Intracranial aneurysms treated with coil placement: test characteristics of follow-up MR angiography--multicenter study.
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.
Schaafsma
Joanna D
JD
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands. j.d.schaafsma@umcutrecht.nl
Velthuis
Birgitta K
BK
Majoie
Charles B L M
CB
van den Berg
René
R
Brouwer
Patrick A
PA
Barkhof
Frederik
F
Eshghi
Omid
O
de Kort
Gerard A P
GA
Lo
Rob T H
RT
Witkamp
Theo D
TD
Sprengers
Marieke E S
ME
van Walderveen
Marianne A
MA
Bot
Joseph C
JC
Sanchez
Esther
E
Vandertop
W Peter
WP
van Gijn
Jan
J
Buskens
Erik
E
van der Graaf
Yolanda
Y
Rinkel
Gabriël J E
GJ
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
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol