000000000002273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Follow-up of aneurysms treated with stent-assisted coil embolization has been performed using digital subtraction angiography (DSA) because in time-of-flight magnetic resonance angiography, metal artifacts from the stent often affect visualization. OBJECTIVE To confirm whether ultrashort echo time (TE) MRA may be an alternative for DSA during follow-up. METHODS Patients with unruptured aneurysms initially treated with stent-assisted coil embolization between April 2019 and March 2021 were enrolled. After 3 months of treatment, follow-up DSA and ultrashort TE MRA were performed. All images were independently reviewed by neurosurgeons to evaluate in-stent flow and rated from 1 (not visible) to 4 (excellent). Aneurysmal embolization status was assessed as complete obliteration, residual neck, or residual aneurysm. Ultrashort TE MRA findings were classified as evaluative or nonevaluative state based on the presence of metal artifacts. We investigated the types of aneurysms that were evaluative and the agreement between ultrashort TE and DSA. RESULTS Overall, 89 aneurysms were examined, of which 74% (n = 66) were classified as evaluative on ultrashort TE. Significant differences were observed in size and stent type. Evaluative cases had an aneurysm size of <7 mm ( P = .0007) and a higher rate of Neuroform Atlas ( P = .0006). The rate of agreement between ultrashort TE with evaluative state and DSA was 95%. CONCLUSION Ultrashort TE MRA could evaluate an embolization status treated with stenting, and the findings are in excellent agreement with those of DSA. Aneurysms measuring <7 mm and treated with Neuroform Atlas are evaluative on ultrashort TE, and DSA might not be necessary.
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Affiliation(s)
- Takeru Umemura
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Taketo Hatano
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takenori Ogura
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Miyata
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yuji Agawa
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroaki Nakajima
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Sakamoto
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yusuke Nakazawa
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Koji Shiomi
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Noriyuki Koga
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takashi Nagahori
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Wataru Shiraishi
- Department of Neurology, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan
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Kandasamy S, Kannath SK, Enakshy Rajana J, Kesavadas C, Thomas B. Non-invasive angiographic analysis of dural carotid cavernous fistula using time-of-flight MR angiography and silent MR angiography: a comparative study. Acta Radiol 2023; 64:1290-1297. [PMID: 35532027 DOI: 10.1177/02841851221097462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A non-invasive, reliable imaging modality that characterizes cavernous sinus dural arteriovenous fistula (CSDAVF) is beneficial for diagnosis and to assess resolution on follow-up. PURPOSE To assess the utility of 3D time-of-flight (TOF) and silent magnetic resonance angiography (MRA) for evaluation of CSDAVF from an endovascular perspective. MATERIAL AND METHODS This prospective study included 37 patients with CSDAVF, who were subjected to digital subtraction angiography (DSA) and 3-T MR imaging with 3D TOF and silent MRA. The main arterial feeders, fistula site, and venous drainage pattern were evaluated, and the results were compared with DSA findings. The diagnostic confidence scores were also recorded using a 4-point Likert scale. RESULTS Silent MRA correlated better for shunt site localization and angiographic classification (86% vs. 75% and 83% vs. 75%, respectively) compared to TOF MRA. The proportion of arterial feeders detected was marginally significant for silent MRA over TOF MRA sequences (92.8% vs. 89.5%; P=0.048), though for veins both were comparable. Sensitivity of silent MRA was higher for identification of cortical venous reflux (CVR) (90.9% vs. 81.8%) and deep venous drainage (82.4% vs. 64.7%), while specificity was >90% for both modalities. The overall diagnostic confidence score fared better for silent MRA for venous assessment (P < 0.001) as well as fistula point identification (P < 0.001), while no significant difference was evident with TOF MRA for arterial feeders (P=0.06). CONCLUSION Various angiographic components of CSDAVF could be identified and delineated by 3D TOF and silent MRA, though silent MRA was superior for overall diagnostic assessment.
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Affiliation(s)
- Sathish Kandasamy
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
- Department of Interventional Radiology, 29904G Kuppusamy Naidu, Memorial Hospital, Coimbatore, Tamil nadu, India
| | - Santhosh Kumar Kannath
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayadevan Enakshy Rajana
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Chandrasekaran Kesavadas
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, 29354Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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13
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Heo YJ, Kim D, Jeong HW, Baek JW, Kim DS, Shin GW, Han JY, Kim ST, Jeong YG. Usefulness of Pointwise Encoding Time Reduction with Radial Acquisition-Magnetic Resonance Angiography after Endovascular Treatment for Intracranial Aneurysms. Interv Neuroradiol 2023; 29:20-29. [PMID: 34913378 PMCID: PMC9893233 DOI: 10.1177/15910199211065906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/19/2021] [Accepted: 11/18/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Imaging follow-up after endovascular treatment is important; however, time-of-flight magnetic resonance angiography (TOF-MRA) has limitations associated with magnetic susceptibility and radiofrequency shielding caused by the stent and coils. We evaluated the diagnostic performance of pointwise encoding time reduction with radial acquisition (PETRA)-MRA after endovascular treatment for intracranial aneurysms. MATERIAL AND METHODS A total of 186 patients with 211 aneurysms who underwent both pointwise encoding time reduction with radial acquisition- and time-of-flight magnetic resonance angiography in the same imaging session for follow-up after endovascular treatment. We subjectively graded the overall image quality, visualization of treated sites, and occlusion status. RESULTS Although the overall image quality scores of pointwise encoding time reduction with radial acquisition-magnetic resonance angiography were significantly lower than those of time-of-flight magnetic resonance angiography for both observers (4.04 ± 0.81 vs. 4.85 ± 0.35 [observer 1], 4.60 ± 0.69 vs. 4.94 ± 0.24 [observer 2]) (both P < .001), the visibility of treated sites using pointwise encoding time reduction with radial acquisition-magnetic resonance angiography was significantly better than that of time-of-flight magnetic resonance angiography overall (4.27 ± 0.97 vs. 3.42 ± 1.01; P < .001), in the distal internal carotid artery (4.46 ± 0.79 vs. 3.40 ± 1.00; P < .001), and in the middle cerebral artery (4.19 ± 0.93 vs. 3.08 ± 0.53, P = 0.007). Pointwise encoding time reduction with radial acquisition-magnetic resonance angiography showed a higher area under the curve than time-of-flight magnetic resonance angiography for the evaluation of treated aneurysm occlusion, except for posterior circulation aneurysms. CONCLUSIONS Pointwise encoding time reduction with radial acquisition-magnetic resonance angiography showed better visualization of treated sites and better diagnostic performance than time-of-flight magnetic resonance angiography for anterior circulation aneurysms. However, Pointwise encoding time reduction with radial acquisition-magnetic resonance angiography showed limitations in the follow-up evaluation of posterior circulation aneurysms.
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Affiliation(s)
- Young Jin Heo
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Donghyun Kim
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Jin Wook Baek
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Da Som Kim
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Gi Won Shin
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Ji-yeon Han
- Department of Radiology, Inje University Busan Paik
Hospital, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Inje University Busan Paik
Hospital, Busan, Korea
| | - Young Gyun Jeong
- Department of Neurosurgery, Inje University Busan Paik
Hospital, Busan, Korea
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Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience. Jpn J Radiol 2023; 41:322-334. [PMID: 36315360 PMCID: PMC9619020 DOI: 10.1007/s11604-022-01354-2] [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] [Received: 05/08/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms. MATERIALS AND METHODS Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9-85). Mean follow-up was 21 months (6-28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH). RESULTS In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete-complete occlusion (O'Kelly-Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0-1) was achieved in 24/25 (96%) of patients. CONCLUSION Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.
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15
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Lu Y, Leng X, Zou R, Chen Q, Li W, Zhou X, Tan S, Huang X, Ding C, Gong F, Xiang J, Wang Y. Non-contrast enhanced silent MR angiography to evaluate hemodynamics and morphology of unruptured intracranial aneurysms: a comparative computational fluid dynamics study. J Neurointerv Surg 2022:jnis-2022-018901. [PMID: 35882551 DOI: 10.1136/jnis-2022-018901] [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: 03/06/2022] [Accepted: 07/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Silent MR angiography (silent MRA) is a new generation of non-contrast enhanced angiography with outstanding advantages in visualizing cerebrovascular lesions and the follow-up after endovascular treatment for intracranial aneurysms (IAs). This study aims to investigate the reliability of silent MRA-based three-dimensional (3D) geometric description and hemodynamic calculation of IAs. METHODS 19 patients with 23 unruptured IAs, who underwent both silent MRA and 3D rotational angiography (3DRA), were included in this study. Computational fluid dynamics simulations were performed on all patient-specific 3D reconstruction images to compare the morphology and hemodynamics of the two different imaging models for IAs. RESULTS Silent MRA models had smaller maximum and perpendicular height (mm), aneurysmal surface area (mm2), and aneurysmal volume (mm3) than 3DRA (p<0.05); the differences of the above parameters between the two models were 9.0±6.2%, 7.7±7.4%, 15.9±13.0%, and 21.4±17.5%, respectively. However, correlation analysis of morphological parameters in various dimensions and model comparison showed good overall consistency in geometrical characteristics between the two models. Moderate coherence was observed between models in time-averaged wall shear stress of aneurysm and parent vessel (TAWSS, PAWSS), aneurysm velocity (AV), parent vessel velocity, and oscillatory shear index (OSI). However, strong correlations were observed among normalized aneurysm wall shear stress (NWSS), low shear area (LSA), inflow concentration index (ICI), and normalized aneurysm velocity (NAV). CONCLUSION Both morphological and hemodynamic assessments of IAs for silent MRA are comparable to 3DRA. Additionally, normalized indicators such as NWSS, LSA, ICI, and NAV were better than TAWSS, AV, and OSI in silent MRA-related hemodynamic evaluation.
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Affiliation(s)
- Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Rong Zou
- ArteryFlow Technology Co Ltd, Hangzhou, Zhejiang, China
| | - Qi Chen
- ArteryFlow Technology Co Ltd, Hangzhou, Zhejiang, China
| | - Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Song Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaofei Huang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Cong Ding
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Feixiang Gong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Yang Wang
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Shahrouki P, Gupta R, Belani P, Chien A, Doshi AH, De Leacy R, Fifi JT, Mocco J, Nael K. Differential Subsampling with Cartesian Ordering-MRA for Classifying Residual Treated Aneurysms. AJNR Am J Neuroradiol 2022; 43:887-892. [PMID: 35672082 DOI: 10.3174/ajnr.a7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differential Subsampling with Cartesian Ordering (DISCO), an ultrafast high-spatial-resolution head MRA, has been introduced. We aimed to determine the diagnostic performance of DISCO-MRA in grading residual aneurysm in comparison with TOF-MRA in patients with treated intracranial aneurysms. MATERIALS AND METHODS Patients with endovascular treatment and having undergone DISCO-MRA, TOF-MRA, and DSA were included for review. The voxel size and acquisition time were 0.75 × 0.75 × 1 mm3/6 seconds for DISCO-MRA and 0.6 × 0.6 × 1 mm3/6 minutes for TOF-MRA. Residual aneurysms were determined using the Modified Raymond-Roy Classification on TOF-MRA and DISCO-MRA by 2 neuroradiologists independently and were compared against DSA as the reference standard. Statistical analysis was performed using the κ statistic and the χ2 test. RESULTS Sixty-eight treated intracranial aneurysms were included. The intermodality agreement was κ = 0.82 (95% CI, 0.67-0.97) between DISCO and DSA and 0.44 (95% CI, 0.28-0.61) between TOF and DSA. Modified Raymond-Roy Classification scores matched DSA scores in 60/68 cases (88%; χ2 = 144.4, P < .001 for DISCO and 46/68 cases (68%; χ2 = 65.0, P < .001) for TOF. The diagnostic accuracy for the detection of aneurysm remnants was higher for DISCO (0.96; 95% CI, 0.88-0.99) than for TOF (0.79; 95% CI, 0.68-0.88). CONCLUSIONS In patients with endovascularly treated intracranial aneurysms, DISCO-MRA provides superior diagnostic performance in comparison with TOF-MRA in delineating residual aneurysms in a fraction of the time.
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Affiliation(s)
- P Shahrouki
- From the Department of Radiological Sciences (P.S., A.C., K.N.), University of California Los Angeles, Los Angeles, California
| | - R Gupta
- Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - P Belani
- Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - A Chien
- From the Department of Radiological Sciences (P.S., A.C., K.N.), University of California Los Angeles, Los Angeles, California
| | - A H Doshi
- Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - R De Leacy
- Department of Neurosurgery (R.D.L., J,F., J.M.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - J T Fifi
- Department of Neurosurgery (R.D.L., J,F., J.M.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - J Mocco
- Department of Neurosurgery (R.D.L., J,F., J.M.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - K Nael
- From the Department of Radiological Sciences (P.S., A.C., K.N.), University of California Los Angeles, Los Angeles, California .,Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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17
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Endo H, Mitome-Mishima Y, Suzuki K, Yatomi K, Teranishi K, Oishi H. Long-term outcomes of Y-stent-assisted coil embolization using Low-profile Visualized Intraluminal Support Junior (LVIS Jr) for intracranial bifurcation aneurysms. Clin Neurol Neurosurg 2022; 217:107275. [PMID: 35525104 DOI: 10.1016/j.clineuro.2022.107275] [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: 03/02/2022] [Revised: 04/01/2022] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Y-stent-assisted coil embolization is indicated for the treatment of complex intracranial bifurcation aneurysms. However, the long-term outcomes associated with this technique remain unclear. The purpose of this study was to evaluate the long-term outcomes of Y-stent-assisted coil embolization using the Low-profile Visualized Intraluminal Support Junior (LVIS Jr) device. METHODS We retrospectively reviewed our databases to identify patients treated with Y-stent-assisted coiling using LVIS Jr. Digital subtraction angiography, silent magnetic resonance angiography (MRA), and time-of-flight MRA were performed at 1 year after the procedure. Patients also received an annual follow-up using MRA. Aneurysm occlusion status was classified into complete occlusion (CO), neck remnant (NR), and body filling (BF). Clinical outcomes were assessed using the modified Rankin Scale. RESULTS Twenty-one patients (22 aneurysms) were included in this study. All procedures were performed successfully. Immediate postprocedural angiograms showed CO in 13 aneurysms (59.1%), NR in two aneurysms (9.1%), and BF in seven aneurysms (31.8%). One-year follow-up angiograms revealed CO in 86.4% of patients. Only one patient had a major recurrence and required retreatment. The mean follow-up duration was 43.5 months. The last angiographic studies demonstrated CO in 18 aneurysms (81.8%), NR in three aneurysms (13.6%), and BF in one aneurysm (4.5%). Periprocedural and delayed complications occurred in two patients and one patient, respectively. There was no permanent morbidity or death. The modified Rankin Scale scores at last clinical follow-up were equal to those before the procedures in all patients. CONCLUSION Y-stent-assisted coil embolization using LVIS Jr for intracranial bifurcation aneurysms has favorable long-term angiographic and clinical outcomes.
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Affiliation(s)
- Hideki Endo
- Department of Neuroendovascular Therapy, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
| | - Yumiko Mitome-Mishima
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
| | - Kazumoto Suzuki
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
| | - Kohsuke Teranishi
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
| | - Hidenori Oishi
- Department of Neuroendovascular Therapy, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
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Suzuki T, Hasegawa H, Ando K, Shibuya K, Takahashi H, Saito S, Oishi M, Fujii Y. Non-contrast-enhanced silent magnetic resonance angiography for assessing cerebral aneurysms after PulseRider treatment. Jpn J Radiol 2022; 40:979-985. [PMID: 35430678 PMCID: PMC9441419 DOI: 10.1007/s11604-022-01276-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
Purpose Conventional time-of-flight (TOF) magnetic resonance angiography (MRA) failed to depict clear visualization of coiled cerebral aneurysms with PulseRider due to metal-induced susceptibility artifacts. Our aim was to overcome the metal artifact using a novel imaging technique of non-contrast-enhanced ultrashort echo-time magnetic resonance angiography (UTE-MRA). Materials and methods Five unruptured intracranial aneurysms were treated using PulseRider and the patients underwent silent MRA (UTE-MRA). The images were compared with TOF-MRA and digital subtraction angiography (DSA). Results Silent MRA can visualize the residual cavity of the coiled aneurysms, which was not well visualized and rather defective when using TOF-MRA. While a segment of the proximal marker composed of stainless steel was poorly visualized, the other parts of the parent artery and the arteries of bifurcation, including the aneurysmal neck, were clearly visualized, equivalent to that of DSA. Conclusions UTE-MRA achieves better visualization of cerebral aneurysms after PulseRider treatment than TOF-MRA.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan.
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan
| | - Kazuhiro Ando
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan
| | - Kohei Shibuya
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan
| | - Haruhiko Takahashi
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan
| | - Shoji Saito
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata, 951-8585, Japan
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Thamburaj K, Zammar S, Tsay A, Tun K, Simon S, Kalapos P, Fiorelli M, Cockroft K. Magnetic Resonance Angiography after Flow Diversion: The use of complementary MRA techniques to monitor aneurysm occlusion as well as device and arterial branch patency after flow diverter placement. World Neurosurg 2022; 162:e147-e155. [PMID: 35248768 DOI: 10.1016/j.wneu.2022.02.096] [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: 11/30/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have been performed to evaluate flow diversion with MRA. They have shown better success for MRA to assess the aneurysm response but limited success for the stent patency. Further, the patency of arterial branches on MRA remains to be explored. METHODS 31 consecutive cases of carotid aneurysms treated with flow diversion were retrospectively evaluated with noncontrast time of flight (TOF), contrast enhanced TOF (CTOF) and cine MRA (TWIST) independently by two investigators for aneurysm occlusion, stent patency and arterial branch patency. DSA served as the gold standard technique. RESULTS There were 6 males and 25 females in the age range of years (mean ±SD). Stent patency, aneurysm occlusion and branch patency, mostly revealed substantial to perfect interobserver agreement (k >0.60). The sensitivity, specificity, positive and negative predictive values for the stent patency on source images of TOF were 0.99,0.84, 0.42 and 0.99 and on CTOF were 0.99, 0.89, 0.50 and 0.99 respectively.Sensitivity for the aneurysm response on the three MRAs ranged from 0.88 to 0.93,specificity from 0.64 to 0.75, positive predictive value from 0.69 to 0.79 and negative predictive value from 0.86 to 0.90. Sensitivity for the arterial branch patency among the three MRAs, ranged from 0.55 to 0.93, specificity from 0.61 to 0.68, positive predictive value from 0.79 to 0.93 and negative predictive value from 0.22 to 0.90. CONCLUSIONS Aneurysm occlusion, stent patency and arterial branch patency in flow diversion can be successfully evaluated with the combination of three MRA techniques.
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Affiliation(s)
| | - Samer Zammar
- Department of Neurosurgery PennState Health Milton S Hershey Medical Center and PennState College of Medicine PennState University, Hershey, PA 17033
| | - Annie Tsay
- Internal Medicine Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139
| | - Kyaw Tun
- Pennstate Health Department of Radiology, Community Practice Division
| | - Scott Simon
- Department of Neurosurgery PennState Health Milton S Hershey Medical Center and PennState College of Medicine PennState University, Hershey, PA 17033
| | | | - Marco Fiorelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale del Universita, 30, 00185, Rome, Italy
| | - Kevin Cockroft
- Department of Neurosurgery PennState Health Milton S Hershey Medical Center and PennState College of Medicine PennState University, Hershey, PA 17033
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20
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Burel J, Gerardin E, Vannier M, Curado A, Verdalle-Cazes M, Magne N, Lefebvre M, Papagiannaki C. Follow-up of Intracranial Aneurysms Treated by Flow Diverters: Evaluation of Parent Artery Patency Using 3D-T1 Gradient Recalled-Echo Imaging with 2-Point Dixon in Combination with 3D-TOF-MRA with Compressed Sensing. AJNR Am J Neuroradiol 2022; 43:554-559. [PMID: 35241422 PMCID: PMC8993198 DOI: 10.3174/ajnr.a7448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MRA assessment of parent artery patency after flow-diverter placement is complicated by imaging artifacts produced by these devices. The purpose of this study was to assess the accuracy of liver acquisition with volume acceleration-flex technique (LAVA-Flex) MRA in combination with 3D-TOF with HyperSense MRA for the evaluation of parent vessel status after intracranial flow-diverter placement. MATERIALS AND METHODS Fifty-six patients treated by flow diversion and followed with both DSA and 3T MRA between November 2020 and August 2021 were included. All patients were evaluated for parent artery patency using the same imaging protocol (DSA, noncontrast MRA including 3D-TOF with HyperSense and LAVA-Flex, and contrast-enhanced MRA, including time-resolved imaging of contrast kinetics MRA and delayed contrast-enhanced MRA). RESULTS With DSA as a criterion standard to evaluate the patency of the parent vessel, noncontrast MRA had a good specificity (0.83) and positive predictive value (0.65), better than contrast-enhanced MRA (0.55 and 0.41, respectively). Both had excellent sensitivity and negative predictive value: noncontrast MRA, 0.93 and 0.97, respectively; contrast-enhanced MRA, 0.93 and 0.96, respectively. Specificity and positive predictive value tended to be lower for patients treated with additional devices than for those treated with flow diverters exclusively and for patients treated with a specific type of flow diverter. CONCLUSIONS Noncontrast MRA can be used for noninvasive follow-up of intracranial aneurysms treated by flow diverters. The combined use of LAVA-Flex and 3D-TOF with HyperSense sequences allows monitoring the status of the parent artery and aneurysm occlusion.
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Affiliation(s)
- J Burel
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - E Gerardin
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - M Vannier
- Biostatistics (M.V.), Rouen University Hospital, Rouen, Normandie, France
| | - A Curado
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - M Verdalle-Cazes
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - N Magne
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - M Lefebvre
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - C Papagiannaki
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
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21
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Algin O, Yuce G, Koc U, Ayberk G. A comparison between the CS-TOF and the CTA/DSA for WEB device management. Interv Neuroradiol 2022; 28:29-42. [PMID: 33957798 PMCID: PMC8905082 DOI: 10.1177/15910199211014708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is no study on the role of three-dimensional compressed sensing time of flight MR angiography (3D-CS-TOF) in the management of the WEB device. We evaluated the efficacy of 3-tesla 3D-CS-TOF for the management and follow-up of the WEB device implantations. MATERIALS AND METHODS Seventy-three aneurysms of 69 patients treated with the WEB device were retrospectively examined. Morphological parameters and embolization results of the aneurysms were assessed and compared on 3D-CS-TOF, CTA, and DSA images. RESULTS Occluded, neck remnant, and recurrent aneurysms were observed in 61 (83.6%), 7 (9.6%), and 5 (6.8%) aneurysms, respectively. Inter- and intra-reader agreement values related to aneurysm size measurements were perfect. Aneurysms size, age, and proximal vessel tortuosity were negatively correlated with the visibility of the aneurysms and parent vessels on 3D-CS-TOF images (p = 0.043; p = 0.032; p < 0.001, respectively). Subarachnoid hemorrhage and age are associated with 3D-CS-TOF artifacts (p = 0.031; p = 0.005, respectively). 3D-CS-TOF findings are in perfect agreement with DSA or CT angiography (CTA) results (p < 0.001). CONCLUSION According to our results, 3D-CS-TOF can be an easy, fast, and reliable alternative for the management or follow-up of WEB assisted embolization.
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Affiliation(s)
- Oktay Algin
- National MR Research Center (UMRAM), Bilkent University, Ankara, Turkey,Department of Radiology, Yildirim Beyazit University, Ankara, Turkey,Department of Interventional Radiology, City Hospital, Bilkent, Ankara, Turkey,Oktay Algin, Department of Radiology, City Hospital, Yildirim Beyazit University, Bilkent, Ankara, Turkey.
| | - Gokhan Yuce
- Department of Interventional Radiology, City Hospital, Bilkent, Ankara, Turkey
| | - Ural Koc
- Department of Interventional Radiology, City Hospital, Bilkent, Ankara, Turkey,General Directorate of Health Information Systems, Ministry of Health, Ankara, Turkey
| | - Gıyas Ayberk
- Department of Neurosurgery, Yildirim Beyazit University, Ankara, Turkey
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22
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Kim YN, Choi JW, Lim YC, Song J, Park JH, Jung WS. Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization. Korean J Radiol 2022; 23:246-255. [PMID: 35029075 PMCID: PMC8814699 DOI: 10.3348/kjr.2021.0332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. MATERIALS AND METHODS Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. RESULTS The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively (p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). CONCLUSION Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.
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Affiliation(s)
- You Na Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jihye Song
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Hyun Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.,Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea.
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23
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Tan S, Lu Y, Li B, Wu Q, Zhou X, Wang Y. Usefulness of Silent Magnetic Resonance Angiography in the Follow-Up of Endovascular-Treated Intracranial Aneurysm: A Prospective Study. J Stroke Cerebrovasc Dis 2021; 31:106256. [PMID: 34923434 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To prospectively evaluate the clinical usefulness of Silent magnetic resonance angiography (Silent MRA) in the follow-up of endovascular-treated intracranial aneurysms by comparing it with time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA). METHODS Patients with endovascular-treated saccular aneurysms and followed with Silent MRA, TOF MRA, and DSA in our center were included. The visualization of the treated sites in the two MRA sequences was assessed using a 5-point scale. The aneurysm occlusion status according to each of the three imaging modalities was assessed using a 3-point scale. RESULTS Forty-one patients with 46 saccular aneurysms were recruited. The image quality score of Silent MRA was significantly higher than that of TOF MRA (4.32 ± 0.87 vs. 3.08 ± 1.48, P < 0.001). In the aneurysms treated by simple coiling, the maximal aneurysm diameter showed a strong negative correlation with image quality score in TOF MRA (Spearman's r = -0.519, P = 0.033), while it showed no significant correlation in Silent MRA (r = -0.037, P = 0.887). For the aneurysm occlusion status, inter-modality agreement was excellent (κ = 0.845) between DSA and Silent MRA, but poor (κ = 0.185) between DSA and TOF MRA. CONCLUSIONS Silent MRA was superior to TOF MRA in the follow-up of endovascular-treated intracranial aneurysms and showed excellent consistency with DSA in the evaluation of aneurysm occlusion. Therefore, Silent MRA is useful for the follow-up of endovascular-treated aneurysms.
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Affiliation(s)
- Song Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Bin Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Qin Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China; Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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24
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Hwang ZA, Li CW, Lin CYE, Chen JH, Chen CY, Chan WP. Intensity of arterial structure acquired by Silent MRA estimates cerebral blood flow. Insights Imaging 2021; 12:185. [PMID: 34894298 PMCID: PMC8665965 DOI: 10.1186/s13244-021-01132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral blood flow (CBF) and the morphology of the cerebral arteries are important for characterizing cerebrovascular disease. Silent magnetic resonance angiography (Silent MRA) is a MRA technique focusing on arterial structural delineation. This study was conducted to investigate the correlation between Silent MRA and CBF quantification, which has not yet been reported. METHODS Both the Silent MRA and time-of-flight magnetic resonance angiography scans were applied in seventeen healthy participants to acquire the arterial structure and to find arterial intensities. Phase-contrast MRA (PC-MRA) was then used to perform the quantitative CBF measurement of 13 cerebral arteries. Due to different dataset baseline signal level of Silent MRA, the signal intensities of the selected 13 cerebral arteries were normalized to the selected ROIs of bilateral internal carotid arteries. The normalized signal intensities were used to determine the relationship between Silent MRA and CBF. RESULTS The image intensity distribution of arterial regions generated by Silent MRA showed similar laminar shape as the phase distribution by PC-MRA (correlation coefficient > 0.62). Moreover, in both the results of individual and group-leveled analysis, the intensity value of arterial regions by Silent MRA showed positively correlation with the CBF by PC-MRA. The coefficient of determination (R2) of individual trends ranged from 0.242 to 0.956, and the R2 of group-leveled result was 0.550. CONCLUSIONS This study demonstrates that Silent MRA provides valuable CBF information despite arterial structure, rendering it a potential tool for screening for cerebrovascular disease.
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Affiliation(s)
- Zhen-An Hwang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Wei Li
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,GE Healthcare, Taipei, Taiwan
| | | | - Jyh-Horng Chen
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Chia-Yuen Chen
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing Long Road, Section 3, Taipei 116, Taiwan. .,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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25
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Ayabe Y, Hamamoto K, Yoshino Y, Ikeda Y, Chiba E, Yuzawa H, Oyama-Manabe N. Ultra-short Echo-time MR Angiography Combined with a Subtraction Method to Assess Intracranial Aneurysms Treated with a Flow-diverter Device. Magn Reson Med Sci 2021; 22:117-125. [PMID: 34897149 PMCID: PMC9849415 DOI: 10.2463/mrms.tn.2021-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A flow-diverter (FD) device is a well-established tool for the treatment of unruptured intracranial aneurysms. Time-of-flight (TOF) MR angiography (MRA) is widely used for postoperative assessment after the treatment with FD; however, it cannot fully visualize intra-aneurysmal and intrastent flow signals due to the magnetic susceptibility from the FD. Recently, the utility of MRA with ultra-short TE (UTE) sequence and arterial spin labeling technique in assessing the therapeutic efficacy of intracranial aneurysms treated with metallic devices has been reported, but long image acquisition time is one of the drawbacks of this method. Herein, we introduce a novel UTE MRA using the subtraction method that enables the reduction in susceptibility artifacts with a short image acquisition time.
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Affiliation(s)
- Yusuke Ayabe
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Kohei Hamamoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan,Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan,Corresponding author: Department of Radiology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama 359-8513, Japan. Phone: +81-4-2995-1689, Fax: +81-4-2996-5214, E-mail:
| | - Yoshikazu Yoshino
- Department of Endovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan,Department of Neurosurgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Yoshimasa Ikeda
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Emiko Chiba
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Hironao Yuzawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
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26
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Fujii T, Teranishi K, Yatomi K, Suzuki K, Mitome-Mishima Y, Kondo A, Oishi H. Long-term Follow-up Results after Flow Diverter Therapy Using the Pipeline Embolization Device for Large or Giant Unruptured Internal Carotid Artery Aneurysms: Single-center Retrospective Analysis in the Japanese Population. Neurol Med Chir (Tokyo) 2021; 62:19-27. [PMID: 34707069 PMCID: PMC8754679 DOI: 10.2176/nmc.oa.2021-0203] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Flow diverter (FD) therapy using Pipeline embolization device (PED) has become an important alternative to treat internal carotid artery (ICA) aneurysms. Herein, we report the long-term outcome for 3 years after FD therapy using PED for ICA aneurysms in Japan. The patients who underwent angiographical and/or clinical follow-up for 3 years after the FD therapy using PED of large or giant unruptured ICA aneurysms from December 2012 at our university hospital are the subjects of this study. We retrospectively reviewed the in- and outpatients’ medical charts, and written operative and radiological records. There were 84 patients with 90 aneurysms who could be clinically and/or angiographically followed up for 3 years. Of these, 7 aneurysms were only available for clinical follow-up. Of the remaining 83 aneurysms, 6 aneurysms had vessel occlusion due to stent thrombosis or parent artery occlusion, and 60 of the remaining 77 (77.9%) had complete occlusion. In multivariate analysis, older age (>70 years), wide neck, and non-adjunctive coiling contributed statistically significantly to incomplete occlusion. Of the 84 patients, 2 patients (2.4%) had delayed complications between 6 months and 3 years after the initial FD placement. Three patients (3.6%) had poor outcome due to postoperative major stroke complications, 2 of which were acute complications. The long-term results after FD therapy are good both angiographically and clinically. Endothelialization of the aneurysmal neck and intra-aneurysmal thrombosis contribute to complete occlusion. The primary reason for the somewhat low complete occlusion in Japan may be the patients are generally older.
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Affiliation(s)
- Takashi Fujii
- Department of Neuroendovascular Therapy, Juntendo University, Graduate School of Medicine
| | - Kohsuke Teranishi
- Department of Neurosurgery, Juntendo University, Graduate School of Medicine
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University, Graduate School of Medicine
| | - Kazumoto Suzuki
- Department of Neurosurgery, Juntendo University, Graduate School of Medicine
| | | | - Akihide Kondo
- Department of Neurosurgery, Juntendo University, Graduate School of Medicine
| | - Hidenori Oishi
- Department of Neuroendovascular Therapy, Juntendo University, Graduate School of Medicine.,Department of Neurosurgery, Juntendo University, Graduate School of Medicine
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27
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Halitcan B, Bige S, Sinan B, Ilkay A, Ergun D, Fatih A, Anil A. The implications of magnetic resonance angiography artifacts caused by different types of intracranial flow diverters. J Cardiovasc Magn Reson 2021; 23:69. [PMID: 34092251 PMCID: PMC8182930 DOI: 10.1186/s12968-021-00753-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Serial cerebral angiographic imaging is necessary to ensure cerebral aneurysm occlusion after flow diverter placement. Time-of-flight (TOF)-magnetic resonance angiography (MRA) is used for this purpose due to its lack of radiation, contrast media and complications. The comparative diagnostic yield of TOF-MRA for different flow diverters has not been previously analyzed. PURPOSE To evaluate the diagnostic accuracy of TOF-MRA in cerebral aneurysms treated w divertersith different flow diverters. MATERIALS AND METHODS Flow-diverted patients whose cerebral follow-up MRA and digital subtraction angiograms (DSA) were obtained within 6 weeks were retrospectively identified. The DSA (as gold standard) and MRA images of these patients were compared by two readers (blinded to both patient data and endovascular procedure data) for residual aneurysms and the status of the parent artery for each type of flow diverter. In a second group of patients, magnetic susceptibility artifacts were manually measured and compared for different FDs. RESULTS Seventy-six patients (85 aneurysms) were included in group one, and 86 patients (95 aneurysms) were included in group 2. TOF-MRA and DSA showed almost perfect agreement for residual aneurysms (κ = 0.88, p < 0.001) (positive predictive value (PPV) = 1.00, specificity = 1.00, negative predictive value (NPV) = 0.89, sensitivity = 0.89). Intermodality agreement (κ = 0.97 vs. κ = 0.74, p < 0.005) and sensitivity (0.97 vs. 0.77, NPV: 0.96 vs. 0.77) were highest with nitinol stents. MRA and DSA showed no agreement for occluded or stenotic parent vessels (κ = 0.13, p = 0.015, specificity = 0.44, NPV = 1.00, sensitivity = 1.00). Specificity was lower in chromium-cobalt based FDs than in nitinol devices (specificity = 0.08 vs. 0.60). Chromium-cobalt stents generated the largest artifacts (p < 0.005). The size of the device-related artifact, in millimeters, increased in respective order, for the Silk, Derivo, Pipeline and Surpass devices. CONCLUSION Unlike DSA, TOF-MRA is susceptible to dissimilarities between flow diverters. MRA is not well-suited for research studies comparing different flow diverters. Nitinol FDs appear to be advantageous for TOF-MRA follow-up so as not to miss small aneurysm remnants or clinically relevant parent artery stenosis.
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Affiliation(s)
- Batur Halitcan
- Department of Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sayin Bige
- Department of Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Balci Sinan
- Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey
| | - Akmangit Ilkay
- Department of Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Daglioglu Ergun
- Department of Neurosurgery, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Alagoz Fatih
- Department of Neurosurgery, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Arat Anil
- Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey.
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28
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Zhang C, Dou W, Yu K, Ji Y, Wang W, Sami MU, Shen Y, Xu K. The feasibility of non-contrast-enhanced zero echo time magnetic resonance angiography for characterization of intracranial atherosclerotic disease. Quant Imaging Med Surg 2021; 11:2442-2452. [PMID: 34079714 DOI: 10.21037/qims-20-696] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Accurate and non-invasive assessment of intracranial atherosclerotic disease (ICAD) is important because of its effect on treatment planning. The aim of this study is to investigate if zero echo time (zTE) magnetic resonance angiography (zTE-MRA) is feasible in the characterization of ICAD. Methods A total of 175 patients with ICAD were recruited. ZTE-MRA and time-of-flight (TOF)-MRA sequences were conducted for all participants using a 3T clinical MR system. Forty-one patients also underwent digital subtraction angiography (DSA), and were confirmed to have intracranial arterial stenosis (ICAS). Weighted kappa (κ) statistics were used to assess the inter-observer agreement and diagnostic consistency of both zTE- and TOF-MRA, using DSA as a reference. The Wilcoxon signed-rank test was used to evaluate differences in image quality between zTE- and TOF-MRA images. The nonparametric test of multiple paired samples was used to compare the results of vascular stenosis diagnosis between zTE-, TOF-MRA and DSA. Results Supported by high inter-observer agreement (weighted κ=0.78), zTE-MRA generated significantly higher scores than TOF-MRA for susceptibility artifact signal (mean: 3.03±0.98 vs. 2.72±1.09; P=0.017) and flow signal in parent artery (mean: 3.63±0.49 vs. 3.07±0.82; P<0.001). Additionally, zTE-MRA showed more robust diagnostic performance than TOF-MRA for patients with ICAD and degree of vascular stenosis (P<0.05), and was highly consistent with reference DSA images (weighted κ=0.80). Conclusions ZTE-MRA has potential for use as a routine clinical method for patients with ICAD.
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Affiliation(s)
- Chao Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Ke Yu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Ji
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Radiology, Traditional Chinese Medical Hospital of Yixing, Yixing, China
| | - Wenliang Wang
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Muhammad Umair Sami
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Shen
- GE Healthcare, MR Enhanced Application China, Beijing, China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Oishi H, Mishima Y, Yatomi K, Teranishi K, Suzuki K, Fujii T. Defective Endothelialization of Pipeline Embolization Device after Flow Diverter Therapy: An Autopsy Case Report. NMC Case Rep J 2021; 8:33-37. [PMID: 34012746 PMCID: PMC8116919 DOI: 10.2176/nmccrj.cr.2020-0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/30/2020] [Indexed: 11/20/2022] Open
Abstract
The authors report a rare autopsy case. A 59-year-old woman underwent flow diverter (FD) therapy using a pipeline embolization device (PED) for a large paraclinoid internal carotid artery aneurysm. Follow-up magnetic resonance (MR) examinations were performed 6 months after the treatment. Although the T2-weighted images showed progressive thrombosis of the aneurysm, the silent MR angiography (MRA) clearly showed the residual blood flow within the aneurysm. The patient committed suicide 2 months after the follow-up MR examinations. An autopsy specimen showed a small section of the defective membranes with the PED that matched the entry point of residual blood flow seen clearly in the silent MRA. Macroscopic photograph and hematoxylin and eosin stained sections showed defective endothelialization. In contrast, complete endothelialization was observed in membranes covering the PED. The autopsy findings after FD therapy showed defective endothelialization that perfectly matched and corroborated the silent MRA findings.
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Affiliation(s)
- Hidenori Oishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yumiko Mishima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kosuke Teranishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazumoto Suzuki
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Fujii
- Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine, Tokyo, Japan
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30
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Hostetter J, Miller TR, Gandhi D. Imaging for Treated Aneurysms (Including Clipping, Coiling, Stents, Flow Diverters). Neuroimaging Clin N Am 2021; 31:251-263. [PMID: 33902878 DOI: 10.1016/j.nic.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intracranial aneurysms are common in the adult population and carry a risk of rupture leading to catastrophic subarachnoid hemorrhage. Treatment of aneurysms has evolved significantly, with the introduction of new techniques and devices for minimally invasive and endovascular approaches. Follow-up imaging after aneurysm treatment is standard of care to monitor for recurrence or other complications, and the preferred imaging modality and schedule for follow-up are areas of active research. The modality and follow-up schedule should be tailored to treatment technique, aneurysm characteristics, and patient factors.
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Affiliation(s)
- Jason Hostetter
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA.
| | - Timothy R Miller
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
| | - Dheeraj Gandhi
- Neurology and Neurosurgery, Department of Radiology, Interventional Neuroradiology, CMIT Center, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
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31
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Sugiyama N, Fujii T, Yatomi K, Teranishi K, Oishi H, Arai H. Endovascular Treatment for Lateral Wall Paraclinoid Aneurysms and the Influence of Internal Carotid Artery Angle. Neurol Med Chir (Tokyo) 2021; 61:275-283. [PMID: 33716235 PMCID: PMC8048120 DOI: 10.2176/nmc.oa.2020-0307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Lateral wall paraclinoid aneurysms (LPA) are a rare type of aneurysm located on the lesser curve side of the internal carotid artery (ICA) bend, at the level of the anterior clinoid process. The objective of this study was to assess the influence of flexion of the ICA on the morphology of aneurysms and outcome of endovascular treatment. Between 2003 and 2018, we treated 643 cases of unruptured paraclinoid aneurysms with endovascular therapy in our institution. Of those cases, aneurysms projecting laterally on preoperative angiography were defined as LPA. The degree of bending of the ICA (ICA angle) was measured and statistically analyzed in relation to the aneurysm characteristics and the occlusion status after treatment. In all, 43 aneurysms were identified. ICA angle was positively correlated with the maximum dome size of the aneurysm (P <0.01) and the aspect ratio (P <0.01), and negatively correlated with the volume coil embolization ratio (P <0.01). Complete occlusion (CO) was achieved in 23 cases (53.5%) immediately after treatment, and in 35 cases (81.4%) at follow-up. The mean ICA angle in the incomplete occlusion group was significantly larger than in the CO group (P = 0.01). Larger ICA angle resulted in recurrence, whereas smaller ICA angle was more likely to obtain progressive thrombosis (P = 0.02). Endovascular treatment for LPA was safe and effective. The degree of flexion of the ICA may contribute to the level of hemodynamic stress on the aneurysm, its morphology, and the embolization effect.
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Affiliation(s)
- Natsuki Sugiyama
- Department of Neurosurgery, Juntendo University Faculty of Medicine
| | - Takashi Fujii
- Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Faculty of Medicine
| | - Kosuke Teranishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine
| | - Hidenori Oishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine.,Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine
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Noncontrast Magnetic Resonance Angiography in the Era of Nephrogenic Systemic Fibrosis and Gadolinium Deposition. J Comput Assist Tomogr 2021; 45:37-51. [PMID: 32976265 DOI: 10.1097/rct.0000000000001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Gadolinium-based contrast agents for clinical magnetic resonance imaging are overall safe. However, the discovery of nephrogenic systemic fibrosis in patients with severe renal impairment and gadolinium deposition in patients receiving contrast have generated developments in contrast-free imaging of the vasculature, that is, noncontrast magnetic resonance angiography. This article presents an update on noncontrast magnetic resonance angiography techniques, with comparison to other imaging alternatives. Potential benefits and challenges to implementation, and evidence to date for various clinical applications are discussed.
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33
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Katsuki M, Narita N, Ishida N, Sugawara K, Watanabe O, Ozaki D, Sato Y, Kato Y, Jia W, Tominaga T. Usefulness of 3 Tesla Ultrashort Echo Time Magnetic Resonance Angiography (UTE-MRA, SILENT-MRA) for Evaluation of the Mother Vessel after Cerebral Aneurysm Clipping: Case Series of 19 Patients. Neurol Med Chir (Tokyo) 2021; 61:193-203. [PMID: 33504734 PMCID: PMC7966203 DOI: 10.2176/nmc.oa.2020-0336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
It is important to assess the cerebral arteries near the clip after cerebral aneurysm clipping. Contrast-enhanced computed tomography angiography has side effects of contrast medium and radiation exposure. Time-of-flight magnetic resonance angiography (TOF-MRA) is a fast and non-invasive method, but clip-induced artifact limits the assessment around the clip. Recently, 3 tesla MRA with ultrashort echo time called SILENT MRA (GE Healthcare Life Sciences, UK) has been reported to have the potential to overcome these disadvantages. We herein present consecutive 19 cerebral aneurysm patients treated by clipping and evaluated using SILENT MRA. The 19 patients (15 women and 4 men) underwent TOF-MRA and SILENT MRA during the same scan session. Two neurosurgeons independently assessed the visibility of the mother vessel at the clipping site in TOF-MRA and SILENT MRA. We also investigated the factors related to visibility in SILENT MRA. All patients’ mother vessels were not described in TOF-MRA, and that of 16 patients (84%) were described in SILENT MRA. Overall agreement was 100% in the two neurosurgeons, and the fixed marginal kappa = 1.00 (95% CI: 0.36–1.00). Univariate analysis revealed that larger aneurysm dome and long clip blade length contributed to the visibility of the mother vessel in SILENT MRA. (p = 0.023, 0.007, each). In conclusion, SILENT MRA can be applied for the assessment of the arteries and aneurysm neck remnants near the clip. Using clips with long blade and ligation with its tip would be related to the visibility of the mother vessels in SILENT MRA.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Naoya Ishida
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kazuya Sugawara
- Department of Radiological Technology, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Ohmi Watanabe
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Dan Ozaki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yoshimichi Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yuya Kato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Wenting Jia
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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34
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Ryu KH, Baek HJ, Moon JI, Choi BH, Park SE, Ha JY, Park H, Kim SS, Kim JS, Cho SB, Carl M. Usefulness of Noncontrast-Enhanced Silent Magnetic Resonance Angiography (MRA) for Treated Intracranial Aneurysm Follow-up in Comparison with Time-of-Flight MRA. Neurosurgery 2019; 87:220-228. [DOI: 10.1093/neuros/nyz421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Flow visualization in time-of-flight magnetic resonance angiography (TOF MRA) is limited for treated intracranial aneurysms owing to magnetic susceptibility and radiofrequency shielding.
OBJECTIVE
To assess the clinical usefulness of noncontrast-enhanced magnetic resonance angiography (MRA) using a silent scan (silent MRA) as a follow-up imaging modality in patients with treated intracranial aneurysms.
METHODS
A total of 119 patients with 126 treated aneurysms underwent silent MRA and TOF MRA during the same scan session. Two neuroradiologists independently assessed overall image quality and visualization of the treated site using a 5-point Likert scale to compare the 2 image sets. We used receiver operating characteristic (ROC) curve analysis to investigate the diagnostic performance of the 2 MRA methods in evaluating aneurysm occlusion. Interobserver reliability was also assessed using weighted kappa statistics.
RESULTS
The overall image quality scores of silent MRA and TOF MRA were 4.04 ± 0.22 and 4.64 ± 0.48, respectively (P < .001), and interobserver agreement was substantial (P < .001). For the treated site, the score of flow visualization on silent MRA was higher than that on TOF MRA, 3.94 ± 0.94 vs 2.59 ± 1.37 (P < .001), with substantial interobserver agreement (P < .001). ROC curve analysis showed that silent MRA was superior to TOF MRA in diagnostic performance (area under the curve [AUC] = 0.962; 95% CI: 0.931-0.982 vs AUC = 0.843; 95% CI: 0.792-0.886; P < .001).
CONCLUSION
Silent MRA can be useful to evaluate treated intracranial aneurysms during follow-up without radiation exposure and use of contrast material. It is characterized by higher diagnostic performance and superior visualization for the treated site.
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Affiliation(s)
- Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seung Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jung-Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Michael Carl
- Applied Science Lab, GE Healthcare, San Diego, CA, United States
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