Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Radiology. 2012 Dec;265(3):858-63. doi: 10.1148/radiol.12112608. Epub 2012 Sep 25.
To assess whether magnetic resonance (MR) angiography can be used as a noninvasive alternative to intraarterial digital subtraction angiography (DSA) to indicate additional treatment in the follow-up of patients with coil-treated intracranial aneurysms.
This was an ethics committee-approved multicenter study. Consecutive patients who were scheduled for follow-up intraarterial DSA after coil placement were invited for additional MR angiography after providing written informed consent. Interventional neuroradiologists gave treatment advice (additional treatment, extended follow-up imaging, or discharge from follow-up) for each imaging modality. Agreement between treatment advices based on intraarterial DSA and MR angiographic findings and interobserver agreement were assessed with weighted κ statistics.
Agreement between intraarterial DSA- and MR angiography-based treatment recommendations was substantial (κ = 0.73; 95% confidence interval [CI]: 0.66, 0.80). In 34 of the 310 patients (11%), the advice was additional treatment based on findings of both modalities. In six patients (2%), the advice based on intraarterial DSA findings was additional treatment, while that based on MR angiographic findings was extended follow-up imaging; therefore, none of these patients were discharged from follow-up on the basis of MR angiographic findings. In six other patients (2%), the advice based on MR angiographic findings was additional treatment, while that based on intraarterial DSA findings was extended follow-up imaging (four patients), discharge from follow-up (one patient), and noninterpretable DSA (one patient). Extended follow-up imaging was suggested for 37 patients (12%) after intraarterial DSA and for 49 patients (16%) after MR angiography (difference: 4%; 95% CI: -0.6%, 8.4%). Interobserver agreement was substantial for intraarterial DSA (κ = 0.73; 95% CI: 0.64, 0.82) and moderate for MR angiography (κ = 0.53; 95% CI: 0.36, 0.70).
The overall proportion of patients advised to undergo additional treatment is similar based on intraarterial DSA and MR angiographic findings, with only few individual discrepancies. MR angiography can therefore be used for therapeutic decision making in the follow-up of patients with coil-treated aneurysms.
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112608/-/DC1.
评估磁共振（MR）血管造影是否可替代血管内数字减影血管造影（DSA）用于 coil 治疗颅内动脉瘤患者的随访，以指示额外的治疗。
这是一项伦理委员会批准的多中心研究。连续入组 coil 治疗后拟行血管内 DSA 随访的患者，在书面知情同意后行额外的 MR 血管造影。介入神经放射科医生根据每种成像方式的结果提供治疗建议（额外治疗、延长随访影像学检查或停止随访）。使用加权 κ 统计评估基于 DSA 和 MR 血管造影的治疗建议之间的治疗建议一致性和观察者间一致性。
基于 DSA 和 MR 血管造影的治疗建议之间的一致性较高（κ=0.73；95%置信区间：0.66，0.80）。在 310 例患者中的 34 例（11%）中，两种方法的建议都是额外治疗。在 6 例患者（2%）中，基于 DSA 检查结果的建议是额外治疗，而基于 MR 血管造影结果的建议是延长随访影像学检查，因此这些患者均未根据 MR 血管造影结果停止随访。在另外 6 例患者（2%）中，基于 MR 血管造影结果的建议是额外治疗，而基于 DSA 检查结果的建议是延长随访影像学检查（4 例）、停止随访（1 例）和 DSA 不可解读（1 例）。血管内 DSA 后建议延长随访影像学检查 37 例（12%），MR 血管造影后建议延长随访影像学检查 49 例（16%）（差异：4%；95%置信区间：-0.6%，8.4%）。DSA 的观察者间一致性较高（κ=0.73；95%置信区间：0.64，0.82），MR 血管造影的观察者间一致性为中等（κ=0.53；95%置信区间：0.36，0.70）。
基于 DSA 和 MR 血管造影的检查结果，建议进行额外治疗的患者比例总体相似，仅有少数个体差异。因此，MR 血管造影可用于 coil 治疗后动脉瘤患者的随访中的治疗决策。
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112608/-/DC1.
