title: Intracranial aneurysms treated with coil placement: test characteristics of follow-up MR angiography--multicenter study.
abstract: OBJECTIVE
  To determine the test characteristics of magnetic resonance (MR) angiography in the assessment of occlusion of aneurysms treated with coil placement.
  
  
  METHODS
  This was an ethics committee-approved multicenter study. written informed consent was obtained in 311 patients with 343 aneurysms, who had been treated with coil placement and were scheduled for routine follow-up with intraarterial digital subtraction angiography (DSA). Thirty-five patients participated two or three times. Either 3.0- or 1.5-T time-of-flight (TOF) and contrast material-enhanced MR angiography were performed in addition to intraarterial DSA. Aneurysm occlusion was evaluated by independent readers at DSA and MR angiography. The test characteristics of MR angiography were assessed by using DSA as the standard. The area under the receiver operating characteristic curve (AUC) was calculated for 3.0- versus 1.5-T MR angiography and for TOF versus contrast-enhanced MR angiography, and factors associated with discrepancies between MR angiography and DSA were assessed with logistic regression.
  
  
  RESULTS
  Aneurysm assessments (n = 381) at DSA and MR angiography were compared. Incomplete occlusion was seen at DSA in 88 aneurysms (23%). Negative predictive value of MR angiography was 94% (95% confidence interval [CI]: 91%, 97%), positive predictive value was 69% (95% CI: 60%, 78%), sensitivity was 82% (95% CI: 72%, 89%), and specificity was 89% (95% CI: 85%, 93%). AUCs were similar for 3.0- (0.90 [95% CI: 0.86, 0.94]) and 1.5-T MR (0.87 [95% CI: 0.78, 0.95]) and for TOF MR (0.86 [95% CI: 0.81, 0.91]) versus contrast-enhanced MR (0.85 [95% CI: 0.80, 0.91]). A small residual lumen (odds ratio, 2.1 [95% CI: 1.1, 4.3]) and suboptimal projection at DSA (odds ratio, 5.5 [95% CI: 1.5, 21.0]) were independently associated with discordance between intraarterial DSA and MR angiography.
  
  
  CONCLUSIONS
  Documentation of good diagnostic performance of TOF MR angiography at both 1.5 and 3.0 T in the current study represents an important step toward replacing intraarterial DSA with MR angiography in the follow-up of patients with aneurysms treated with coils.
authors.affiliation: Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands. j.d.schaafsma@umcutrecht.nl
authors.forename: Joanna D
authors.initials: JD
authors.lastname: Schaafsma
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.forename: Charles B L M
authors.initials: CB
authors.lastname: Majoie
authors.forename: René
authors.initials: R
authors.lastname: van den Berg
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Brouwer
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Omid
authors.initials: O
authors.lastname: Eshghi
authors.forename: Gerard A P
authors.initials: GA
authors.lastname: de Kort
authors.forename: Rob T H
authors.initials: RT
authors.lastname: Lo
authors.forename: Theo D
authors.initials: TD
authors.lastname: Witkamp
authors.forename: Marieke E S
authors.initials: ME
authors.lastname: Sprengers
authors.forename: Marianne A
authors.initials: MA
authors.lastname: van Walderveen
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Bot
authors.forename: Esther
authors.initials: E
authors.lastname: Sanchez
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
authors.forename: Jan
authors.initials: J
authors.lastname: van Gijn
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D019540:Area Under Curve; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000628:therapy*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D012372:ROC Curve; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol