Boddu S R, Tong F C, Dehkharghani S, Dion J E, Saindane A M
From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.)
From the Departments of Radiology and Imaging Sciences (S.R.B., F.C.T., S.D., J.E.D., A.M.S.) Neurological Surgery (F.C.T., J.E.D.), Emory University School of Medicine, Atlanta, Georgia.
AJNR Am J Neuroradiol. 2014 Nov-Dec;35(11):2112-8. doi: 10.3174/ajnr.A4008. Epub 2014 Jul 3.
Endovascular reconstruction and flow diversion by using the Pipeline Embolization Device is an effective treatment for complex cerebral aneurysms. Accurate noninvasive alternatives to DSA for follow-up after Pipeline Embolization Device treatment are desirable. This study evaluated the accuracy of contrast-enhanced time-resolved MRA for this purpose, hypothesizing that contrast-enhanced time-resolved MRA will be comparable with DSA and superior to 3D-TOF MRA.
During a 24-month period, 37 Pipeline Embolization Device-treated intracranial aneurysms in 26 patients underwent initial follow-up by using 3D-TOF MRA, contrast-enhanced time-resolved MRA, and DSA. MRA was performed on a 1.5T unit by using 3D-TOF and time-resolved imaging of contrast kinetics. All patients underwent DSA a median of 0 days (range, 0-68) after MRA. Studies were evaluated for aneurysm occlusion, quality of visualization of the reconstructed artery, and measurable luminal diameter of the Pipeline Embolization Device, with DSA used as the reference standard.
The sensitivity, specificity, and positive and negative predictive values of contrast-enhanced time-resolved MRA relative to DSA for posttreatment aneurysm occlusion were 96%, 85%, 92%, and 92%. Contrast-enhanced time-resolved MRA demonstrated superior quality of visualization (P = .0001) and a higher measurable luminal diameter (P = .0001) of the reconstructed artery compared with 3D-TOF MRA but no significant difference compared with DSA. Contrast-enhanced time-resolved MRA underestimated the luminal diameter of the reconstructed artery by 0.965 ± 0.497 mm (27% ± 13%) relative to DSA.
Contrast-enhanced time-resolved MRA is a reliable noninvasive method for monitoring intracranial aneurysms following flow diversion and vessel reconstruction by using the Pipeline Embolization Device.
使用Pipeline栓塞装置进行血管内重建和血流导向是治疗复杂脑动脉瘤的有效方法。对于Pipeline栓塞装置治疗后的随访，需要准确的无创替代DSA的方法。本研究评估了对比增强时间分辨MRA在此方面的准确性，假设对比增强时间分辨MRA将与DSA相当且优于三维时间飞跃法（3D-TOF）MRA。
在24个月期间，对26例患者中37个经Pipeline栓塞装置治疗的颅内动脉瘤进行了初始随访，采用三维时间飞跃法（3D-TOF）MRA、对比增强时间分辨MRA和DSA。MRA在1.5T设备上采用三维时间飞跃法（3D-TOF）和对比剂动力学时间分辨成像进行。所有患者在MRA后中位数0天（范围0 - 68天）接受DSA检查。以DSA作为参考标准，对研究进行动脉瘤闭塞情况、重建动脉可视化质量以及Pipeline栓塞装置可测量管腔直径的评估。
对比增强时间分辨MRA相对于DSA对治疗后动脉瘤闭塞情况的敏感性、特异性、阳性和阴性预测值分别为96%、85%、92%和92%。与三维时间飞跃法（3D-TOF）MRA相比，对比增强时间分辨MRA显示出重建动脉更高的可视化质量（P = 0.0001）和更大的可测量管腔直径（P = 0.0001），但与DSA相比无显著差异。对比增强时间分辨MRA相对于DSA低估了重建动脉的管腔直径0.965±0.497mm（27%±13%）。
对比增强时间分辨MRA是一种可靠的无创方法，用于监测使用Pipeline栓塞装置进行血流导向和血管重建后的颅内动脉瘤。
