title: Coil-treated aneurysms: decision making regarding additional treatment based on findings of MR angiography and intraarterial DSA.
abstract: OBJECTIVE
  To assess whether magnetic resonance (MR) angiography can be used as a noninvasive alternative to intraarterial digital subtraction angiography (DSA) to indicate additional treatment in the follow-up of patients with coil-treated intracranial aneurysms.
  
  
  METHODS
  This was an ethics committee-approved multicenter study. Consecutive patients who were scheduled for follow-up intraarterial DSA after coil placement were invited for additional MR angiography after providing written informed consent. Interventional neuroradiologists gave treatment advice (additional treatment, extended follow-up imaging, or discharge from follow-up) for each imaging modality. Agreement between treatment advices based on intraarterial DSA and MR angiographic findings and interobserver agreement were assessed with weighted κ statistics.
  
  
  RESULTS
  Agreement between intraarterial DSA- and MR angiography-based treatment recommendations was substantial (κ = 0.73; 95% confidence interval [CI]: 0.66, 0.80). In 34 of the 310 patients (11%), the advice was additional treatment based on findings of both modalities. In six patients (2%), the advice based on intraarterial DSA findings was additional treatment, while that based on MR angiographic findings was extended follow-up imaging; therefore, none of these patients were discharged from follow-up on the basis of MR angiographic findings. In six other patients (2%), the advice based on MR angiographic findings was additional treatment, while that based on intraarterial DSA findings was extended follow-up imaging (four patients), discharge from follow-up (one patient), and noninterpretable DSA (one patient). Extended follow-up imaging was suggested for 37 patients (12%) after intraarterial DSA and for 49 patients (16%) after MR angiography (difference: 4%; 95% CI: -0.6%, 8.4%). Interobserver agreement was substantial for intraarterial DSA (κ = 0.73; 95% CI: 0.64, 0.82) and moderate for MR angiography (κ = 0.53; 95% CI: 0.36, 0.70).
  
  
  CONCLUSIONS
  The overall proportion of patients advised to undergo additional treatment is similar based on intraarterial DSA and MR angiographic findings, with only few individual discrepancies. MR angiography can therefore be used for therapeutic decision making in the follow-up of patients with coil-treated aneurysms.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112608/-/DC1.
authors.affiliation: Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA 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: René
authors.initials: R
authors.lastname: van den Berg
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Brouwer
authors.forename: Charles B L M
authors.initials: CB
authors.lastname: Majoie
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: Marieke E S
authors.initials: ME
authors.lastname: Sprengers
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: van Rooij
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Bot
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D002533:Cerebral Angiography / Q000379:methods*; D016001:Confidence Intervals; D003657:Decision Making; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome