Pierot L, Delcourt C, Bouquigny F, Breidt D, Feuillet B, Lanoix O, Gallas S
Service de Radiologie, Hôpital Maison-Blanche, Reims cedex, France.
AJNR Am J Neuroradiol. 2006 Apr;27(4):744-9.
The aim of this study was to determine the feasibility and usefulness of contrast-enhanced MR angiography (CE-MRA) for the follow-up of intracranial aneurysms treated with detachable coils, by comparing CE-MRA with digital subtraction angiography (DSA) and 3D time-of- flight (TOF) MRA.
Thirty-two patients with 42 treated aneurysms were included in the study; 6 had been treated for multiple aneurysms. All MRAs were performed with a 1.5T unit within 48 hours of DSA. We performed 2 types of acquisition: a 3D TOF sequence and CE-MRA. Twenty-eight patients were included 1 year after endovascular treatment, and 4 patients, after 3 years or more. DSA was the technique of reference for the detection of a residual neck or residual aneurysm.
Compared with DSA, the sensitivity of MRA was good. For the detection of residual neck, there was no significant difference between the results of 3D TOF MRA (sensitivity, 75%-87.5%; specificity, 92.9%, according to both readers) and CE-MRA (sensitivity, 75%-82.1%; specificity, 85.7%-92.9%). For the detection of residual aneurysm, sensitivity and specificity of both techniques were the same, respectively 80%-100% and 97.3%-100%. Therefore, CE-MRA was not better than 3D TOF MRA for the detection of residual neck or residual aneurysm. For large treated aneurysms, there was no difference between decisions regarding further therapy after CE and 3D TOF MRA, even though CE-MRA with a short echotime and enhancement gave fewer artifacts and better visualization of recanalization than 3D TOF MRA. The interpretation of transverse source images and the detection of coil mesh packing seemed easier with 3D TOF imaging.
This prospective study did not show that CE-MRA was significantly better than 3D TOF MRA for depicting aneurysm or neck remnants after selective endovascular treatment using coils. For aneurysms treated with coils, 3D TOF MRA seems a valid and useful technique for the follow-up of coiled aneurysms.
本研究旨在通过对比增强磁共振血管造影（CE-MRA）与数字减影血管造影（DSA）及三维时间飞跃（TOF）MRA，确定其在使用可脱卸弹簧圈治疗的颅内动脉瘤随访中的可行性与实用性。
本研究纳入了32例患有42个已治疗动脉瘤的患者；其中6例曾接受过多个动脉瘤的治疗。所有磁共振血管造影均在DSA检查后48小时内使用1.5T设备进行。我们进行了两种类型的采集：三维TOF序列和CE-MRA。28例患者在血管内治疗后1年进行检查，4例患者在3年或更长时间后进行检查。DSA是检测残余瘤颈或残余动脉瘤的参考技术。
与DSA相比，MRA的敏感性良好。对于残余瘤颈的检测，三维TOF MRA（两位阅片者的敏感性分别为75%-87.5%；特异性为92.9%）和CE-MRA（敏感性为75%-82.1%；特异性为85.7%-92.9%）的结果之间无显著差异。对于残余动脉瘤的检测，两种技术的敏感性和特异性分别相同，分别为80%-100%和97.3%-100%。因此，在检测残余瘤颈或残余动脉瘤方面，CE-MRA并不优于三维TOF MRA。对于大型已治疗动脉瘤，CE和三维TOF MRA后关于进一步治疗的决策没有差异，尽管与三维TOF MRA相比，具有短回波时间和增强的CE-MRA产生的伪影更少，再通的可视化效果更好。三维TOF成像对横断源图像的解读和弹簧圈网眼填充的检测似乎更容易。
这项前瞻性研究并未表明，在使用弹簧圈进行选择性血管内治疗后，CE-MRA在描绘动脉瘤或瘤颈残余方面明显优于三维TOF MRA。对于用弹簧圈治疗的动脉瘤，三维TOF MRA似乎是一种用于盘绕动脉瘤随访的有效且有用的技术。
