title: Follow-up after embolization of ruptured intracranial aneurysms: a prospective comparison of two-dimensional digital subtraction angiography, three-dimensional digital subtraction angiography, and time-of-flight magnetic resonance angiography.
abstract: BACKGROUND
  To prospectively compare of the diagnostic value of digital subtraction angiography (DSA) and time-of-flight magnetic resonance angiography (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular treatment.
  
  
  METHODS
  Seventy-two consecutive patients were examined 3 months after the embolization. The index tests included: two-dimensional DSA (2D-DSA), three-dimensional DSA (3D-DSA), and TOF-MRA. The reference test was a retrospective consensus between 2D-DSA images, 3D-DSA images, and source rotational DSA images. The evaluation included: detection of the residual flow, quantification of the flow, and validity of the decision regarding retreatment. Intraobserver agreement and interobserver agreement were determined.
  
  
  RESULTS
  The sensitivity and specificity of residual flow detection ranged from 84.6 % (2D-DSA and TOF-MRA) to 92.3 % (3D-DSA) and from 91.3 % (TOF-MRA) to 97.8 % (3D-DSA), respectively. The accuracy of occlusion degree evaluation ranged from 0.78 (2D-DSA) to 0.92 (3D-DSA, Cohen's kappa). The 2D-DSA method presented lower performance in the decision on retreatment than 3D-DSA (P < 0.05, ROC analysis). The intraobserver agreement was very good for all techniques (κ = 0.80-0.97). The interobserver agreement was moderate for TOF-MRA and very good for 2D-DSA and 3D-DSA (κ = 0.72-0.94).
  
  
  CONCLUSIONS
  Considering the invasiveness of DSA and the minor difference in the diagnostic performance between 3D-DSA and TOF-MRA, the latter method should be the first-line modality for follow-up after aneurysm embolization.
authors.affiliation: Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, ul. M. Skłodowskiej-Curie 9, Bydgoszcz, Poland. serafin@cm.umk.pl
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Serafin
authors.forename: Piotr
authors.initials: P
authors.lastname: Strześniewski
authors.forename: Władysław
authors.initials: W
authors.lastname: Lasek
authors.forename: Wojciech
authors.initials: W
authors.lastname: Beuth
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy*; D015901:Angiography, Digital Subtraction / Q000379:methods*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies