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Comparative Study
. 2012 Dec;54(12):1381-8.
doi: 10.1007/s00234-012-1063-3. Epub 2012 Jul 13.

Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA

Zbigniew Serafin  1 , Piotr Strześniewski, Władysław Lasek, Wojciech Beuth
Affiliations
Comparative Study

Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA

Zbigniew Serafin et al. Neuroradiology. 2012 Dec.

Abstract

Introduction: The possibility of recanalization and the need for retreatment are the most important limitations of intracranial aneurysm embolization. The purpose of the study was to compare the size of aneurysm remnants measured at follow-up with three-dimensional digital subtracted angiography (3D-DSA) and magnetic resonance angiography (MRA).

Methods: Twenty-six aneurysms were found incompletely occluded in 72 consecutively examined patients at a follow-up after 3 months. The diameters and volume of aneurysm remnants were compared between 3D-DSA, time-of-flight MRA (TOF-MRA), contrast-enhanced TOF-MRA (CE-TOF-MRA), and contrast-enhanced MRA (CE-MRA) at 1.5 T.

Results: There was a significant correlation between remnant volumes calculated based on 3D-DSA and all MRA modalities. The intraobserver variability of the measurements ranged from 3.4 to 4.1 % and the interobserver variability from 5.8 to 7.3 %. There were no significant differences in the variability between the techniques. The mean residual filling volume ranged from 16.3 ± 19.0 mm(3) in TOF-MRA to 30.5 ± 44.6 mm(3) in 3D-DSA (P < 0.04). Significant differences were found in the volumes measured with 3D-DSA and CE-MRA as compared to TOF-MRA and CE-TOF-MRA (P < 0.01). There was a moderate significant correlation between the residual filling and the relative error of measurement in the case of TOF-MRA and CE-TOF-MRA.

Conclusions: TOF-MRA seems to underestimate the size of aneurysm remnants detected at follow-up and should not be used as a sole imaging method to decide on re-embolization.

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Figures

Fig. 1
Fig. 1
Residual aneurysm (arrows) of the left internal carotid artery presented on MIP reconstructions of 3D-DSA (a), TOF-MRA (b), CE-TOF-MRA (c), and CE-MRA (d)
Fig. 2
Fig. 2
Mean volumes of aneurysm remnants with their 95% confidence intervals as measured on 3D-DSA, TOF-MRA, CE-TOF-MRA, and CE-MRA images
Fig. 3
Fig. 3
Direct comparison of the residual flow volume measured with 3D-DSA, TOF-MRA, CE-TOF-MRA, and CE-MRA in particular aneurysms
Fig. 4
Fig. 4
A case of recanalization of the right internal carotid artery aneurysm. The aneurysm remnant (arrows) has different sizes in 3D-DSA (a), TOF-MRA (b), CE-TOF-MRA (c), and CE-MRA (d)
Fig. 5
Fig. 5
Relation between the volume of aneurysm remnants measured with 3D-DSA and the relative error of volume measurement with TOF-MRA, CE-TOF-MRA, and CE-MRA. Aneurysm remnant volumes were natural log-transformed in order to reduce unilateral skewness of the data
See this image and copyright information in PMC

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