Department of Radiology, Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine, Penn State University, Hershey, Pennsylvania, USA.
Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine, Penn State University, Hershey, Pennsylvania, USA.
World Neurosurg. 2022 Jun;162:e147-e155. doi: 10.1016/j.wneu.2022.02.096. Epub 2022 Mar 3.
Few studies have evaluated flow diversion with magnetic resonance angiography (MRA). Studies have shown better success of MRA in assessing the aneurysm response, but limited success in assessing stent patency. The patency of arterial branches on MRA remains to be explored.
Retrospective evaluation of 31 consecutive cases of carotid aneurysms treated with flow diversion was performed with noncontrast time-of-flight (TOF), contrast-enhanced TOF, and cine MRA (time-resolved angiography with interleaved stochastic trajectories) independently by 2 investigators for aneurysm occlusion, stent patency, and arterial branch patency. Digital subtraction angiography served as the gold standard technique.
Patients were 6 men and 25 women with a mean ± SD age of 57.8 ± 12.27 years (range, 32-79 years). Stent patency, aneurysm occlusion, and branch patency mostly revealed substantial to perfect interobserver agreement (κ >0.60). Sensitivity, specificity, positive predictive value, and negative predictive value for stent patency on raw data images of TOF were 0.50, 0.86, 0.20, and 0.96 and on contrast-enhanced TOF were 1.0, 0.93, 0.50, and 1.0. Ranges for aneurysm response on the 3 MRA scans were 0.78-0.89 for sensitivity, 0.54-0.92 for specificity, 0.73-0.93 for positive predictive value, and 0.78-0.86 for negative predictive value. Ranges for arterial branch patency among the 3 MRA scans were 0.87-0.96 for sensitivity, 0.50-1.0 for specificity, 0.90-1.0 for positive predictive value, and 0.33-0.80 for negative predictive value.
Aneurysm occlusion, stent patency, and arterial branch patency in flow diversion can be successfully evaluated with the combination of 3 MRA techniques.
很少有研究评估磁共振血管造影（MRA）下的血流导向。研究表明，MRA 在评估动脉瘤反应方面更成功，但在评估支架通畅性方面的成功有限。MRA 上动脉分支的通畅性仍有待探索。
对 31 例连续接受血流导向治疗的颈动脉动脉瘤患者进行回顾性评估，由 2 名研究者分别使用非对比时间飞越（TOF）、对比增强 TOF 和电影 MRA（随机轨迹时间分辨血管造影）独立评估动脉瘤闭塞、支架通畅性和动脉分支通畅性。数字减影血管造影作为金标准技术。
患者为 6 名男性和 25 名女性，平均年龄±标准差为 57.8±12.27 岁（范围 32-79 岁）。支架通畅性、动脉瘤闭塞和分支通畅性大多显示出观察者间高度至极好的一致性（κ>0.60）。TOF 原始数据图像上支架通畅性的灵敏度、特异性、阳性预测值和阴性预测值分别为 0.50、0.86、0.20 和 0.96，对比增强 TOF 分别为 1.0、0.93、0.50 和 1.0。3 种 MRA 扫描的动脉瘤反应灵敏度范围为 0.78-0.89，特异性范围为 0.54-0.92，阳性预测值范围为 0.73-0.93，阴性预测值范围为 0.78-0.86。3 种 MRA 扫描中动脉分支通畅性的灵敏度范围为 0.87-0.96，特异性范围为 0.50-1.0，阳性预测值范围为 0.90-1.0，阴性预测值范围为 0.33-0.80。
通过 3 种 MRA 技术的结合，可以成功评估血流导向的动脉瘤闭塞、支架通畅性和动脉分支通畅性。
