Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography.
OBJECTIVE
Data about non-invasive follow-up of aneurysm after stent-assisted coiling is scarce. We aimed to compare time-of-flight (TOF) magnetic resonance angiography (MRA) (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3-Tesla, with digital subtraction angiography (DSA) for evaluating aneurysm occlusion and parent artery patency after stent-assisted coiling.


METHODS
In this retrospective single-center study, patients were included if they had an intracranial aneurysm treated by stent-assisted coiling between March 2008 and June 2015, followed with both MRA sequences (3D-TOF-MRA and CE-MRA) at 3-Tesla and DSA, performed in an interval<48hours.


RESULTS
Thirty-five aneurysms were included. Regarding aneurysm occlusion evaluation, agreement with DSA was better for CE-MRA (K=0.53) than 3D-TOF-MRA (K=0.28). Diagnostic accuracies for aneurysm remnant depiction were similar for 3D-TOF-MRA and CE-MRA (P=1). Both 3D-TOF-MRA (K=0.05) and CE-MRA (K=-0.04) were unable to detect pathological vessel compared to DSA, without difference in accuracy (P=0.68). For parent artery occlusion detection, agreement with DSA was substantial for 3D-TOF-MRA (K=0.64) and moderate for CE-MRA (K=0.45), with similar good diagnostic accuracies (P=1).


CONCLUSIONS
After stent-assisted coiling treatment, 3D-TOF-MRA and CE-MRA demonstrated good accuracy to detect aneurysm remnant (but tended to overestimation). Although CE-MRA agreement with DSA was better, there was no statistical difference between 3D-TOF-MRA and CE-MRA accuracies. Both MRAs were unable to provide a precise evaluation of in-stent status but could detect parent vessel occlusion.
Department of diagnostic and therapeutic neuroradiology, hôpital Maison-Blanche, université de Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims, France.
David
D
Marciano
Department of diagnostic and therapeutic neuroradiology, hôpital Maison-Blanche, université de Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims, France. Electronic address: sebastien.soize@gmail.com.
Sébastien
S
Soize
Department of diagnostic and therapeutic neuroradiology, hôpital Maison-Blanche, université de Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims, France.
Georgios
G
Metaxas
CReSTIC SIC EA3804, université de Champagne-Ardenne, 51100 Reims, France.
Christophe
C
Portefaix
Department of diagnostic and therapeutic neuroradiology, hôpital Maison-Blanche, université de Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims, France.
Laurent
L
Pierot
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome
D003287:Contrast Media
Follow-up; Intracranial aneurysm; MR angiography; Sensitivity and specificity; Stent