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Getting More Out of Follow-up Three-Dimensional Time-of-Flight Magnetic Resonance Angiography in Endovascularly
Rajendra Vishnu Phadke1,2, Vivek Singh3, Madan Mohan Balaguruswamy4,5
1Department of Radiodiagnosis and Interventional Radiology, Apollomedics Superspeciality Hospitals, Lucknow, India.
Background:
We retrospectively re-evaluated follow-up three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) in patients with aneurysms treated with coiling at our Institute.
Aims:
To document the type and frequency of postcoiling residue patterns as seen on follow-up MRA and to document their evolution with time where a further follow-up MRA was available. To assess the implications of the location of the aneurysm on residue and recurrence.
Subjects And Methods:
3D TOF MRA for 104 aneurysms were evaluated for residue size and residue pattern. Mainly, three residue patterns were identified. The aneurysms were allocated to different groups depending on the location. Multiple MRA studies were available in subgroup 1* and subgroup 2* where the residue growth or reduction and pattern change was noted and residue growth rates were calculated.
Results:
Collectively 54 (51.92%) aneurysms showed occlusion (pattern 1 and 1A), 31 (29.81%) showed neck residue (pattern 2A, 2B and 2C) and 19 (18.27%) showed recurrence (pattern 3A, 3B and 3C, residue size >3 mm) at the last follow-up MRA. Type 2A/3A patterns were more common. In terms of residue and recurrence, the distally located aneurysms (Group 3) appeared to do well. For those showing growing residue/recurrence, the average growth rate was calculated at 0.094 mm/month and 0.15 mm/month, respectively, for subgroup 1* and subgroup 2*, although the difference was not statistically significant. With longer follow-up the persisting and growing residues from both the subgroups, not warranting early re-treatment, showed a low growth rate at approximately 0.05 mm/month.
Conclusions:
TOF MRA helps in identifying different residue patterns in coiled aneurysms. Serial follow-up MRA appears useful in showing the pattern and size changes in the residual aneurysm. Although more work is required in this regard, calculation of aneurysm/residue growth rate may be useful in prognostication and in scheduling further follow-up or retreatment. The risk factor related to the location of the aneurysm warrants further study.
Insights
Follow-up three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) effectively identifies residue patterns after aneurysm coiling. Serial TOF MRA aids in monitoring changes and may help predict outcomes for coiled aneurysms.
Area of Science:
- Neuroimaging
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Retrospective analysis of follow-up 3D TOF MRA in patients with coiled aneurysms.
- Focus on evaluating post-coiling residue patterns and their evolution over time.
Purpose of the Study:
- Document the types and frequency of post-coiling residue patterns on follow-up MRA.
- Assess the temporal evolution of these residue patterns.
- Evaluate the impact of aneurysm location on residue and recurrence rates.
Main Methods:
- Retrospective review of 3D TOF MRA for 104 aneurysms.
- Classification of aneurysms based on residue size and pattern.
- Grouping aneurysms by location to assess site-specific implications.
- Calculation of residue growth rates in subgroups with serial MRA.
Main Results:
- Occlusion observed in 51.92% of aneurysms; neck residue in 29.81%; recurrence (>3 mm) in 18.27%.
- Distally located aneurysms showed favorable outcomes regarding residue and recurrence.
- Average growth rates for residue/recurrence were calculated, with a low rate (~0.05 mm/month) for persisting residues not requiring immediate re-treatment.
Conclusions:
- 3D TOF MRA is valuable for identifying residue patterns post-coiling.
- Serial MRA effectively monitors changes in residual aneurysm size and pattern.
- Calculating growth rates may aid in prognostication and treatment planning for coiled aneurysms.
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