Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan.
Department of Medical Image Sciences, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan.
Eur Radiol. 2023 Nov;33(11):7923-7933. doi: 10.1007/s00330-023-09755-1. Epub 2023 Jun 7.
As a novel follow-up method for intracranial aneurysms treated with stent-assisted coil embolization (SACE), we developed four-dimensional magnetic resonance angiography (MRA) with minimized acoustic noise utilizing ultrashort-echo time (4D mUTE-MRA). We aimed to assess whether 4D mUTE-MRA is useful for the evaluation of intracranial aneurysms treated with SACE.
This study included 31 consecutive patients with intracranial aneurysm treated with SACE who underwent 4D mUTE-MRA at 3 T and digital subtraction angiography (DSA). For 4D mUTE-MRA, five dynamic MRA images with a spatial resolution of 0.5 × 0.5 × 0.5 mm were obtained every 200 ms. Two readers independently reviewed the 4D mUTE-MRA images to evaluate the aneurysm occlusion status (total occlusion, residual neck, and residual aneurysm) and the flow in the stent using a 4-point scale (from 1 [not visible] to 4 [excellent]). The interobserver and intermodality agreement was assessed using κ statistics.
On DSA images, 10 aneurysms were classified as total occlusion, 14 as residual neck, and 7 as residual aneurysm. In terms of aneurysm occlusion status, the intermodality and interobserver agreement was excellent (κ = 0.92 and κ = 0.96, respectively). For the flow in the stents on 4D mUTE-MRA, the mean score was significantly higher for single stents than multiple stents (p < .001) and for open-cell type stents than closed-cell type (p < .01).
4D mUTE-MRA is a useful tool with a high spatial and temporal resolution for the evaluation of intracranial aneurysms treated with SACE.
• In the evaluation of intracranial aneurysms treated with SACE on 4D mUTE-MRA and DSA, the intermodality and interobserver agreement in aneurysm occlusion status was excellent. • 4D mUTE-MRA shows good to excellent visualization of flow in the stents, especially for cases treated with a single or open-cell stent. • 4D mUTE-MRA can provide hemodynamic information related to embolized aneurysms and the distal arteries to stented parent arteries.
我们开发了一种利用超短回波时间（4D mUTE-MRA）的最小化噪声的四维磁共振血管造影（MRA），作为支架辅助线圈栓塞（SACE）治疗颅内动脉瘤的一种新的随访方法。我们旨在评估 4D mUTE-MRA 是否可用于评估 SACE 治疗的颅内动脉瘤。
本研究纳入了 31 例接受 SACE 治疗的颅内动脉瘤患者，这些患者在 3T 磁共振扫描仪上接受了 4D mUTE-MRA 和数字减影血管造影（DSA）检查。对于 4D mUTE-MRA，每 200ms 可获得 5 张具有 0.5×0.5×0.5mm 空间分辨率的动态 MRA 图像。两位读者使用 4 分制（1[不可见]至 4[极好]）独立评估 4D mUTE-MRA 图像以评估动脉瘤闭塞状态（完全闭塞、残余颈部和残余动脉瘤）和支架内的血流。使用κ统计量评估观察者间和观察者内的一致性。
在 DSA 图像上，10 个动脉瘤被分类为完全闭塞，14 个为残余颈部，7 个为残余动脉瘤。在动脉瘤闭塞状态方面，两种模态之间和观察者之间的一致性非常好（κ=0.92 和 κ=0.96）。对于 4D mUTE-MRA 上支架内的血流，单支架的平均评分明显高于多支架（p<.001），开放细胞型支架的平均评分也高于封闭细胞型支架（p<.01）。
4D mUTE-MRA 是一种具有高空间和时间分辨率的有用工具，可用于评估 SACE 治疗的颅内动脉瘤。
在 4D mUTE-MRA 和 DSA 上评估 SACE 治疗的颅内动脉瘤，动脉瘤闭塞状态的两种模态之间和观察者之间的一致性非常好。
4D mUTE-MRA 可很好地显示支架内血流，尤其适用于单支架或开放细胞支架治疗的病例。
4D mUTE-MRA 可提供与栓塞动脉瘤和支架母动脉相关的远端动脉相关的血流动力学信息。
