Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany.
Eur Radiol. 2021 Jun;31(6):4104-4113. doi: 10.1007/s00330-020-07492-3. Epub 2020 Nov 21.
The aim of this study was a detailed analysis of the value of contrast-enhanced magnetic resonance angiography (ceMRA) compared to digital subtraction angiography (DSA) for follow-up imaging of intracranial aneurysms treated by coil embolization.
Patients with coiled aneurysms and follow-up exams including both DSA and 3 T ceMRA were retrospectively identified. In blinded readings, both modalities were graded according to the modified Raymond-Roy classification (MRRC) and the Meyers scale. Additionally, readers were asked to make a decision regarding retreatment/follow-up based on the respective imaging findings.
The study comprised 92 patients harboring 102 coiled aneurysms. There was good intermethod agreement of DSA and ceMRA concerning both the MRRC (κ = 0.64) and the Meyers scale (κ = 0.74). Agreement regarding occlusion of < 90% of the aneurysm (Meyers grade ≥ 2) was very good (κ = 0.87). Regarding the detection of a remnant with contrast between the coil mass and the aneurysm wall (MRRC IIIb), there were 12 discrepant findings and agreement was good (κ = 0.70). Comparing treatment/follow-up decisions, the two methods agreed very well (κ = 0.92). In seven patients with discrepant treatment decisions, the authors concurred with DSA in four cases and with ceMRA in three cases when evaluating both modalities together. Interval aneurysm growth was found in more cases with ceMRA (n = 19) than with DSA (n = 16).
CeMRA is very unlikely to miss a relevant aneurysm remnant and thus could be suitable as the primary follow-up method. In case of remnant growth or recurrence, however, additional DSA might be required to guide treatment decisions.
• There is high accordance between ceMRA and DSA regarding the evaluation of intracranial aneurysms treated by endovascular coil embolization, but closer analysis also revealed relevant differences. • CeMRA could be suitable as the primary follow-up imaging modality, potentially eliminating the need for routine DSA. • DSA will still be required in case of aneurysm remnant growth or recurrence as detected by ceMRA.
本研究的目的是详细分析对比增强磁共振血管造影（ceMRA）与数字减影血管造影（DSA）在颅内动脉瘤弹簧圈栓塞治疗后随访成像中的价值。
回顾性识别接受弹簧圈栓塞治疗且有包括 DSA 和 3 T ceMRA 随访检查的患者。在盲法阅读中，根据改良 Raymond-Roy 分类（MRRC）和 Meyers 量表对两种方式进行分级。此外，根据各自的影像学发现，要求读者对再治疗/随访做出决定。
该研究共纳入 92 例患者的 102 个弹簧圈动脉瘤。DSA 和 ceMRA 在 MRRC（κ=0.64）和 Meyers 量表（κ=0.74）方面具有良好的方法间一致性。对于<90%的动脉瘤闭塞（Meyers 分级≥2）的一致性非常好（κ=0.87）。对于线圈质量与动脉瘤壁之间存在对比的残留（MRRC IIIb）的检测，有 12 个不一致的发现，一致性良好（κ=0.70）。比较治疗/随访决策，两种方法非常一致（κ=0.92）。在 7 例治疗决策不一致的患者中，当评估两种方式时，作者在 4 例中与 DSA 一致，在 3 例中与 ceMRA 一致。ceMRA 检测到的动脉瘤生长更多（n=19），而 DSA 检测到的动脉瘤生长较少（n=16）。
ceMRA 不太可能遗漏相关的动脉瘤残留，因此可能适合作为主要的随访方法。然而，在残留生长或复发的情况下，可能需要额外的 DSA 来指导治疗决策。
ceMRA 与 DSA 评估血管内弹簧圈栓塞治疗的颅内动脉瘤具有高度一致性，但更仔细的分析也显示出相关差异。
ceMRA 可能适合作为主要的随访成像方式，可能无需常规 DSA。
在 ceMRA 检测到动脉瘤残留生长或复发的情况下，仍需要 DSA。
