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Surveillance of Unruptured Intracranial Saccular Aneurysms Using Noncontrast 3D-Black-Blood MRI: Comparison of 3D-TOF
C Zhu1, X Wang2,3, L Eisenmenger1
1From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California.
Background And Purpose:
Patients with unruptured intracranial aneurysms routinely undergo surveillance imaging to monitor growth. Angiography is the criterion standard for aneurysm diagnosis, but it is invasive. This study aimed to evaluate the accuracy and reproducibility of a 3D noncontrast black-blood MR imaging technique for unruptured intracranial aneurysm measurement in comparison with 3D-TOF and contrast-enhanced MRA, using 3D rotational angiography as a reference standard.
Materials And Methods:
Sixty-four patients (57.3 ± 10.9 years of age, 41 women) with 68 saccular unruptured intracranial aneurysms were recruited. Patients underwent 3T MR imaging with 3D-TOF-MRA, 3D black-blood MR imaging, and contrast-enhanced MRA, and they underwent 3D rotational angiography within 2 weeks. The neck, width, and height of the unruptured intracranial aneurysms were measured by 2 radiologists independently on 3D rotational angiography and 3 MR imaging sequences. The accuracy and reproducibility were evaluated by Bland-Altman plots, the coefficient of variance, and the intraclass correlation coefficient.
Results:
3D black-blood MR imaging demonstrates the best agreement with DSA, with the smallest limits of agreement and measurement error (coefficients of variance range, 5.87%-7.04%). 3D-TOF-MRA had the largest limits of agreement and measurement error (coefficients of variance range, 12.73%-15.78%). The average coefficient of variance was 6.26% for 3D black-blood MR imaging, 7.03% for contrast-enhanced MRA, and 15.54% for TOF-MRA. No bias was found among 3 MR imaging sequences compared with 3D rotational angiography. All 3 MR imaging sequences had excellent interreader agreement (intraclass correlation coefficient, >0.95). 3D black-blood MR imaging performed the best for patients with intraluminal thrombus (n = 10).
Conclusions:
3D black-blood MR imaging achieves better accuracy for aneurysm size measurements compared with 3D-TOF, using 3D rotational angiography as a criterion standard. This noncontrast technique is promising for surveillance of unruptured intracranial aneurysms.
Insights
A new 3D noncontrast black-blood MR imaging technique accurately measures unruptured intracranial aneurysms. This method shows superior agreement with digital subtraction angiography compared to other MRI techniques, making it promising for patient surveillance.
Area of Science:
- Neuroradiology
- Medical Imaging
- Aneurysm Diagnostics
Background:
- Unruptured intracranial aneurysms require regular surveillance imaging to monitor growth.
- Conventional angiography, while a gold standard, is invasive.
- Accurate and reproducible noninvasive measurement techniques are crucial for patient management.
Purpose of the Study:
- To evaluate the accuracy and reproducibility of a 3D noncontrast black-blood MR imaging technique for measuring unruptured intracranial aneurysms.
- To compare this novel technique against 3D Time-of-Flight Magnetic Resonance Angiography (3D-TOF-MRA) and contrast-enhanced MRA.
- To use 3D rotational angiography as the reference standard for comparison.
Main Methods:
- Sixty-four patients with 68 unruptured intracranial aneurysms underwent 3T MRI including 3D-TOF-MRA, 3D black-blood MR imaging, and contrast-enhanced MRA.
- 3D rotational angiography was performed within two weeks as the reference standard.
- Aneurysm neck, width, and height were independently measured by two radiologists on all sequences; accuracy and reproducibility were assessed using Bland-Altman plots, coefficient of variance, and intraclass correlation coefficient.
Main Results:
- 3D black-blood MR imaging demonstrated the best agreement with digital subtraction angiography (DSA), showing the smallest limits of agreement and measurement error (coefficient of variance: 5.87%-7.04%).
- 3D-TOF-MRA exhibited the largest limits of agreement and measurement error (coefficient of variance: 12.73%-15.78%).
- All tested MR imaging sequences showed excellent interreader agreement (intraclass correlation coefficient >0.95), with 3D black-blood MR imaging performing best for aneurysms containing intraluminal thrombus.
Conclusions:
- 3D noncontrast black-blood MR imaging offers superior accuracy for unruptured intracranial aneurysm size measurements compared to 3D-TOF.
- This noncontrast technique shows significant promise as a reliable tool for the surveillance of unruptured intracranial aneurysms.
- The findings support the clinical utility of 3D black-blood MR imaging in noninvasively monitoring aneurysm progression.
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