Phadke Rajendra Vishnu, Singh Vivek, Balaguruswamy Madan Mohan, Udiya Alok, Shetty Gurucharan Sunnari, Prasad Surya Nandan, Mittal Somit, Chauhan Gaurav, Dhull Vedita, Neyaz Zafar
Department of Radiodiagnosis and Interventional Radiology, Apollomedics Superspeciality Hospitals, Lucknow, India.
Department of (former Prof. and Head), Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Asian J Neurosurg. 2020 Dec 21;15(4):889-898. doi: 10.4103/ajns.AJNS_374_20. eCollection 2020 Oct-Dec.
We retrospectively re-evaluated follow-up three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) in patients with aneurysms treated with coiling at our Institute.
To document the type and frequency of postcoiling residue patterns as seen on follow-up MRA and to document their evolution with time where a further follow-up MRA was available. To assess the implications of the location of the aneurysm on residue and recurrence.
3D TOF MRA for 104 aneurysms were evaluated for residue size and residue pattern. Mainly, three residue patterns were identified. The aneurysms were allocated to different groups depending on the location. Multiple MRA studies were available in subgroup 1* and subgroup 2* where the residue growth or reduction and pattern change was noted and residue growth rates were calculated.
Collectively 54 (51.92%) aneurysms showed occlusion (pattern 1 and 1A), 31 (29.81%) showed neck residue (pattern 2A, 2B and 2C) and 19 (18.27%) showed recurrence (pattern 3A, 3B and 3C, residue size >3 mm) at the last follow-up MRA. Type 2A/3A patterns were more common. In terms of residue and recurrence, the distally located aneurysms (Group 3) appeared to do well. For those showing growing residue/recurrence, the average growth rate was calculated at 0.094 mm/month and 0.15 mm/month, respectively, for subgroup 1* and subgroup 2*, although the difference was not statistically significant. With longer follow-up the persisting and growing residues from both the subgroups, not warranting early re-treatment, showed a low growth rate at approximately 0.05 mm/month.
TOF MRA helps in identifying different residue patterns in coiled aneurysms. Serial follow-up MRA appears useful in showing the pattern and size changes in the residual aneurysm. Although more work is required in this regard, calculation of aneurysm/residue growth rate may be useful in prognostication and in scheduling further follow-up or retreatment. The risk factor related to the location of the aneurysm warrants further study.
我们对在我院接受线圈栓塞治疗的动脉瘤患者的随访三维（3D）时间飞跃（TOF）磁共振血管造影（MRA）进行了回顾性重新评估。
记录随访MRA上所见的栓塞后残留模式的类型和频率，并在有进一步随访MRA的情况下记录其随时间的演变。评估动脉瘤位置对残留和复发的影响。
对104个动脉瘤的3D TOF MRA进行残留大小和残留模式评估。主要识别出三种残留模式。根据位置将动脉瘤分为不同组。在亚组1和亚组2中有多个MRA研究，记录了残留的生长或缩小以及模式变化，并计算了残留生长率。
在最后一次随访MRA时，共有54个（51.92%）动脉瘤显示闭塞（模式1和1A），31个（29.81%）显示颈部残留（模式2A、2B和2C），19个（18.27%）显示复发（模式3A、3B和3C，残留大小>3mm）。2A/3A模式更为常见。就残留和复发而言，位于远端的动脉瘤（第3组）似乎情况较好。对于那些显示残留/复发增长的患者，亚组1和亚组2的平均生长率分别计算为0.094mm/月和0.15mm/月，尽管差异无统计学意义。随着随访时间延长，两个亚组中持续存在且不断生长的残留，虽无需早期再次治疗，但生长率较低，约为0.05mm/月。
TOF MRA有助于识别线圈栓塞动脉瘤的不同残留模式。系列随访MRA似乎有助于显示残留动脉瘤的模式和大小变化。尽管在这方面还需要更多工作，但计算动脉瘤/残留生长率可能有助于预后评估以及安排进一步随访或再次治疗。与动脉瘤位置相关的危险因素值得进一步研究。
