Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
China International Neuroscience Institute, Beijing, China.
J Neurointerv Surg. 2021 Dec;13(12):1172-1179. doi: 10.1136/neurintsurg-2020-016788. Epub 2021 Feb 25.
Time-of-flight magnetic resonance angiography (TOF-MRA) is widely used in detecting intracranial aneurysms (IA), but it is limited and controversial for use during follow-up to assess the outcome of interventional coiling or clipping surgery.
To evaluate the specificity and sensitivity of using TOF-MRA as an imaging follow-up for IA with different treatments. A total of 280 patients with 326 treated IA underwent simultaneous TOF-MRA and digital subtraction angiography (DSA) as follow-up imaging on the same day. All images were independently reviewed by two neurosurgeons and two radiologists. The consensus evaluation of intra-arterial DSA as a reference test was used to evaluate the result of aneurysm occlusions. The aneurysmal embolization status was assessed with two ratings involving complete or incomplete occlusions. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value of three-dimensional-TOF-MRA to investigate the diagnostic performance.
Overall sensitivity and specificity of TOF-MRA for diagnosing the remnant were 83.3% and 95.2%, respectively. The sensitivity and specificity of interventional therapy was 90.0% and 94.2%, respectively, while the clipping group showed sensitivity and specificity of 50.0% and 100%, respectively. For additional groups, involving coil only, stent-assisted, and flow diverter, the analysis of interventional therapy showed sensitivities and specificities of 100.0% and 90.1%, 66.7% and 95.1%, and 91.7% and 100%, respectively.
TOF-MRA can be used as a first-line noninvasive imaging modality during follow-up, especially for the patients treated with a pipeline embolization device and coils only. But it may not be enough for clipped aneurysms.
时间飞跃磁共振血管造影（TOF-MRA）广泛用于检测颅内动脉瘤（IA），但在评估介入线圈或夹闭手术的结果时，其作为随访的成像方法存在局限性和争议。
评估 TOF-MRA 作为不同治疗方法的 IA 影像学随访的特异性和敏感性。共有 280 例 326 个治疗后的 IA 患者在同一天同时进行 TOF-MRA 和数字减影血管造影（DSA）作为随访成像。两名神经外科医生和两名放射科医生独立对所有图像进行了审查。以动脉内 DSA 的共识评估作为参考测试，评估动脉瘤闭塞的结果。使用两种评分评估动脉瘤栓塞状态，包括完全或不完全闭塞。我们计算了三维-TOF-MRA 的灵敏度、特异性、阴性预测值和阳性预测值，以研究诊断性能。
TOF-MRA 对诊断残留的总体灵敏度和特异性分别为 83.3%和 95.2%。介入治疗的灵敏度和特异性分别为 90.0%和 94.2%，而夹闭组的灵敏度和特异性分别为 50.0%和 100%。对于包括线圈、支架辅助和血流导向装置的其他组，介入治疗的分析显示灵敏度和特异性分别为 100.0%和 90.1%、66.7%和 95.1%以及 91.7%和 100%。
TOF-MRA 可作为随访期间的一线无创成像方式，特别是对于接受Pipeline 栓塞装置和仅线圈治疗的患者。但对于夹闭的动脉瘤可能不够。
