Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated
C Timsit1, S Soize1, A Benaissa1
1From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France.
Background And Purpose:
Imaging follow-up at 3T of intracranial aneurysms treated with the WEB Device has not been evaluated yet. Our aim was to assess the diagnostic accuracy of 3D-time-of-flight MRA and contrast-enhanced MRA at 3T against DSA, as the criterion standard, for the follow-up of aneurysms treated with the Woven EndoBridge (WEB) system.
Materials And Methods:
From June 2011 to December 2014, patients treated with the WEB in our institution, then followed for ≥6 months after treatment by MRA at 3T (3D-TOF-MRA and contrast-enhanced MRA) and DSA within 48 hours were included. Aneurysm occlusion was assessed with a simplified 2-grade scale (adequate occlusion [total occlusion + neck remnant] versus aneurysm remnant). Interobserver and intermodality agreement was evaluated by calculating the linear weighted κ. MRA test characteristics and predictive values were calculated from a 2 × 2 contingency table, by using DSA data as the standard of reference.
Results:
Twenty-six patients with 26 WEB-treated aneurysms were included. The interobserver reproducibility was good with DSA (κ = 0.71) and contrast-enhanced-MRA (κ = 0.65) compared with moderate with 3D-TOF-MRA (κ = 0.47). Intermodality agreement with DSA was fair with both contrast-enhanced MRA (κ = 0.36) and 3D-TOF-MRA (κ = 0.36) for the evaluation of total occlusion. For aneurysm remnant detection, the prevalence was low (15%), on the basis of DSA, and both MRA techniques showed low sensitivity (25%), high specificity (100%), very good positive predictive value (100%), and very good negative predictive value (88%).
Conclusions:
Despite acceptable interobserver reproducibility and predictive values, the low sensitivity of contrast-enhanced MRA and 3D-TOF-MRA for aneurysm remnant detection suggests that MRA is a useful screening procedure for WEB-treated aneurysms, but similar to stents and flow diverters, DSA remains the criterion standard for follow-up.
Insights
Magnetic Resonance Angiography (MRA) at 3T is a useful screening tool for Woven EndoBridge (WEB) device-treated aneurysms. However, Digital Subtraction Angiography (DSA) remains the gold standard for definitive follow-up due to MRA
Area of Science:
- Neuroradiology
- Medical Imaging
- Interventional Neurology
Background:
- Intracranial aneurysms treated with the Woven EndoBridge (WEB) device require effective imaging follow-up.
- 3T Magnetic Resonance Angiography (MRA) has not been previously evaluated for WEB device treatment follow-up.
Purpose of the Study:
- To assess the diagnostic accuracy of 3T 3D-time-of-flight MRA (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) compared to Digital Subtraction Angiography (DSA).
- To evaluate MRA's effectiveness in the follow-up of intracranial aneurysms treated with the WEB system.
Main Methods:
- Retrospective analysis of 26 patients treated with WEB devices and followed for ≥6 months.
- Comparison of 3T 3D-TOF-MRA and CE-MRA against DSA (criterion standard) for aneurysm occlusion assessment.
- Evaluation of interobserver and intermodality agreement using linear weighted kappa (κ) and calculation of MRA test characteristics.
Main Results:
- Interobserver reproducibility was good for DSA (κ=0.71) and CE-MRA (κ=0.65), moderate for 3D-TOF-MRA (κ=0.47).
- Intermodality agreement with DSA was fair for both MRA techniques (κ=0.36) in evaluating total occlusion.
- For aneurysm remnant detection (15% prevalence), MRA showed low sensitivity (25%) but high specificity (100%), with excellent positive (100%) and negative (88%) predictive values.
Conclusions:
- 3T MRA techniques demonstrate acceptable interobserver reproducibility and predictive values for WEB-treated aneurysms.
- Low sensitivity of MRA for detecting aneurysm remnants suggests it is a useful screening tool.
- DSA remains the criterion standard for definitive follow-up of WEB-treated aneurysms, similar to other endovascular devices.
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