Three-dimensional time-of-flight MR angiography at 3 T compared to digital subtraction angiography in the follow-up of ruptured and coiled intracranial aneurysms: a prospective study

• Published in: Neuroradiology Vol. 50; no. 5; pp. 383 - 389
• Main Authors: Urbach, H., Dorenbeck, U., von Falkenhausen, M., Wilhelm, K., Willinek, W., Schaller, C., Flacke, S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-05-2008; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - therapy; Aneurysms; Angiography, Digital Subtraction; Biological and medical sciences; Child; Diagnostic Neuroradiology; Embolization, Therapeutic; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Human; Humans; Imaging; Imaging, Three-Dimensional; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Investigative techniques, diagnostic techniques (general aspects); Learning. Memory; Magnetic Resonance Angiography; Male; Medical diagnosis; Medical imaging; Medical sciences; Medicine; Medicine & Public Health; Memory; Middle Aged; Nervous system; Neurology; Neuroradiology; Neurosciences; Neurosurgery; NMR; Nuclear magnetic resonance; Observer Variation; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Treatment Outcome; Time-of-flight angiography; Subarachnoid haemorrhage; Coiling; Aneurysm; MR angiography; Intracranial; Nervous system diseases; Radiodiagnosis; Flight; Cardiovascular disease; Coil; Vascular disease; Prospective; Subtraction; Aneurysm .Subarachnoid haemorrhage; Digital angiography; NMR angiography; Coiling .MR angiography .Time-of-flight angiography
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-007-0355-5

Introduction
Since digital subtraction angiography (DSA) carries a low risk of morbidity, and is associated with patient discomfort and higher cost, our objective was to determine whether high-resolution 3-D time-of-flight MR angiography (TOF-MRA) at 3 T may replace DSA in the follow-up of patients after coiling of an intracranial aneurysm.
Methods
This prospective study included 50 consecutive patients with a ruptured and subsequently coiled intracranial aneurysm. All patients were followed up at a mean of 14 months after coiling with DSA and high-resolution 3-D TOF-MRA at 3 T generating 0.02 mm
3
isotropic voxels. One examiner used DSA and TOF-MR angiograms to assess the need for and risk of retreatment; these data were used to calculate intermodality agreement. Another two examiners independently assessed aneurysm occlusion by DSA and TOF-MRA according to the Raymond scale; these data were used to calculate interobserver agreement.
Results
Discrepancies between DSA and TOF-MRA were found in three patients (intermodality agreement κ = 0.86). While DSA indicated complete aneurysm occlusion, TOF-MRA showed small neck remnants in the three patients. Coils on all DSA projections obscured these three neck remnants. Interobserver agreement was higher for DSA (κ = 0.82) than for TOF-MRA (κ = 0.68), which was in part due to the complexity of the information provided by TOF source images and reconstructions.
Conclusion
3-D TOF-MRA at 3 T is not only an adjunctive tool but is ready to replace DSA in the follow-up of patients with previously coiled intracranial aneurysms. Additional DSA may only be performed in complex and not clearly laid out aneurysms.