MR-angiography as a method for evaluating endovascular coiled cerebral aneurysms

Area of Science:

• Neuroradiology
• Medical Imaging
• Interventional Neurology

Background:

• Intracranial aneurysms pose significant risks, necessitating effective follow-up imaging after treatment.
• Guglielmi Detachable Coils (GDCs) are commonly used for endovascular embolization of cerebral aneurysms.
• Accurate assessment of treatment efficacy and detection of recurrence are crucial for patient management.

Purpose of the Study:

• To compare digital subtraction angiography (DSA) with magnetic resonance angiography (MRA) for evaluating GDC-embolized intracranial aneurysms.
• To assess the utility of 3D Time-of-Flight (TOF) MRA source data, Maximum Intensity Projection (MIP), and 3D iso-surface reconstructions in follow-up.
• To determine the correlation between MRA techniques and DSA in assessing aneurysm status post-GDC treatment.

Main Methods:

• A comparative study involving 28 patients with 32 GDC-coiled aneurysms.
• Analysis of 3D TOF MRA (source data, MIP, iso-surface) and DSA images.
• Evaluation of parent and branch artery flow, neck recurrence, and aneurysm regrowth.

Main Results:

• DSA revealed no flow in 62.5% of aneurysms, coil loop flow in 34%, and neck flow in 25%.
• 3D iso-surface MRA and source data showed good correlation with DSA findings.
• MIP MRA correlation with DSA was less robust, with weak or non-diagnostic results in 6.25% of cases. MRA missed residual aneurysm neck in 2 cases.

Conclusions:

• MRA is a valuable, non-invasive tool for evaluating GDC-treated cerebral aneurysms.
• 3D iso-surface reconstructions and source data from MRA provide reliable information.
• DSA remains the gold standard for definitive assessment due to MRA's limitations.