Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography

• DOI: 10.1016/j.neurad.2016.10.004
• Publication Date: 2016-11-09T11:45:35Z
• Authors: David Marciano; Sébastien Soize; Georgios Metaxas; Christophe Portefaix; Laurent Pierot
• Keywords: Male; Observer Variation; [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging; 610; Angiography, Digital Subtraction; Contrast Media; Intracranial Aneurysm; Middle Aged; Embolization, Therapeutic; Sensitivity and Specificity; 3. Good health; 03 medical and health sciences; Imaging, Three-Dimensional; Treatment Outcome; 0302 clinical medicine; 616; Humans; Female; Stents; Magnetic Resonance Angiography; Aged; Follow-Up Studies; Retrospective Studies

Data about non-invasive follow-up of aneurysm after stent-assisted coiling is scarce. We aimed to compare time-of-flight (TOF) magnetic resonance angiography (MRA) (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3-Tesla, with digital subtraction angiography (DSA) for evaluating aneurysm occlusion and parent artery patency after stent-assisted coiling.In this retrospective single-center study, patients were included if they had an intracranial aneurysm treated by stent-assisted coiling between March 2008 and June 2015, followed with both MRA sequences (3D-TOF-MRA and CE-MRA) at 3-Tesla and DSA, performed in an interval<48hours.Thirty-five aneurysms were included. Regarding aneurysm occlusion evaluation, agreement with DSA was better for CE-MRA (K=0.53) than 3D-TOF-MRA (K=0.28). Diagnostic accuracies for aneurysm remnant depiction were similar for 3D-TOF-MRA and CE-MRA (P=1). Both 3D-TOF-MRA (K=0.05) and CE-MRA (K=-0.04) were unable to detect pathological vessel compared to DSA, without difference in accuracy (P=0.68). For parent artery occlusion detection, agreement with DSA was substantial for 3D-TOF-MRA (K=0.64) and moderate for CE-MRA (K=0.45), with similar good diagnostic accuracies (P=1).After stent-assisted coiling treatment, 3D-TOF-MRA and CE-MRA demonstrated good accuracy to detect aneurysm remnant (but tended to overestimation). Although CE-MRA agreement with DSA was better, there was no statistical difference between 3D-TOF-MRA and CE-MRA accuracies. Both MRAs were unable to provide a precise evaluation of in-stent status but could detect parent vessel occlusion.