1
|
Uetani H, Kitajima M, Ohmori Y, Morita K, Yamashita Y, Kaku Y, Nakaura T, Sasao A, Sasaki G, Ishiuchi S, Mukasa A, Hirai T. Intracranial aneurysms treated with stent-assisted coil embolization: evaluation with four-dimensional ultrashort-TE MR angiography. Eur Radiol 2023; 33:7923-7933. [PMID: 37284863 DOI: 10.1007/s00330-023-09755-1] [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: 10/31/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES As a novel follow-up method for intracranial aneurysms treated with stent-assisted coil embolization (SACE), we developed four-dimensional magnetic resonance angiography (MRA) with minimized acoustic noise utilizing ultrashort-echo time (4D mUTE-MRA). We aimed to assess whether 4D mUTE-MRA is useful for the evaluation of intracranial aneurysms treated with SACE. METHODS This study included 31 consecutive patients with intracranial aneurysm treated with SACE who underwent 4D mUTE-MRA at 3 T and digital subtraction angiography (DSA). For 4D mUTE-MRA, five dynamic MRA images with a spatial resolution of 0.5 × 0.5 × 0.5 mm3 were obtained every 200 ms. Two readers independently reviewed the 4D mUTE-MRA images to evaluate the aneurysm occlusion status (total occlusion, residual neck, and residual aneurysm) and the flow in the stent using a 4-point scale (from 1 [not visible] to 4 [excellent]). The interobserver and intermodality agreement was assessed using κ statistics. RESULTS On DSA images, 10 aneurysms were classified as total occlusion, 14 as residual neck, and 7 as residual aneurysm. In terms of aneurysm occlusion status, the intermodality and interobserver agreement was excellent (κ = 0.92 and κ = 0.96, respectively). For the flow in the stents on 4D mUTE-MRA, the mean score was significantly higher for single stents than multiple stents (p < .001) and for open-cell type stents than closed-cell type (p < .01). CONCLUSIONS 4D mUTE-MRA is a useful tool with a high spatial and temporal resolution for the evaluation of intracranial aneurysms treated with SACE. KEY POINTS • In the evaluation of intracranial aneurysms treated with SACE on 4D mUTE-MRA and DSA, the intermodality and interobserver agreement in aneurysm occlusion status was excellent. • 4D mUTE-MRA shows good to excellent visualization of flow in the stents, especially for cases treated with a single or open-cell stent. • 4D mUTE-MRA can provide hemodynamic information related to embolized aneurysms and the distal arteries to stented parent arteries.
Collapse
Affiliation(s)
- Hiroyuki Uetani
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan.
| | - Mika Kitajima
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
- Department of Medical Image Sciences, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Kosuke Morita
- Central Radiology Section, Kumamoto University Hospital, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Yuichi Yamashita
- Canon Medical Systems Corporation, MRI Sales Department, Sales Engineer Group, 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-0015, Japan
| | - Yasuyuki Kaku
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Takeshi Nakaura
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Akira Sasao
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
- Joint Research Course of Imaging Dynamics Applied Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Goh Sasaki
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Soichiro Ishiuchi
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Toshinori Hirai
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Kato H, Ootani N, Abiru K, Okahara M. Investigating Signal Loss due to a Carotid Artery Stent in 3D-TOF-MRA. Magn Reson Med Sci 2021; 20:303-311. [PMID: 32963183 PMCID: PMC8424025 DOI: 10.2463/mrms.mp.2019-0083] [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] [Indexed: 12/01/2022] Open
Abstract
Purpose: In this study, we investigated the factors of signal loss out because of the presence of a stent and optimized imaging parameters for improvement in depiction ability. Methods: We investigated the relationship between the stent type and magnetic susceptibility effect by measuring the signal value between the inside and outside of the stent with different Bw and TE for two different kinds of stents respectively. Similarly, flip angles were changed for two different kinds of stents respectively to the signal intensity between the inside and the outside of the stent was measured, in which examine the relationship between the stent type and the Ernst angles in RF-shielding effect. The conventional imaging parameters and the optimum imaging parameters for each stent obtained from the result of the phantom experiment were examined. Optimized 3D time-of-flight MR angiography (3D-TOF-MRA) was performed and compared with conventional 3D-TOF-MRA and computed tomography angiography (CTA). Results: The influence of the magnetic susceptibility effect is small in the central part of Carotid Wallstent and in PRECISE, and large in the Carotid Wallstent at the both ends. The influence of RF-shielding effect was large at PRECISE, where the Ernst angle was greatly shifted while the effect is no longer influenced at Carotid Wallstent. Both Carotid Wallstent and PRECISE made imaging capability improved by optimizing the imaging parameters. Conclusion: During clinical imaging of patients post-carotid artery stenting (CAS) using our protocol, the ability to visualize blood vessels was improved. Thus, we demonstrated that the ability of 3D-TOF-MRA post-CAS was improved via optimizing imaging parameters.
Collapse
Affiliation(s)
- Hiroshi Kato
- Radiology Department, Federation of National Public Service Personnel Mutual Aid Associations Shinbeppu Hospital
| | - Norio Ootani
- Radiology Department, Federation of National Public Service Personnel Mutual Aid Associations Shinbeppu Hospital
| | - Kentaro Abiru
- Radiology Department, Federation of National Public Service Personnel Mutual Aid Associations Shinbeppu Hospital
| | - Mika Okahara
- Radiology Department, Federation of National Public Service Personnel Mutual Aid Associations Shinbeppu Hospital
| |
Collapse
|
6
|
Nguyen AV, Reed LK, Lesley WS. PulseRider Treated Aneurysm with Significant Artifact on Postoperative Magnetic Resonance Angiography: A Case Report and Literature Review. Neurointervention 2021; 16:293-297. [PMID: 34425636 PMCID: PMC8561032 DOI: 10.5469/neuroint.2021.00241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
The PulseRider is a neuroendovascular adjunct for wide-necked intracranial aneurysms. The decreased metal burden of the PulseRider theoretically reduces artifact on radiologic imaging. However, we report here on a case of a patient who underwent PulseRider-assisted stent-coiling of a basilar tip aneurysm. He returned 19 months later for intermittent diplopia and darkening of vision but was neurologically intact on exam. Both contrast-enhanced and time-of-flight magnetic resonance angiography (MRA) demonstrated absence of signal in the basilar artery in the proximal anchors of the PulseRider. Given his lack of reproducible symptoms and high functional status, it is presumed that the imaging reflected artifact and not thrombosis/stenosis. Although the PulseRider is a useful treatment option for wide-necked intracranial aneurysms, the clinician should be aware that even contrast-enhanced MRA can produce artifact that resembles thrombosis/stenosis. Non-angiogram radiologic imaging modalities may be appropriate for evaluation for residual aneurysm but not patency of the parent artery.
Collapse
Affiliation(s)
- Anthony V Nguyen
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Laura K Reed
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Walter S Lesley
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| |
Collapse
|
7
|
Takatsu Y, Yoshida R, Yamamura K, Yamatani Y, Ueyama T, Kimura T, Nohara Y, Sahara T, Nishiyama K, Miyati T. Three-dimensional Gradient-echo is Effective in Suppressing Radiofrequency Shielding by a Titanium Mesh. Magn Reson Med Sci 2021; 20:182-189. [PMID: 32595187 PMCID: PMC8203480 DOI: 10.2463/mrms.mp.2019-0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/24/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine which sequence for frequently used general contrast-enhanced brain MRI shows the least radiofrequency shielding effect of a titanium mesh in cranioplasty using a phantom. METHODS A 1.5T MRI scanner was used. Frequently used general 2D and 3D spin-echo sequences (SE) and T1 spoiled gradient echo sequences (GRE) used for MRI in clinical settings were adopted in this study. A titanium mesh was placed above a cubic phantom containing manganese chloride tetrahydrate and sodium chloride. The signal attenuation ratio and normalized absolute average deviation (NAAD) were calculated. Moreover, the flip angle (FA) dependency in SE and area of excitation dependency in 3D sequences were analyzed using NAAD. RESULTS The signal attenuation ratio at the position nearest to the titanium mesh for 2D SE was 71.8% larger than that at the position nearest to the titanium mesh for 3D GRE. With regard to NAAD, 3D GRE showed the highest values among the sequences. When FA was increased, radiofrequency shielding effect was improved. There were no significant differences between the narrow and wide area of excitation. 3D GRE showed the least radiofrequency shielding effect, and it was considered as the optimal sequence for MRI in the presence of a titanium mesh. CONCLUSION 3D GRE shows the least radiofrequency shielding effect of a titanium mesh after cranioplasty among frequently used general sequences for contrast-enhanced brain MRI.
Collapse
Affiliation(s)
- Yasuo Takatsu
- Department of Radiological Technology, Faculty of Health and Welfare, Tokushima Bunri University, Kagawa, Japan
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Rei Yoshida
- Department of Radiology, Kurihara Central Hospital, Miyagi, Japan
| | | | - Yuya Yamatani
- Division of Central Radiology, Nara Medical University Hospital, Nara, Japan
| | - Tsuyoshi Ueyama
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tetsuya Kimura
- Department of Radiological Technology, Sakai City Medical Center, Osaka, Japan
| | - Yuriko Nohara
- Department of Radiology, Daini Osaka Police Hospital, Osaka, Japan
| | - Tomohiro Sahara
- Division of Radiological Technology, Osaka City University Hospital, Osaka, Japan
| | - Kengo Nishiyama
- Department of Radiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| |
Collapse
|
8
|
Zheng J, Zhou R, Meng B, Li F, Liu H, Wu X. Knowledge framework and emerging trends in intracranial aneurysm magnetic resonance angiography: a scientometric analysis from 2004 to 2020. Quant Imaging Med Surg 2021; 11:1854-1869. [PMID: 33936970 DOI: 10.21037/qims-20-729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background As magnetic resonance angiography (MRA) has been increasingly used in the follow-up of intracranial aneurysms (IAs) as a non-invasive technique, the knowledge framework and areas of research interest in intracranial aneurysms magnetic resonance angiography (IAMRA) change approximately every 10 years. However, few studies have quantitatively analyzed the published literature in this field. In the present study, we used scientometrics to survey the knowledge field, development trends, and research focus of IAMRA with the aim of providing a reference for further study. Methods We collected articles on IAMRA published from 2004 (Jan 1, 2004) to 2020 (May 24, 2020). Web of Science Core Collection databases (WoSCCd) including the Science Citation Index Expanded were searched. An experienced staff member from the Department of Radiology at Southern Medical University, assisted in screening articles for relevant articles. We used ArcGIS (a mapping and location analytics platform) to perform geographic visualization. Excel 2016 was used to analyze the literature data, including number of publications, impact factor (IF), and publication year. CiteSpace V was used to conduct a series of literature feature clustering, including author co-citation analysis, reference co-citation analysis (RCA), and burst keywords analysis. Results A total of 1,272 articles on IAMRA published between 2004 and 2020 were included. Of 257 journals, American Journal of Neuroradiology (IF 2018: 3.256) published the most IAMRA articles (109 publications, 8.57%), followed by Journal of Neurosurgery (IF 2018: 4.131, 51 publications, 4.16%), and Neuroradiology (IF 2018: 2.504, 51 publications, 4.01%). Of 56 countries, the USA published the most, with 347 articles [27.28%, IF: 3.14 (average IF of all journals in the country)], followed by Japan (242 articles, 19.03%, IF: 2.38), Germany (135 articles, 10.61%, IF: 3.21), and China (101 articles, 7.94%, IF: 2.86). A total of 1387 institutions published articles, with the Mayo Clinic publishing the most (33 articles, 2.59%), followed by Shanghai Jiao Tong University (25 article, 1.97%), Seoul National University (23 articles, 1.81%), and University Medical Center Utrecht (19 articles, 1.49%). Of 399 authors, Rinkel ranked first with 19 articles, followed by Li MH (18 articles), Uchino A (15 articles), and Saito N (13 articles). Cluster RCA showed that the first cluster was "#0 growth", followed by "#1 Guglielmi detachable coils". Timeline views showed that the time span of "#0 growth" was the closest to today. The modularity value was 0.6971, and the mean silhouette value was 0.5477. According to the burst keyword analysis, "risk factors associated to rupture" was the topic with the strongest burst since 2017. Studies conducted in several countries suggested that age is inversely related to the risk of rupture, which implies the importance of MRA follow-up for patients of different age. Conclusions From 2004 to 2020, the number of published IAMRA-related articles gradually increased. The USA and Western Europe lead in the field, with a concentration of cutting-edge talents and high-level scientific research institutions. A synthesis of the clustering results of RCA and burst keyword analysis indicated that unruptured IA growth, stent-assisted coil embolization, and risk factors associated to rupture were the current hotspots in IAMRA research.
Collapse
Affiliation(s)
- Jiazhen Zheng
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Bingyao Meng
- Department of Radiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Furong Li
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Huamin Liu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| |
Collapse
|
9
|
You SH, Kim B, Yang KS, Kim BK, Ryu J. Ultrashort Echo Time Magnetic Resonance Angiography in Follow-up of Intracranial Aneurysms Treated With Endovascular Coiling: Comparison of Time-of-Flight, Pointwise Encoding Time Reduction With Radial Acquisition, and Contrast-Enhanced Magnetic Resonance Angiography. Neurosurgery 2021; 88:E179-E189. [PMID: 33319900 DOI: 10.1093/neuros/nyaa467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The optimal magnetic resonance angiography (MRA) sequence for assessing the aneurysm occlusion state or in-stent flow after endovascular coiling is not well established. OBJECTIVE To evaluate the diagnostic performance of pointwise encoding time reduction with radial acquisition (PETRA)-MRA in patients who underwent endovascular coiling relative to that of time-of-flight (TOF)-MRA and contrast-enhanced (CE)-MRA. METHODS We evaluated the aneurysm occlusion state using digital subtraction angiography (DSA) and MRA. In patients who underwent stent-assisted coiling, we estimated the visibility of in-stent flow. RESULTS We enrolled 189 patients with assessable TOF, PETRA, and CE-MRAs after coiling. In patients who underwent simple coiling (128 patients), PETRA showed a higher sensitivity in the detection of residual flow than TOF and CE (PETRA, 100%; CE, 83%; TOF, 80%). There were no significant differences in the height of residual flow between DSA (0.68 ± 1.45 mm) and PETRA (0.70 ± 1.50 mm; P = 1.000). In patients who underwent stent-assisted coiling (61 patients), PETRA showed the highest sensitivity (88%) in detecting residual flow (CE, 56%; TOF, 31%). Regarding in-stent flow, PETRA, CE, and TOF showed visual scores of ≥3 with frequencies of 96.7%, 85.2%, and 37.7%, respectively. Relative signal-to-noise ratio of PETRA (0.62 ± 0.18) was significantly higher than that of CE (0.56 ± 0.12) and TOF (0.39 ± 0.12; P < .001 for both). CONCLUSION PETRA-MRA showed excellent diagnostic performance in terms of residual flow detection and in-stent flow assessment. PETRA could be a versatile alternative sequence for following up patients with coiled aneurysm.
Collapse
Affiliation(s)
- Sung-Hye You
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byungjun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bo Kyu Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jaeil Ryu
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Xiang S, Fan F, Hu P, Yang K, Zhai X, Geng J, Ji Z, Lu J, Zhang H. The sensitivity and specificity of TOF-MRA compared with DSA in the follow-up of treated intracranial aneurysms. J Neurointerv Surg 2021; 13:1172-1179. [PMID: 33632877 DOI: 10.1136/neurintsurg-2020-016788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/17/2021] [Accepted: 01/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Time-of-flight magnetic resonance angiography (TOF-MRA) is widely used in detecting intracranial aneurysms (IA), but it is limited and controversial for use during follow-up to assess the outcome of interventional coiling or clipping surgery. METHODS To evaluate the specificity and sensitivity of using TOF-MRA as an imaging follow-up for IA with different treatments. A total of 280 patients with 326 treated IA underwent simultaneous TOF-MRA and digital subtraction angiography (DSA) as follow-up imaging on the same day. All images were independently reviewed by two neurosurgeons and two radiologists. The consensus evaluation of intra-arterial DSA as a reference test was used to evaluate the result of aneurysm occlusions. The aneurysmal embolization status was assessed with two ratings involving complete or incomplete occlusions. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value of three-dimensional-TOF-MRA to investigate the diagnostic performance. RESULTS Overall sensitivity and specificity of TOF-MRA for diagnosing the remnant were 83.3% and 95.2%, respectively. The sensitivity and specificity of interventional therapy was 90.0% and 94.2%, respectively, while the clipping group showed sensitivity and specificity of 50.0% and 100%, respectively. For additional groups, involving coil only, stent-assisted, and flow diverter, the analysis of interventional therapy showed sensitivities and specificities of 100.0% and 90.1%, 66.7% and 95.1%, and 91.7% and 100%, respectively. CONCLUSIONS TOF-MRA can be used as a first-line noninvasive imaging modality during follow-up, especially for the patients treated with a pipeline embolization device and coils only. But it may not be enough for clipped aneurysms.
Collapse
Affiliation(s)
- Sishi Xiang
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Fu Fan
- Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Peng Hu
- China International Neuroscience Institute, Beijing, China
| | - Kun Yang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Zhai
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Jiewen Geng
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Zhe Ji
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Jie Lu
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Hongqi Zhang
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China .,China International Neuroscience Institute, Beijing, China
| |
Collapse
|
11
|
Sato K, Asano A, Kobayashi T, Aoki H, Jinguji S, Seto H, Demachi H, Hasegawa H, Fujii Y. Validity of PETRA-MRA for Stent-Assisted Coil Embolization of Intracranial Aneurysms. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:352-359. [PMID: 37502413 PMCID: PMC10370957 DOI: 10.5797/jnet.oa.2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/15/2020] [Indexed: 07/29/2023]
Abstract
Objective Pointwise encoding time reduction with radial acquisition (PETRA) using magnetic resonance angiography (MRA) is a non-enhanced MRA technique employing an ultrashort echo time, and is known to significantly reduce the magnetic susceptibility of coils and stents during post-embolization imaging. We evaluated the quality of PETRA-MRA images for use at the follow-up assessment of stent-assisted coil embolization procedures performed to treat aneurysms. Methods A total of six aneurysm patients who were treated by stent-assisted coil embolization were included. All patients underwent PETRA-MRA, time-of-flight (TOF)-MRA performed with MAGNETOM Skyra (Siemens), and digital subtraction angiography (DSA) performed with Infinix Celeve-i INFX-8000V (Canon Medical Systems) and Allura Clarity FD20/15 (Philips). The PETRA-MRA images were compared with those from DSA and TOF-MRA to validate the aneurysm occlusion status and visually assess the blood flow within the stent. Four independent specialists graded occlusion status and flow visualization through the stent using a four-point scale, where 4 points represented excellent visualization of flow within the stent. Results The aneurysm was located in the internal carotid artery in two patients, the middle cerebral artery in two patients, the top of the basilar artery in one patient, and the vertebral artery-posterior inferior cerebellar artery (VA-PICA) in one patient. Three patients were treated using a Neuroform Atlas Stent system, one using an Enterprise2 VRD, one using two Neuroform Atlas stents for Y-stenting, and the remaining patient using a Neuroform Atlas and an Enterprise2 VRD for Y-stenting. With DSA, the postoperative aneurysm occlusion status was neck remnant (NR) in five cases and complete obliteration (CO) in one case. DSA and PETRA-MRA evaluations demonstrated an equal occlusion status in five of six cases, whereas DSA and TOF-MRA were equal in two of six cases. The mean visualization score for PETRA-MRA was 3.33 ± 0.82, whereas that for TOF-MRA was 2.17 ± 1.33. On the PETRA-MRA images, blood flow through the stent was well-visualized and produced an aneurysm occlusion status score comparable to DSA, especially in the three cases using the Neuroform Atlas Stent System where the visualization was scored 4 points. In the case of the VA-PICA aneurysm, for which an Enterprise2 VRD was used, PETRA-MRA images were insufficient for postoperative assessment. Conclusion PETRA-MRA can provide good visualization of the blood flow within a stent and displays a clear blood signal near the coils, barring small magnetic susceptibility artifacts. Therefore, PETRA-MRA may be an effective option for follow-up imaging after stent-assisted coil embolization.
Collapse
Affiliation(s)
- Keisuke Sato
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Akihiro Asano
- Department of Medical Technology, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Tsutomu Kobayashi
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hiroshi Aoki
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Shinya Jinguji
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hiroki Seto
- Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hiroshi Demachi
- Department of Diagnostic Radiology, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| |
Collapse
|
12
|
Nishikawa A, Kakizawa Y, Wada N, Yamamoto Y, Katsuki M, Uchiyama T. Usefulness of Pointwise Encoding Time Reduction with Radial Acquisition and Subtraction-Based Magnetic Resonance Angiography after Cerebral Aneurysm Clipping. World Neurosurg X 2020; 9:100096. [PMID: 33426517 PMCID: PMC7776957 DOI: 10.1016/j.wnsx.2020.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/25/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Time-of-flight magnetic resonance angiography (MRA) is limited by clip-induced artifacts after cerebral aneurysmal clipping. Recently, ultrashort echo time was shown to reduce metal artifacts. We assessed the pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA as an ultrashort echo time method during follow-up for clipping surgery. Methods We retrospectively evaluated 114 branches of 63 aneurysms in 56 patients treated with titanium clips using MRA and 3-dimensional computed tomography angiography. The appearance using each method was compared, and the associations between visibility on PETRA-MRA, clip number and shape, and amount of hematoma were examined. Furthermore, the visibility of the aneurysm remnants and 2 clipping cases with cobalt-chromium-nickel-molybdenum clips were evaluated. Results No branches were visible using time-of-flight-MRA, but 79 of 114 branches (69.3%) were visible on PETRA-MRA. PETRA-MRA was effective for follow-up imaging in 33 of 63 aneurysms (52.4%). The median vessel diameters were 1.67 mm (interquartile range, 1.24–2.62 mm) and 0.96 mm (interquartile range, 0.59–1.53 mm) in the visible and invisible groups, respectively. Only the vessel diameter correlated significantly (P < 0.001) with the visibility on PETRA-MRA. A receiver operating characteristic curve for the association between the vessel diameter and visibility on PETRA-MRA showed a cutoff value of 1.26 mm for vessel diameter. Cobalt-chromium-nickel-molybdenum clips produced a strong artifact, even on PETRA-MRA. All 4 residual aneurysms were visible on PETRA-MRA. Conclusions PETRA-MRA can be useful for follow-up aneurysm imaging when the diameter of vessels adjacent to the clip exceeds 1.26 mm. However, its usefulness is limited to titanium clips.
Collapse
Affiliation(s)
- Akihiro Nishikawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yasunaga Yamamoto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Toshiya Uchiyama
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| |
Collapse
|
13
|
Howard BM, Hu R, Barrow JW, Barrow DL. Comprehensive review of imaging of intracranial aneurysms and angiographically negative subarachnoid hemorrhage. Neurosurg Focus 2020; 47:E20. [PMID: 31786554 DOI: 10.3171/2019.9.focus19653] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 11/06/2022]
Abstract
Intracranial aneurysms confer the risk of subarachnoid hemorrhage (SAH), a potentially devastating condition, though most aneurysms will remain asymptomatic for the lifetime of the patient. Imaging is critical to all stages of patient care for those who harbor an unruptured intracranial aneurysm (UIA), including to establish the diagnosis, to determine therapeutic options, to undertake surveillance in patients who elect not to undergo treatment or whose aneurysm(s) portends such a low risk that treatment is not indicated, and to perform follow-up after treatment. Neuroimaging is equally as important in patients who suffer an SAH. DSA remains the reference standard for imaging of intracranial aneurysms due to its high spatial and temporal resolution. As noninvasive imaging technology, such as CTA and MRA, improves, the diagnostic accuracy of such tests continues to increasingly approximate that of DSA. In cases of angiographically negative SAH, imaging protocols are necessary not only for diagnosis but also to search for an initially occult vascular lesion, such as a thrombosed, ruptured aneurysm that might be detected in a delayed fashion. Given the crucial role of neuroimaging in all aspects of care for patients with UIAs and SAH, it is incumbent on those who care for these patients, including cerebrovascular neurosurgeons, interventional neurologists and neuroradiologists, and diagnostic radiologists and neurointensivists, to understand the role of imaging in this disease and how individual members of the multispecialty team use imaging to ensure best practices to deliver cutting-edge care to these often complex cases. This review expounds on the role of imaging in the management of UIAs and ruptured intracranial aneurysms and in the workup of angiographically negative subarachnoid hemorrhage.
Collapse
Affiliation(s)
- Brian M Howard
- 1Department of Neurosurgery, and.,2Department of Radiology and Imaging Sciences, Division of Interventional Neuroradiology, Emory University School of Medicine, Atlanta; and
| | - Ranliang Hu
- 2Department of Radiology and Imaging Sciences, Division of Interventional Neuroradiology, Emory University School of Medicine, Atlanta; and
| | - Jack W Barrow
- 3Mercer University School of Medicine, Savannah, Georgia
| | | |
Collapse
|
14
|
Grossberg JA, Howard BM, Saindane AM. The use of contrast-enhanced, time-resolved magnetic resonance angiography in cerebrovascular pathology. Neurosurg Focus 2020; 47:E3. [PMID: 31786556 DOI: 10.3171/2019.9.focus19627] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/06/2022]
Abstract
Digital subtraction angiography (DSA) has long been the imaging gold standard in the evaluation, treatment, and follow-up of cerebro- and spinovascular disorders. However, DSA has the disadvantages of invasiveness, contrast allergy or nephropathy, the impracticality of procedural preparation and recovery, and expense. Contrast-enhanced (CE), time-resolved (TR) magnetic resonance angiography (CE TR-MRA) is a sophisticated, relatively novel imaging modality that provides multiphasic contrast-enhanced visualization of the neurovasculature. Given the crucial role of angiography in all aspects of care for patients with complex neurovascular disorders, it is incumbent on those who care for these patients to understand the usefulness and pitfalls of novel imaging in this arena to ensure best practices, and to deliver cutting edge care to these patients in a way that minimizes cost, but does not compromise quality. CE TR-MRA has the potential to play an expanded role in the workup and follow-up across the spectrum of neurovascular disease, and this review is aimed to help neurosurgeons better understand how CE TR-MRA can be used to better manage patients in this cohort.
Collapse
Affiliation(s)
| | - Brian M Howard
- Departments of1Neurosurgery and.,2Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Amit M Saindane
- 2Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
15
|
Diagnostic Value of Low-Dose 256-Slice Spiral CT Angiography, MR Angiography, and 3D-DSA in Cerebral Aneurysms. DISEASE MARKERS 2020; 2020:8536471. [PMID: 32399089 PMCID: PMC7201482 DOI: 10.1155/2020/8536471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the diagnostic value of low-dose 256-slice CT angiography (CTA), MR angiography (MRA), and three dimensional-digital subtraction angiography (3D-DSA) in cerebral aneurysms. Methods CTA, MRA, and 3D-DSA were performed in all enrolled patients to explore the diagnostic significance of the three different examinations. Results There were 92 aneurysms confirmed during DSA and surgery in 79 patients. The diagnostic coincidence rates of DSA, CTA, and MRA were 96.7%, 89.1%, and 86%, respectively. The diagnostic coincidence rates of CTA and MRA were lower than those of DSA. The detection rate of CTA for aneurysms less than 3 mm in diameter was higher than that of MRA. Conclusion CTA, DSA, and MRA have their own advantages and disadvantages in the diagnosis of cerebral aneurysms. They all have the diagnostic value for aneurysms.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Murakami T, Nishida T, Asai K, Kadono Y, Nakamura H, Fujinaka T, Kishima H. Long-Term Results and Follow-Up Examinations after Endovascular Embolization for Unruptured Cerebral Aneurysms. AJNR Am J Neuroradiol 2019; 40:1191-1196. [PMID: 31248865 DOI: 10.3174/ajnr.a6101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The appropriate period of follow-up examinations after endovascular embolization for cerebral aneurysms using time-of-flight MR angiography is not well-known. We retrospectively investigated long-term results after endovascular embolization for unruptured cerebral aneurysms and evaluated the periods from embolization to recanalization and retreatment. MATERIALS AND METHODS Between April 2006 and March 2011, one hundred forty-eight unruptured aneurysms were treated with endovascular coil embolization. Among them, we investigated 116 unruptured aneurysms, which were followed up for >5 years. Time-of-flight MR angiography was performed at 1 day, 3-6 months, 1 year after the procedure, and every year thereafter. RESULTS The mean follow-up period was 7.0 ± 1.4 years. Recanalization was observed in 19 (16.3%) aneurysms within 2 years. Among them, retreatment for recanalization was performed in 8 (6.8%) aneurysms. No recanalization was detected in any aneurysms that had been stable in the first 2 years after embolization. A larger maximum aneurysm size was significantly correlated with recanalization (P = .019). CONCLUSIONS Aneurysms in which recanalization was not observed within 2 years after endovascular coil embolization were stable during a mean follow-up of 7 years. This result may be helpful in considering the appropriate span or frequency of follow-up imaging for embolized cerebral aneurysms.
Collapse
Affiliation(s)
- T Murakami
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Neurosurgery (T.M.), Osaka Neurological Institute, Osaka, Japan
| | - T Nishida
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - K Asai
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Kadono
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - H Nakamura
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Fujinaka
- Department of Neurosurgery (T.F.), Osaka National Hospital, Osaka, Japan
| | - H Kishima
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
18
|
Oishi H, Fujii T, Suzuki M, Takano N, Teranishi K, Yatomi K, Kitamura T, Yamamoto M, Aoki S, Arai H. Usefulness of Silent MR Angiography for Intracranial Aneurysms Treated with a Flow-Diverter Device. AJNR Am J Neuroradiol 2019; 40:808-814. [PMID: 31048297 DOI: 10.3174/ajnr.a6047] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The flow-diverter device has been established as a treatment procedure for large unruptured intracranial aneurysms. The purpose of this study was to compare the usefulness of Silent MR angiography and time-of-flight MRA to assess the parent artery and the embolization state of the aneurysm after a flow-diverter placement. MATERIALS AND METHODS Seventy-eight large, unruptured internal carotid aneurysms in 78 patients were the subjects of this study. After 6 months of treatment, they underwent follow-up digital subtraction angiography, Silent MRA, and TOF-MRA, performed simultaneously. All images were independently reviewed by 2 neurosurgeons and 1 radiologist and rated on a 4-point scale from 1 (not visible) to 4 (excellent) to evaluate the parent artery. The aneurysmal embolization status was assessed with 2 ratings: complete or incomplete occlusion. RESULTS The mean scores of Silent MRA and TOF-MRA regarding the parent artery were 3.18 ± 0.72 and 2.31 ± 0.86, respectively, showing a significantly better score with Silent MRA (P < .01). In the assessment of the embolization of aneurysms on Silent MRA and TOF-MRA compared with DSA, the percentages of agreement were 91.0% and 80.8%, respectively. CONCLUSIONS Silent MRA is superior for visualizing blood flow images inside flow-diverter devices compared with TOF-MRA. Furthermore, Silent MRA enables the assessment of aneurysmal embolization status. Silent MRA is useful for assessing the status of large and giant unruptured internal carotid aneurysms after flow-diverter placement.
Collapse
Affiliation(s)
- H Oishi
- From the Departments of Neuroendovascular Therapy (H.O., T.F., T.K.)
- Neurosurgery (H.O., K.T., K.Y., M.Y., H.A.)
| | - T Fujii
- From the Departments of Neuroendovascular Therapy (H.O., T.F., T.K.)
| | - M Suzuki
- Radiology (M.S., N.T., S.A.), Juntendo University Faculty of Medicine, Tokyo, Japan
| | - N Takano
- Radiology (M.S., N.T., S.A.), Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - K Yatomi
- Neurosurgery (H.O., K.T., K.Y., M.Y., H.A.)
| | - T Kitamura
- From the Departments of Neuroendovascular Therapy (H.O., T.F., T.K.)
| | - M Yamamoto
- Neurosurgery (H.O., K.T., K.Y., M.Y., H.A.)
| | - S Aoki
- Radiology (M.S., N.T., S.A.), Juntendo University Faculty of Medicine, Tokyo, Japan
| | - H Arai
- Neurosurgery (H.O., K.T., K.Y., M.Y., H.A.)
| |
Collapse
|
19
|
Heo YJ, Jeong HW, Baek JW, Kim ST, Jeong YG, Lee JY, Jin SC. Pointwise Encoding Time Reduction with Radial Acquisition with Subtraction-Based MRA during the Follow-Up of Stent-Assisted Coil Embolization of Anterior Circulation Aneurysms. AJNR Am J Neuroradiol 2019; 40:815-819. [PMID: 30975655 DOI: 10.3174/ajnr.a6035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Time-of-flight MR angiography, though widely used after coil embolization, is associated with limitations owing to magnetic susceptibility and radiofrequency shielding following stent-assisted coil embolization. We evaluated the pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA (qMRA) using an ultrashort TE relative to TOF-MRA during the follow-up of stent-assisted coil embolization for anterior circulation aneurysms. MATERIALS AND METHODS Twenty-five patients (3 men and 22 women; mean age, 59.1 ± 14.0 years) underwent stent-assisted coil embolization for anterior circulation aneurysms and were retrospectively evaluated using TOF-MRA and PETRA qMRA data from the same follow-up session. Two neuroradiologists independently reviewed both MRA findings and subjectively graded flow within the stents (relative to the latest DSA findings) and occlusion status (complete occlusion or neck/aneurysm remnant). Interobserver and intermodality agreement for TOF-MRA and PETRA qMRA were evaluated. RESULTS The mean score for flow visualization within the stents was significantly higher in PETRA qMRA than in TOF-MRA (P < .001 for both observers), and good interobserver agreement was reported (κ = 0.63). The aneurysm occlusion status of PETRA qMRA (observer 1, 92.0%; observer 2, 88.0%) was more consistent with DSA than with TOF-MRA (observer 1, 76.0%; observer 2, 80.0%), and there was a better intermodality agreement between DSA and PETRA qMRA than between DSA and TOF-MRA. CONCLUSIONS These findings indicate that PETRA qMRA is a useful follow-up technique for patients who have undergone stent-assisted coil embolization for anterior circulation aneurysms.
Collapse
Affiliation(s)
- Y J Heo
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - H W Jeong
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - J W Baek
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - S T Kim
- Neurosurgery (S.T.K., Y.G.J.)
| | | | - J Y Lee
- Internal Medicine (J.Y.L.), Inje University Busan Paik Hospital, Busan, Korea
| | - S-C Jin
- Department of Neurosurgery (S.-C.J.), Inje University Haeundae Paik Hospital, Busan, Korea
| |
Collapse
|
20
|
Zhu Y, Zhang H, Zhang Y, Wu H, Wei L, Zhou G, Zhang Y, Deng L, Cheng Y, Li M, Santos HA, Cui W. Endovascular Metal Devices for the Treatment of Cerebrovascular Diseases. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1805452. [PMID: 30589125 DOI: 10.1002/adma.201805452] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/20/2018] [Indexed: 06/09/2023]
Abstract
Cerebrovascular disease involves various medical disorders that obstruct brain blood vessels or deteriorate cerebral circulation, resulting in ischemic or hemorrhagic stroke. Nowadays, platinum coils with or without biological modification have become routine embolization devices to reduce the risk of cerebral aneurysm bleeding. Additionally, many intracranial stents, flow diverters, and stent retrievers have been invented with uniquely designed structures. To accelerate the translation of these devices into clinical usage, an in-depth understanding of the mechanical and material performance of these metal-based devices is critical. However, considering the more distal location and tortuous anatomic characteristics of cerebral arteries, present devices still risk failing to arrive at target lesions. Consequently, more flexible endovascular devices and novel designs are under urgent demand to overcome the deficiencies of existing devices. Herein, the pros and cons of the current structural designs are discussed when these devices are applied to the treatment of diseases ranging broadly from hemorrhages to ischemic strokes, in order to encourage further development of such kind of devices and investigation of their use in the clinic. Moreover, novel biodegradable materials and drug elution techniques, and the design, safety, and efficacy of personalized devices for further clinical applications in cerebral vasculature are discussed.
Collapse
Affiliation(s)
- Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hongbo Zhang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Yiran Zhang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Huayin Wu
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Gen Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Yuezhou Zhang
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Minghua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014, Helsinki, Finland
- Helsinki Institute of Life Science, University of Helsinki, FI-00014, Helsinki, Finland
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| |
Collapse
|
21
|
Akatsu T, Ishimori Y, Kobayashi T, Miyamoto K. [Imaging Parameter Optimization of Non-contrast Three-dimensional Time-of-flight Magnetic Resonance Angiography for Patients with Intracranial Stents Using a 1.5 T Magnetic Resonance Imaging System]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:1437-1445. [PMID: 31866642 DOI: 10.6009/jjrt.2019_jsrt_75.12.1437] [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] [Indexed: 06/10/2023]
Abstract
The imaging parameters of non-contrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) were optimized to improve the image quality for patients treated using stent-assisted coiling. A simulated blood flow phantom with three types of stents (Enterprise 2, Neuroform Atlas, and LVIS) was imaged by changing echo time (TE), band width (BW), flip angle (FA), and matrix (phase, frequency). The difference between the signal intensity in the simulated vessel and the background was measured at each imaging condition. The ratio of this difference with and without the stent was evaluated as the relative in-stent signal (RIS). In addition, the error ratio of the stent lumen diameter was assessed by comparing the full width at half maximum (FWHM) to that measured by 3D X-ray angiography. The RIS was higher in order of LVIS, Neuroform Atlas, and Enterprise 2 in all conditions. The RIS was higher in imaging conditions with short TE, narrow BW, high FA, and large phase matrix. The highest RIS was seen with a frequency matrix of 320 in the Enterprise 2 and 256 in the others. FWHM error ratio was smaller in the same order as the RIS. FWHM error ratio was smaller in imaging conditions with short TE, large frequency matrix (>384), large phase matrix (>224), and high FA (>20°). Imaging conditions of 3D TOF-MRA that were effective to improve the image quality for stent lumen evaluation were short TE and high spatial resolution.
Collapse
Affiliation(s)
- Toshiya Akatsu
- Department of Radiological Technology, Tsukuba Medical Center Hospital
- Department of Radiological Sciences, Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences
| | - Yoshiyuki Ishimori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences
| | - Tomoya Kobayashi
- Department of Radiological Technology, Tsukuba Medical Center Hospital
| | - Katsumi Miyamoto
- Department of Radiological Technology, Tsukuba Medical Center Hospital
| |
Collapse
|
22
|
Kim S, Kang M, Kim DW, Choi JH. Usefulness of Vessel Wall MR Imaging for Follow-Up after Stent-Assisted Coil Embolization of Intracranial Aneurysms. AJNR Am J Neuroradiol 2018; 39:2088-2094. [PMID: 30262640 DOI: 10.3174/ajnr.a5824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Follow-up with MRA for intracranial aneurysms after stent-assisted coiling is complicated by imaging artifacts. We evaluated the usefulness of an alternative method: vessel wall MR imaging. MATERIALS AND METHODS We conducted a single-center, retrospective review of medical records of 47 patients who underwent 3D TOF-MRA, vessel wall MRI, and DSA after stent-assisted coiling between March 2016 and January 2018. We evaluated the mean value of the signal intensity in the stented artery and the contralateral normal artery on vessel wall MRI. The quality of visualization was further compared between TOF-MRA and vessel wall MRI. Furthermore, we evaluated the diagnostic accuracy and concordance rate of TOF-MRA and vessel wall MRI for assessing the patency of the stented parent artery. DSA was used as a reference test. RESULTS The mean signal intensities of the stented and normal arteries on vessel wall MRI were not significantly different (P = .133). The mean scores for the visualization of the stented parent artery on vessel wall MRI were significantly superior to those of TOF-MRA images (P < .001). Vessel wall MRI reached an excellent positive predictive value (100%). However, TOF-MRA had a poor positive predictive value (11%; 95% CI, 9%-12%). The likelihood ratios of vessel wall MRI and TOF-MRA were 27.36 (P < .001) and 2.98 (P = .225), respectively. The concordance rate of vessel wall MRI and TOF-MRA with DSA for evaluating the state of the stented artery was 100% (κ = 1) and 28% (κ = 0.038), respectively. CONCLUSIONS Vessel wall MRI may be useful in evaluating the patency of stented arteries after stent-assisted coil embolization for intracranial aneurysms.
Collapse
Affiliation(s)
- S Kim
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - M Kang
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - D W Kim
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - J-H Choi
- Neurosurgery (J.-H.C.), Dong-A University Medical Center, Busan, Korea
| |
Collapse
|
23
|
Ikemura A, Yuki I, Suzuki H, Suzuki T, Ishibashi T, Abe Y, Urashima M, Dahmani C, Murayama Y. Time-resolved magnetic resonance angiography (TR-MRA) for the evaluation of post coiling aneurysms; A quantitative analysis of the residual aneurysm using full-width at half-maximum (FWHM) value. PLoS One 2018; 13:e0203615. [PMID: 30192859 PMCID: PMC6128576 DOI: 10.1371/journal.pone.0203615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance image (MRI) is now widely used for imaging follow-up for post coiling brain aneurysms. However, the accuracy on the estimation of residual aneurysm, which is crucial for the retreatment planning, remains to be controversial. The purpose of this study is to evaluate a new post-processing technique that provides improved estimation of the residual aneurysm after coil embolization. One hundred aneurysms on 93 patients who underwent coil embolization for brain aneurysm were evaluated using the 1.5 Tesla time-resolved magnetic resonance angiography (TR-MRA) one year after the treatment. To minimize the inter-observer variability caused by the window level adjustment, an automatic post processing protocol using the full-width at half-maximum (FWHM) value was utilized. The result was then compared with that from the conventional cerebral angiography. Of the 97 aneurysms that underwent both TR-MRA and DSA, 23 (23.7%) showed residual neck / dome during follow-up. After window level adjustment, the size of the parent artery in the TR-MRA was consistent with that in the DSA. The reconstructed Volume Rendering images provided clear contours of the residual aneurysms and contributed to the understanding the configuration of residual aneurysm. The largest and the smallest diameter of the residual aneurysms was larger in the TR-MRA than in the DSA (8.05 vs. 7.72 mm, p = 0.0004; 4.99 vs. 4.19 mm, p = 0.007 respectively). The sensitivity, specificity, and positive and negative predictive values of TR-MRA compared to DSA were 100%, 97%, 73%, and 100%, respectively. Using the FWHM value to optimize the window level adjustment, the size of the residual component observed in the TR-MRA was larger compared to that in the DSA whereas the size of neck and the parent artery showed consistency between the two modalities. This image processing technique can be used as an effective screening tool for evaluating residual component in post-coiling brain aneurysms.
Collapse
Affiliation(s)
- Ayako Ikemura
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | - Ichiro Yuki
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
- * E-mail:
| | - Hiroaki Suzuki
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - Tomoaki Suzuki
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | | | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - Mitsuyoshi Urashima
- Department of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| |
Collapse
|
24
|
Akkaya S, Akca O, Arat A, Peker A, Balci S. Usefulness of contrast-enhanced and TOF MR angiography for follow-up after low-profile stent-assisted coil embolization of intracranial aneurysms. Interv Neuroradiol 2018; 24:655-661. [PMID: 29976108 DOI: 10.1177/1591019918785910] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Low-profile, self-expandable stents are used to treat wide-neck aneurysms located on the smaller distal intracranial arteries. This study aimed to assess the usefulness of time-of-flight (TOF) and contrast-enhanced (CE) magnetic resonance angiography (MRA) for follow-up after LEO Baby stent (LBS)-assisted coil embolization. METHODS Twenty-four aneurysms treated with LBS-assisted coil embolization were evaluated. Researchers reviewed TOF MRA and CE MRA images in terms of occlusion and stent patency. Aneurysm occlusion was graded according to Raymond-Roy classification as follows: total occlusion (grade 1), residual neck (grade 2), and residual aneurysm (grade 3). Stent patency was scored as follows: occlusion (1), stenosis (2), and normal (3). Interobserver and intermodality agreement values were determined by weighted kappa (κ) statistics. RESULTS Intermodality and interobserver values of TOF MRA and CE MRA with digital subtraction angiography (DSA) were perfect (κ = 1.00, p < 0.001) in terms of aneurysm occlusion. Rate of stent occlusion and stenosis in DSA, TOF, and MRA, respectively, were as follows: 0 and 12.5%, 16.6 and 70.8%, and 0 and 62.5%. Intermodality agreement values of TOF MRA and CE MRA with DSA were insignificant in terms of stent patency (κ = 0.065, p = 0.27; κ = 0.158, p = 0.15, respectively). Interobserver agreement was substantial in both TOF MRA (κ = 0.71, p < 0.001) and CE MRA (κ = 0.64, p = 0.001). CONCLUSIONS Both TOF and CE MRA techniques have strong concordance with DSA for the detection of aneurysm occlusion status. CE MRA can be used as a first-line noninvasive imaging modality due to its superiority to TOF MRA with respect to the visualization of in-stent signals.
Collapse
Affiliation(s)
- Selcuk Akkaya
- 1 Department of Radiology, Kaçkar State Hospital, Rize, Turkey
| | - Onur Akca
- 2 Department of Radiology, Güven Hospital, Ankara, Turkey
| | - Anıl Arat
- 3 Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Ahmet Peker
- 3 Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Sinan Balci
- 4 Department of Radiology, Artvin State Hospital, Artvin, Turkey
| |
Collapse
|
25
|
Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation. Pol J Radiol 2018; 83:e137-e142. [PMID: 30038691 PMCID: PMC6047089 DOI: 10.5114/pjr.2018.75622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/29/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study is to assess the feasibility and usefulness of time-resolved magnetic resonance angiography (TR-MRA) for follow-up of visceral artery aneurysms (VAAs) after embolotherapy. Material and methods Twenty-one VAAs (11 splenic, six renal, three internal iliac, and one superior pancreaticoduodenal artery aneurysms) in 18 patients (median age, 64 years; range, 36-88 years) previously treated by embolisation with platinum coils, were evaluated. The mean size of the aneurysm was 10.5 cm3 (range, 0.3-132 cm3). Among them, 19 lesions were treated by aneurysmal packing with or without distal-to-proximal embolisation. For the remaining two lesions, distal-to-proximal embolization alone was performed. The mean observation period after embolotherapy was 35 weeks (range, 4-216). All patients underwent TR-MRA following an intravenous bolus injection of gadolinium chelate. Recanalisation was diagnosed when any portion of the aneurysmal sac was enhanced in the arterial phase. Results On TR-MRA, two lesions were diagnosed as recanalised. They were confirmed by transcatheter arteriography and re-treated by embolotherapy. For the remaining 19 lesions, there were no findings of recanalisation on TR-MRA. Conclusions TR-MRA appears to be a feasible method for follow-up examination of VAAs treated by embolotherapy.
Collapse
|
26
|
Lin A, Rawal S, Agid R, Mandell DM. Cerebrovascular Imaging: Which Test is Best? Neurosurgery 2017; 83:5-18. [DOI: 10.1093/neuros/nyx325] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 05/12/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
Optimal diagnosis and characterization of cerebrovascular disease requires selection of the appropriate imaging exam for each clinical situation. In this review, we focus on intracranial arterial disease and discuss the techniques in current clinical use for imaging the blood vessel lumen and blood vessel wall, and for mapping cerebral hemodynamic impairment at the tissue level. We then discuss specific strategies for imaging intracranial aneurysms, arteriovenous malformations, dural arterial venous fistulas, and arterial steno-occlusive disease.
Collapse
Affiliation(s)
- Amy Lin
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Sapna Rawal
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Mandell
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
27
|
Takano N, Suzuki M, Irie R, Yamamoto M, Teranishi K, Yatomi K, Hamasaki N, Kumamaru KK, Hori M, Oishi H, Aoki S. Non-Contrast-Enhanced Silent Scan MR Angiography of Intracranial Anterior Circulation Aneurysms Treated with a Low-Profile Visualized Intraluminal Support Device. AJNR Am J Neuroradiol 2017; 38:1610-1616. [PMID: 28522664 DOI: 10.3174/ajnr.a5223] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Low-Profile Visualized Intraluminal Support Device comprises a small-cell nitinol structure and a single-wire braided stent that provides greater metal coverage than previously reported intracranial stents, as well as assumed strong susceptibility artifacts. This study aimed to assess the benefits of non-contrast-enhanced MRA by using a Silent Scan (Silent MRA) for intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents. MATERIALS AND METHODS Thirty-one aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents were assessed by using Silent MRA, 3D TOF-MRA, and x-ray DSA. The quality of MRA visualization of the reconstructed artery was graded on a 4-point scale from 1 (not visible) to 4 (excellent). Aneurysm occlusion status was evaluated by using a 2-grade scale (total occlusion/remnant [neck or aneurysm]). Weighted κ statistics were used to evaluate interobserver and intermodality agreement. RESULTS The mean scores ± SDs for Silent MRA and 3D TOF-MRA were 3.16 ± 0.79 and 1.48 ± 0.67 (P < .05), respectively, with substantial interobserver agreement (κ = 0.66). The aneurysm occlusion rates of the 2-grade scale (total occlusion/remnant [neck or aneurysm]) were 69%/31% for DSA, 65%/35% for Silent MRA, and 92%/8% for 3D TOF-MRA, respectively. The intermodality agreements were 0.88 and 0.30 for DSA/Silent MRA and DSA/3D TOF-MRA, respectively. CONCLUSIONS Silent MRA seems to be useful for visualizing intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents.
Collapse
Affiliation(s)
- N Takano
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan .,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Suzuki
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - R Irie
- Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Yamamoto
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - K Teranishi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - K Yatomi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - N Hamasaki
- Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K K Kumamaru
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Hori
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - H Oishi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.).,Neuroendovascular Therapy (H.O.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Aoki
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| |
Collapse
|
28
|
Bak SH, Roh HG, Moon WJ, Choi JW, An HS. Appropriate Minimal Dose of Gadobutrol for 3D Time-Resolved MRA of the Supra-Aortic Arteries: Comparison with Conventional Single-Phase High-Resolution 3D Contrast-Enhanced MRA. AJNR Am J Neuroradiol 2017; 38:1383-1390. [PMID: 28473338 DOI: 10.3174/ajnr.a5176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/13/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The development of nephrogenic systemic fibrosis and neural tissue deposition is gadolinium dose-dependent. The purpose of this study was to determine the appropriate minimal dose of gadobutrol with time-resolved MRA to assess supra-aortic arterial stenosis with contrast-enhanced MRA as a reference standard. MATERIALS AND METHODS Four hundred sixty-two consecutive patients underwent both standard-dose contrast-enhanced MRA and low-dose time-resolved MRA and were classified into 3 groups; group A (a constant dose of 1 mL for time-resolved MRA), group B (2 mL), or group C (3 mL). All studies were independently evaluated by 2 radiologists for image quality by using a 5-point scale (from 0 = failure to 4 = excellent), grading of arterial stenosis (0 = normal, 1 = mild [<30%], 2 = moderate [30%-69%], 3 = severe to occlusion [≥70%]), and signal-to-noise ratio. RESULTS The image quality of time-resolved MRA was similar to that of contrast-enhanced MRA in groups B and C, but it was inferior to contrast-enhanced MRA in group A. For the grading of arterial stenosis, there was an excellent correlation between contrast-enhanced MRA and time-resolved MRA (R = 0.957 for group A, R = 0.988 for group B, R = 0.991 for group C). The SNR of time-resolved MRA tended to be lower than that of contrast-enhanced MRA in groups A and B. However, SNR was higher for time-resolved MRA compared with contrast-enhanced MRA in group C. CONCLUSIONS Low-dose time-resolved MRA is feasible in the evaluation of supra-aortic stenosis and could be used as an alternative to contrast-enhanced MRA for a diagnostic technique in high-risk populations.
Collapse
Affiliation(s)
- S H Bak
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.,Department of Radiology (S.H.B.), Kangwon National University Hospital, Chuncheon, Korea
| | - H G Roh
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - W-J Moon
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - J W Choi
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - H S An
- Department of Radiology (H.S.A.), Armed Forces Yangju Hospital, Yangju, Korea
| |
Collapse
|
29
|
Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography. J Neuroradiol 2017; 44:44-51. [DOI: 10.1016/j.neurad.2016.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
|
30
|
Takano N, Suzuki M, Irie R, Yamamoto M, Hamasaki N, Kamagata K, Kumamaru KK, Hori M, Oishi H, Aoki S. Usefulness of Non-Contrast-Enhanced MR Angiography Using a Silent Scan for Follow-Up after Y-Configuration Stent-Assisted Coil Embolization for Basilar Tip Aneurysms. AJNR Am J Neuroradiol 2016; 38:577-581. [PMID: 28007767 DOI: 10.3174/ajnr.a5033] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Y-configuration stent-assisted coil embolization is used for treating wide-neck aneurysms. Noninvasive alternatives to x-ray DSA for follow-up after Y-configuration stent-assisted coil embolization treatment are required. This study aimed to assess the usefulness of non-contrast-enhanced MRA by using a Silent Scan (silent MRA) for follow-up after Y-configuration stent-assisted coil embolization for basilar tip aneurysms. MATERIALS AND METHODS Seven patients treated with Y-configuration stent-assisted coil embolization for basilar tip aneurysms underwent silent MRA, 3D TOF-MRA, and DSA. Silent MRA and 3D TOF-MRA images were obtained during the same scan session on a 3T MR imaging system. Two neuroradiologists independently reviewed both types of MRA images and subjectively scored the flow in the stents on a scale of 1 (not visible) to 5 (nearly equal to DSA) by referring to the latest DSA image as a criterion standard. Furthermore, we evaluated the visualization of the neck remnant. RESULTS In all patients, the 2 observers gave a higher score for the flow in the stents on silent MRA than on 3D TOF-MRA. The average score ± standard deviation was 4.07 ± 0.70 for silent MRA and 1.93 ± 0.80 (P < .05) for 3D TOF-MRA. Neck remnants were depicted by DSA in 5 patients. In silent MRA, neck remnants were depicted in 5 patients, and visualization was similar to DSA; however, in 3D TOF-MRA, neck remnants were depicted in only 1 patient. CONCLUSIONS Silent MRA might be useful for follow-up after Y-configuration stent-assisted coil embolization.
Collapse
Affiliation(s)
- N Takano
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan .,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Suzuki
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - R Irie
- Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Yamamoto
- Departments of Neurosurgery (M.Y., H.O.)
| | - N Hamasaki
- Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K Kamagata
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K K Kumamaru
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Hori
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - H Oishi
- Departments of Neurosurgery (M.Y., H.O.).,Neuroendovascular Therapy (H.O.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Aoki
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| |
Collapse
|
31
|
Thamburaj K, Cockroft K, Agarwal AK, Sabat S, Kalapos P. A Comparison of Magnetic Resonance Angiography Techniques for the Evaluation of Intracranial Aneurysms Treated With Stent-assisted Coil Embolization. Cureus 2016; 8:e909. [PMID: 28083453 PMCID: PMC5208631 DOI: 10.7759/cureus.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To identify the effective magnetic resonance angiography (MRA) technique to monitor intracranial aneurysms treated with stent-assisted coiling. MATERIALS AND METHODS Retrospective analysis of various MRA techniques was performed in 42 patients. Three neuroradiologists independently compared non-contrast time of flight (ncTOF) MRA of the head, contrast-enhanced time of flight (cTOF) MRA of the head and dynamic contrast-enhanced MRA (CEMRA) of the head and neck or of the head. Digital subtraction angiography (DSA) was available for comparison in 32 cases. Inter-rater agreement (kappa statistic) was assessed. RESULTS Artifactual in-stent severe stenosis or flow gap was identified by ncTOF MRA in 23 of 42 cases (55%) and by cTOF MRA in 23 of 38 cases (60%). DSA excluded in-stent stenosis or occlusion in all 32 cases. No difference was noted between ncTOF and cTOF in the demonstration of neck remnants or residual aneurysms in three cases each. CEMRA of the head and neck or of the head was rated superior to ncTOF and cTOF MRA by all three investigators in seven out of eight cases. In one case, all three techniques demonstrated signifcant artifacts due to double stent placement during coiling. The kappa statistic revealed 0.8 agreement between investigators. CONCLUSIONS In the assessment of stent-assisted coiling of intracranial aneurysm, both ncTOF and cTOF MRA show similar results. CEMRA tends to show better flow signals in stent and residual aneurysm.
Collapse
Affiliation(s)
| | - Kevin Cockroft
- Department of Neurosurgery, Penn State Hershey Medical Center
| | - Amit K Agarwal
- Department of Radiology, Penn State Hershey Medical Center
| | - Shyam Sabat
- Department of Radiology, Penn State Hershey Medical Center
| | - Paul Kalapos
- Department of Radiology, Penn State Hershey Medical Center
| |
Collapse
|
32
|
Kawai T, Shimohira M, Ohta K, Hashizume T, Muto M, Suzuki K, Kurosaka K, Shibamoto Y. The Role of Time-Resolved MRA for Post-treatment Assessment of Pulmonary Arteriovenous Malformations: A Pictorial Essay. Cardiovasc Intervent Radiol 2016; 39:965-72. [PMID: 26983704 DOI: 10.1007/s00270-016-1325-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/07/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Takuya Hashizume
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Masahiro Muto
- Department of Radiology, Nagoya City East Medical Center, 1-2-23 Wakamizu, Chikusa Ward, Nagoya, 464-0071, Japan
| | - Kazushi Suzuki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kenichiro Kurosaka
- Department of Radiology, Kariya-Toyota General Hospital, 5-15 Sumiyosi-cho, Kariya, Aichi Prefecture, 448-8505, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| |
Collapse
|
33
|
Ghinda D, Dos Santos MP, Sabri A, Iancu D, Lum C, Lesiuk HJ. Clinical and angiographic outcomes of stent-assisted coiling of intracranial aneurysms. Interv Neuroradiol 2015; 21:146-54. [PMID: 25953772 DOI: 10.1177/1591019915582152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the increasing use of stent-assisted coiling (SAC), data on its long-term clinical and angiographic results are limited. OBJECTIVE The objective of this article is to assess the long-term clinical and angiographic outcomes in SAC in our single-center practice. METHODS We conducted a retrospective analysis of intracranial aneurysms treated with detachable coils during the period 2003-2012. Patients were divided into SAC and non-SAC groups and were analyzed for aneurysm occlusion, major recurrence and clinical outcome. Logistic regression analyses identified factors associated with clinical/angiographic outcomes (p value <0.05 was statistically significant). RESULTS A total of 516 procedures met inclusion criteria: Sixty-three (12.2%) patients underwent SAC, of whom 56 (89%) had an elective procedure whereas 286 (63.1%) aneurysms from the non-SAC group were ruptured. In the unruptured subcohort, baseline class I was achieved in 24 (38%, p = 0.91), and predischarge modified Rankin scale score (mRS) 0-2 was obtained in 96.4% of cases in the SAC group versus 90.4% in the non-stent group. The major recurrence was 9.5% versus 11.3% in the SAC and non-SAC group, respectively (p = 0.003). At last clinical assessment, 98.2% of the patients from the unruptured SAC group had mRS 0-2 (mean follow-up, 58 months) versus 93.6% (mean follow-up, 56 months) in the unruptured non-SAC group (p = 0.64). Periprocedural vasospasm was associated with long-term poor outcome in the unruptured SAC subcohort (p = 0.0008). CONCLUSIONS SAC and non-SCA techniques show comparable safety and clinical outcome. The SAC technique significantly decreases retreatment rates. Periprocedural vasospasm resulting from vessel manipulation is associated with poor outcome in SAC of unruptured aneurysms.
Collapse
Affiliation(s)
- Diana Ghinda
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Canada
| | - Marlise Peruzzo Dos Santos
- Neuroradiology Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada
| | - Armin Sabri
- Department of Medical Imaging, University of Ottawa, Canada
| | - Daniela Iancu
- Neuroradiology Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada
| | - Cheemun Lum
- Neuroradiology Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada
| | - Howard J Lesiuk
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Canada
| |
Collapse
|
34
|
Oh HH, Jung C, Lee TH, Kwon BJ, Kim Y, Lee KC. Will Fluoroscopic Follow-up after Stent-Assisted Coiling of Cerebral Aneurysms Provide Information on Recanalization? Interv Neuroradiol 2014; 20:693-703. [PMID: 25496679 DOI: 10.15274/inr-2014-10062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/10/2014] [Indexed: 11/12/2022] Open
Abstract
Fluoroscopic images for comparison (FICs) can be easily obtained for follow-up on an outpatient basis. This study retrospectively assessed the diagnostic performance of a set of FICs for evaluation of recanalization after stent-assisted coiling, with digital subtraction angiography (DSA) as the reference standard. A total of 124 patients harboring 144 stent-assisted coiled aneurysms were included. At least one month postembolization they underwent follow-up angiograms comprising a routine frontal and lateral DSA and a working-angle DSA. For analysis, FICs should be compared with the mask images of postprocedural DSAs to find recanalization. Instead of FIC acquisition, the mask images of follow-up DSAs were taken as a substitute because of the same view-making processes as FICs, full availability, and perfect coincidence with follow-up DSAs. Two independent readers evaluated a set of 169 FICs and DSA images for the presence of recanalization one month apart. Sensitivity, specificity, and interreader agreement were determined. Recanalization occurred in 24 (14.2%) cases. Of these, nine (5.3%) cases were found to have significant recanalization in need of retreatment. Sensitivity and specificity rates were 79.2% (19 of 24) and 95.9% (139 of 145) respectively for reader 1, and 66.7% (16 of 24) and 97.9% (142 of 145) for reader 2. Minimal recanalization was identified in seven out of all eight false negative cases. Excluding minimally recanalized cases in no need for retreatment from the recanalization group, calculation resulted in high sensitivity and specificity of over 94% for both readers. Interreader agreement between the two readers was excellent (96.4%; κ = 0.84). FICs may be a good imaging modality to detect significant recanalization of stent-assisted coiled aneurysms.
Collapse
Affiliation(s)
- Hyun Ho Oh
- Department of Neurosurgery, Myongji Hospital; Goyang, South Korea -
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital; Seongnam, South Korea
| | - Tae Hong Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital; Pusan, South Korea
| | - Bae Ju Kwon
- Department of Radiology, Myongji Hospital; Goyang, South Korea
| | - Young Kim
- Department of Neurosurgery, Myongji Hospital; Goyang, South Korea
| | - Kyu Chang Lee
- Department of Neurosurgery, Myongji Hospital; Goyang, South Korea
| |
Collapse
|
35
|
Attali J, Benaissa A, Soize S, Kadziolka K, Portefaix C, Pierot L. Follow-up of intracranial aneurysms treated by flow diverter: comparison of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MR angiography (CE-MRA) sequences with digital subtraction angiography as the gold standard. J Neurointerv Surg 2014; 8:81-6. [DOI: 10.1136/neurintsurg-2014-011449] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/13/2014] [Indexed: 11/04/2022]
Abstract
Background and purposeFollow-up of intracranial aneurysms treated by flow diverter with MRI is complicated by imaging artifacts produced by these devices. This study compares the diagnostic accuracy of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3 T for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment, with digital subtraction angiography (DSA) as the gold standard.Materials and methodsPatients treated with flow diverters between January 2009 and January 2013 followed by MRA at 3 T (3D-TOF-MRA and CE-MRA) and DSA within a 48 h period were included in a prospective single-center study. Aneurysm occlusion was assessed with full and simplified Montreal scales and parent artery patency with three-grade and two-grade scales.ResultsTwenty-two patients harboring 23 treated aneurysms were included. Interobserver agreement using simplified scales for occlusion (Montreal) and parent artery patency were higher for DSA (0.88 and 0.61) and CE-MRA (0.74 and 0.55) than for 3D-TOF-MRA (0.51 and 0.02). Intermodality agreement was higher for CE-MRA (0.88 and 0.32) than for 3D-TOF-MRA (0.59 and 0.11). CE-MRA yielded better accuracy than 3D-TOF-MRA for aneurysm remnant detection (sensitivity 83% vs 50%; specificity 100% vs 100%) and for the status of the parent artery (specificity 63% vs 32%; sensitivity 100% vs 100%).ConclusionsAt 3 T, CE-MRA is superior to 3D-TOF-MRA for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment. However, intraluminal evaluation remains difficult with MRA regardless of the sequence used.
Collapse
|
36
|
Kawai T, Shimohira M, Kan H, Hashizume T, Ohta K, Kurosaka K, Muto M, Suzuki K, Shibamoto Y. Feasibility of Time-Resolved MR Angiography for Detecting Recanalization of Pulmonary Arteriovenous Malformations Treated with Embolization with Platinum Coils. J Vasc Interv Radiol 2014; 25:1339-47. [DOI: 10.1016/j.jvir.2014.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 11/16/2022] Open
|
37
|
Boddu SR, Tong FC, Dehkharghani S, Dion JE, Saindane AM. Contrast-enhanced time-resolved MRA for follow-up of intracranial aneurysms treated with the pipeline embolization device. AJNR Am J Neuroradiol 2014; 35:2112-8. [PMID: 24994828 DOI: 10.3174/ajnr.a4008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular reconstruction and flow diversion by using the Pipeline Embolization Device is an effective treatment for complex cerebral aneurysms. Accurate noninvasive alternatives to DSA for follow-up after Pipeline Embolization Device treatment are desirable. This study evaluated the accuracy of contrast-enhanced time-resolved MRA for this purpose, hypothesizing that contrast-enhanced time-resolved MRA will be comparable with DSA and superior to 3D-TOF MRA. MATERIALS AND METHODS During a 24-month period, 37 Pipeline Embolization Device-treated intracranial aneurysms in 26 patients underwent initial follow-up by using 3D-TOF MRA, contrast-enhanced time-resolved MRA, and DSA. MRA was performed on a 1.5T unit by using 3D-TOF and time-resolved imaging of contrast kinetics. All patients underwent DSA a median of 0 days (range, 0-68) after MRA. Studies were evaluated for aneurysm occlusion, quality of visualization of the reconstructed artery, and measurable luminal diameter of the Pipeline Embolization Device, with DSA used as the reference standard. RESULTS The sensitivity, specificity, and positive and negative predictive values of contrast-enhanced time-resolved MRA relative to DSA for posttreatment aneurysm occlusion were 96%, 85%, 92%, and 92%. Contrast-enhanced time-resolved MRA demonstrated superior quality of visualization (P = .0001) and a higher measurable luminal diameter (P = .0001) of the reconstructed artery compared with 3D-TOF MRA but no significant difference compared with DSA. Contrast-enhanced time-resolved MRA underestimated the luminal diameter of the reconstructed artery by 0.965 ± 0.497 mm (27% ± 13%) relative to DSA. CONCLUSIONS Contrast-enhanced time-resolved MRA is a reliable noninvasive method for monitoring intracranial aneurysms following flow diversion and vessel reconstruction by using the Pipeline Embolization Device.
Collapse
Affiliation(s)
- S R Boddu
- From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.)
| | - F C Tong
- From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.) Neurological Surgery (F.C.T., J.E.D.), Emory University School of Medicine, Atlanta, Georgia
| | - S Dehkharghani
- From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.)
| | - J E Dion
- From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.) Neurological Surgery (F.C.T., J.E.D.), Emory University School of Medicine, Atlanta, Georgia
| | - A M Saindane
- From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.)
| |
Collapse
|
38
|
Cho WS, Kim SS, Lee SJ, Kim SH. The effectiveness of 3T time-of-flight magnetic resonance angiography for follow-up evaluations after the stent-assisted coil embolization of cerebral aneurysms. Acta Radiol 2014; 55:604-13. [PMID: 24003259 DOI: 10.1177/0284185113502335] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Artifacts introduced by stents limit the value of magnetic resonance (MR) imaging as a follow-up modality after the stent-assisted coil embolization of cerebral aneurysms. PURPOSE To investigate the usefulness of 3 Tesla (3T) time-of-flight (TOF) MR angiography (MRA) for the follow-up evaluation. MATERIAL AND METHODS Twenty-two aneurysms of 20 patients treated with stent-assisted coil embolization were followed up with 3T TOF MRA and digital subtraction angiography (DSA) with three-dimensional rotational angiography (3DRA). The status of coiled aneurysms was compared with 3T TOF MRA and DSA with 3DRA in terms of complete occlusion, residual neck, and residual aneurysm. TOF MRA at 3T was performed 1 day before DSA with 3DRA, with a mean follow-up period of 20.1 ± 10.8 months. RESULTS Twenty (90.9%) of 22 cases were concordant between the two modalities. The degree of agreement and correlation between them were high (κ=0.771, P<0.001; r=0.832 and P<0.001). When evaluating the status of residual neck, the sensitivity was 80% (4/5 cases); specificity was not available because there were no cases of complete occlusion. For the status of residual aneurysm, the sensitivity and specificity were 94.1% (16/17 cases) and 100% (all 5 cases), respectively. CONCLUSION TOF MRA at 3T with source images could be useful as a non-invasive follow-up modality after the stent-assisted coil embolization of cerebral aneurysms. Further study with a larger patient sample is needed to confirm the effectiveness of 3T TOF MRA.
Collapse
Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sam Soo Kim
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| |
Collapse
|
39
|
Cho YD, Kim KM, Lee WJ, Sohn CH, Kang HS, Kim JE, Han MH. Time-of-flight magnetic resonance angiography for follow-up of coil embolization with enterprise stent for intracranial aneurysm: usefulness of source images. Korean J Radiol 2014; 15:161-8. [PMID: 24497808 PMCID: PMC3909851 DOI: 10.3348/kjr.2014.15.1.161] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/23/2013] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to determine the interobserver and intermodality agreement in the interpretation of time-of-flight (TOF) MR angiography (MRA) for the follow-up of coiled intracranial aneurysms with the Enterprise stent. Materials and Methods Two experienced neurointerventionists independently reviewed the follow-up MRA studies of 40 consecutive patients with 44 coiled aneurysms. All aneurysms were treated with assistance from the Enterprise stent and the radiologic follow-up intervals were greater than 6 months after the endovascular therapy. Digital subtraction angiography (DSA) served as the reference standard. The degree of aneurysm occlusion was determined by an evaluation of the maximal intensity projection (MIP) and source images (SI) of the TOF MRA. The capability of the TOF MRA to depict the residual flow within the coiled aneurysms and the stented parent arteries was compared with that of the DSA. Results DSA showed stable occlusions in 25 aneurysms, minor recanalization in 8, and major recanalization in 11. Comparisons between the TOF MRA and conventional angiography showed that the MIP plus SI had almost perfect agreement (κ = 0.892, range 0.767 to 1.000) and had better agreement than with the MIP images only (κ = 0.598, range 0.370 to 0.826). In-stent stenosis of more than 33% was observed in 5 cases. Both MIP and SI of the MRA showed poor depiction of in-stent stenosis compared with the DSA. Conclusion TOF MRA seemed to be reliable in screening for aneurysm recurrence after coil embolization with Enterprise stent assistance, especially in the evaluation of the SI, in addition to MIP images in the TOF MRA.
Collapse
Affiliation(s)
- Young Dae Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Kang Min Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Woong Jae Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| |
Collapse
|
40
|
Menke J, Schramm P, Sohns JM, Kallenberg K, Staab W. Diagnosing flow residuals in coiled cerebral aneurysms by MR angiography: meta-analysis. J Neurol 2013; 261:655-62. [PMID: 23893001 PMCID: PMC3973941 DOI: 10.1007/s00415-013-7053-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 07/14/2013] [Accepted: 07/15/2013] [Indexed: 11/03/2022]
Abstract
This meta-analysis summarizes the accuracy of magnetic resonance angiography (MRA) for diagnosing residuals in coiled cerebral aneurysms by using the threefold Roy classification (residuals: none, neck, or sac). Four databases were searched from 2000 to June 2013 for eligible studies that compared MRA to digital subtraction angiography (DSA) and reported 3 × 3 count data of threefold Roy classification, or a reduced scheme of 2 × 2 count data. Bivariate and trivariate Bayesian random-effects models were used for meta-analysis. Among 27 included studies (2,119 coiled aneurysms in 1,809 patients) the average prevalence of DSA-confirmed sac residuals was 18.2 % (range 0-43 %). The pooled sensitivity was 88.0 % (95 % CI 81.4-94.0) and specificity was 97.2 % (94.6-99.0 %) for assessing sac residuals by MRA. In the trivariate meta-analysis, a "sac residual" finding at MRA had a high positive likelihood ratio of 28.2 (14.0-79.0). A "neck residual" finding had a moderate negative likelihood ratio of 0.246 (0.111-0.426), and the MRA finding of "no residual" had a good negative likelihood ratio of 0.044 (0.013-0.096). Subgroup analyses identified no significant influence of covariates on diagnostic accuracy (P > 0.05). In conclusion, in coiled cerebral aneurysms MRA with application of the threefold Roy classification is well suited for detecting or excluding sac residuals that might require retreatment.
Collapse
Affiliation(s)
- Jan Menke
- Department of Diagnostic Radiology, University Hospital, Robert-Koch-Strasse 40, 37075, Goettingen, Germany,
| | | | | | | | | |
Collapse
|
41
|
Kurosaka K, Kawai T, Shimohira M, Hashizume T, Ohta K, Suzuki Y, Shibamoto Y. Time-resolved Magnetic Resonance Angiography for assessment of recanalization after coil embolization of visceral artery aneurysms. Pol J Radiol 2013; 78:64-8. [PMID: 23493525 PMCID: PMC3596147 DOI: 10.12659/pjr.883769] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 01/15/2013] [Indexed: 11/09/2022] Open
Abstract
Background: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, CT examination is susceptible to coil artifacts, which sometimes makes it difficult to assess recanalization. We report 2 cases where recanalization was successfully visualized using time-resolved magnetic resonance angiography after coil embolization of visceral artery aneurysms (one case of right internal iliac artery aneurysm and one case of splenic artery aneurysm). Repeat coil embolization was successfully performed. Case Report: Case 1. An 80-year-old male patient with right internal iliac artery (IIA) aneurysm underwent coil embolization. Aneurysm was located at the bifurcation of the right IIA and therefore, after making a femorofemoral bypass, the distal part of the right IIA, aneurysm and the common iliac artery were embolized with a coil. One year later, the size of the aneurysm seemed to have increased on CT. However, the details were not determined because of metal artifacts. Thus, time-resolved MRA was performed and showed minute vascular flow inside the aneurysm. Angiography was subsequently performed and blood flow inside the aneurysm was visualized similar to the findings in time-resolved MRA. Coil embolization was performed once more and vascular flow inside the aneurysm disappeared. Case 2. A 36-year-old male patient with a splenic artery aneurysm underwent coil packing with preservation of splenic artery patency. Four years later, coil compaction was suspected in a CT scan, but CT could not evaluate recanalization because of severe metal artifacts. Angiography was subsequently performed, showing recanalization of the aneurysm as did the time-resolved MRA. Therefore, coil embolization of the aneurysm and splenic artery was performed again. Conclusions: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, it is sometimes difficult to assess recanalization with CT because of artifacts caused by metal. In our cases, recanalization of aneurysms was clearly shown by time-resolved MRA and re-embolization was successfully performed. In conclusion, time-resolved MRA appears to be useful in assessment of recanalization of visceral artery aneurysms after coil embolization.
Collapse
Affiliation(s)
- Kenichiro Kurosaka
- Department of Radiology, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | | | | | | | | | | | | |
Collapse
|