title: Can we now dispense with DSA in the evaluation of aneurysm occlusion even in the most crucial first follow-up after endovascular treatment?
abstract: OBJECTIVE
  Catheter angiography (DSA) as gold standard for the evaluation of aneurysmal occlusion after coiling has now been largely replaced by MRI or CTA in long term observations. However, the first year after treatment is crucial because most recurrences occur in this time. Until now no guidelines exist concerning the imaging modality to adopt in this period. Aim of the study was to determine whether DSA could also be omitted in the first follow-up examination after coiling due to MRI results.
  
  
  METHODS
  489 consecutive half-year follow-up examinations consisting of DSA, CE-MRA and TOF-MRA at 1.5 or 3T were reviewed retrospectively. Visualization of residual or recurrent aneurysms in both MRA-techniques was compared to DSA by two experienced readers.
  
  
  RESULTS
  Remnants/recurrences could be visualized in at least one of the three techniques in 190 (38.9%) aneurysms. Remnants/recurrences requiring retreatment (n=52) were detectable with at least one of the two MRI-techniques. In three cases (0.6%) remnants/recurrences were only visible on DSA but neither on CE-MRA nor on TOF-MRA. However, they were small (<2mm) and therapy concept did not change. In one case (0.2%) they were only visible on the CE-MRA and TOF-MRA but not on the DSA, in five cases (1%) visible on DSA and TOF-MRA but not on the CE-MRA and in four cases (0.8%) not visible on the TOF-MRA but on both of the other imaging modalities.
  
  
  CONCLUSIONS
  The combination of CE-MRA und TOF-MRA is also an appropriate alternative to DSA concerning the evaluation of residual or recurrent aneurysms in the crucial first follow-up.
authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Department of Neuroradiology, University Hospital Gießen, Gießen, Germany. Electronic address: Carolin.Gramsch@radiol.med.uni-giessen.de.
authors: Carolin
authors: C
authors: Gramsch
authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
authors: Stefan
authors: S
authors: Zülow
authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
authors: Felix
authors: F
authors: Nensa
authors: Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, University Hospital Essen, Essen, Germany.
authors: Stefan
authors: S
authors: Maderwald
authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
authors: Sophia
authors: S
authors: Göricke
authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
authors: Adrian
authors: A
authors: Ringelstein
authors: Department of Neurosurgery, University Hospital Essen, Essen, Germany.
authors: Oliver
authors: O
authors: Müller
authors: Department of Neurosurgery, University Hospital Essen, Essen, Germany.
authors: Ulrich
authors: U
authors: Sure
authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Neuroradiology, Clinic Hirslanden, Zurich, Switzerland.
authors: Isabel
authors: I
authors: Wanke
authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Department of Neuroradiology, University Hospital Gießen, Gießen, Germany.
authors: Marc
authors: M
authors: Schlamann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods* / Q000592:standards; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Aneurysms; CE-MRA; Coiling; DSA; Half year follow-up; TOF-MRA