Noninvasive follow-up of GDC-treated saccular aneurysms by MR angiography

The aim of this study was to determine sensitivity and specificity of magnetic resonance angiography (MRA) for the assessment of durable occlusion of intracranial aneurysms with Guglielmi detachable coils (GDC) and to point out the influence of MRA results in re-intervention strategies. Forty-five patients with 54 aneurysms that were previously treated by endovascular occlusion with GDC were selected for this study. All patients underwent digital subtraction angiography (DSA) and MRA examinations on the same day. The time-of-flight MRA studies were performed on a 1-T scanner. The MRA images were first read by radiologists who were not aware of the DSA results. In a second consensus reading by the neuroradiologists who had performed all interventional procedures of this series, the decision was made as to whether re-treatment was necessary. The distribution of aneurysm sizes, configurations and treatment results were sufficient for an unbiased evaluation. The first blinded evaluation revealed a sensitivity of 71% and a specificity of 95% for MRA assessment of aneurysm reperfusion. In the second consensus reading, the sensitivity increased to 92% and the specificity was 98%. The blinded reading indicates that MRA is a useful adjunct to DSA for the assessment of durable results after endovascular treatment of intracranial aneurysms. In the consensus reading it became obvious that sensitivity and specificity of MRA can be increased to 92 and 98%, respectively, if the results were evaluated by experienced neuroradiologists, including prior knowledge of all other examinations. We have already increased the follow-up intervals for DSA and use MRA intermittently, based on these results.