title: Contrast-enhanced time-resolved MRA for follow-up of intracranial aneurysms treated with the pipeline embolization device.
abstract: OBJECTIVE
  Endovascular reconstruction and flow diversion by using the Pipeline Embolization Device is an effective treatment for complex cerebral aneurysms. Accurate noninvasive alternatives to DSA for follow-up after Pipeline Embolization Device treatment are desirable. This study evaluated the accuracy of contrast-enhanced time-resolved MRA for this purpose, hypothesizing that contrast-enhanced time-resolved MRA will be comparable with DSA and superior to 3D-TOF MRA.
  
  
  METHODS
  During a 24-month period, 37 Pipeline Embolization Device-treated intracranial aneurysms in 26 patients underwent initial follow-up by using 3D-TOF MRA, contrast-enhanced time-resolved MRA, and DSA. MRA was performed on a 1.5T unit by using 3D-TOF and time-resolved imaging of contrast kinetics. All patients underwent DSA a median of 0 days (range, 0-68) after MRA. Studies were evaluated for aneurysm occlusion, quality of visualization of the reconstructed artery, and measurable luminal diameter of the Pipeline Embolization Device, with DSA used as the reference standard.
  
  
  RESULTS
  The sensitivity, specificity, and positive and negative predictive values of contrast-enhanced time-resolved MRA relative to DSA for posttreatment aneurysm occlusion were 96%, 85%, 92%, and 92%. Contrast-enhanced time-resolved MRA demonstrated superior quality of visualization (P = .0001) and a higher measurable luminal diameter (P = .0001) of the reconstructed artery compared with 3D-TOF MRA but no significant difference compared with DSA. Contrast-enhanced time-resolved MRA underestimated the luminal diameter of the reconstructed artery by 0.965 ± 0.497 mm (27% ± 13%) relative to DSA.
  
  
  CONCLUSIONS
  Contrast-enhanced time-resolved MRA is a reliable noninvasive method for monitoring intracranial aneurysms following flow diversion and vessel reconstruction by using the Pipeline Embolization Device.
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.) sboddu6@gmail.com.
authors.forename: S R
authors.initials: SR
authors.lastname: Boddu
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.) Neurological Surgery (F.C.T., J.E.D.), Emory University School of Medicine, Atlanta, Georgia.
authors.forename: F C
authors.initials: FC
authors.lastname: Tong
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.).
authors.forename: S
authors.initials: S
authors.lastname: Dehkharghani
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.) Neurological Surgery (F.C.T., J.E.D.), Emory University School of Medicine, Atlanta, Georgia.
authors.forename: J E
authors.initials: JE
authors.lastname: Dion
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.).
authors.forename: A M
authors.initials: AM
authors.lastname: Saindane
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D002533:Cerebral Angiography / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D016896:Treatment Outcome