Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?
BACKGROUND
Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation. The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography (DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up.


METHODS
From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers 1 and 2) and two other reviewed DSA images.


RESULTS
Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity of CE-MRA to detect aneurysm recanalisation was 95.5%.


CONCLUSIONS
CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up.
Lubicz
Boris
B
Department of Neuroradiology, Erasme University Hospital, 808 route de Lennik, 1070, Brussels, Belgium. blubicz@ulb.ac.be
Neugroschl
Carine
C
Collignon
Laurent
L
François
Olivier
O
Balériaux
Danielle
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome
D003287:Contrast Media
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