nach oben

European Radiology

Erschienen in:

21.11.2020 | Neuro

The clinical value of ceMRA versus DSA for follow-up of intracranial aneurysms treated by coil embolization: an assessment of occlusion classifications and impact on treatment decisions

verfasst von: Maximilian Patzig, Robert Forbrig, Margaretha Gruber, Thomas Liebig, Franziska Dorn

Erschienen in: European Radiology | Ausgabe 6/2021

Einloggen, um Zugang zu erhalten

Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

Key Points

• 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.

Lin N, Cahill KS, Frerichs KU, Friedlander RM, Claus EB (2012) Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift. J Neurointerv Surg 4(3):182–189. https://doi.org/10.1136/jnis.2011.004978CrossRefPubMed

Brinjikji W, Lanzino G, Rabinstein AA, Kallmes DF, Cloft HJ (2013) Age-related trends in the treatment and outcomes of ruptured cerebral aneurysms: a study of the nationwide inpatient sample 2001-2009. AJNR Am J Neuroradiol 34(5):1022–1027. https://doi.org/10.3174/ajnr.A3321CrossRefPubMedPubMedCentral

Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J (2010) Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology 256(3):887–897. https://doi.org/10.1148/radiol.10091982CrossRefPubMed

Molyneux AJ, Kerr RS, Yu LM et al (2005) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817. https://doi.org/10.1016/S0140-6736(05)67214-5CrossRefPubMed

Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS (2015) The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 385(9969):691–697. https://doi.org/10.1016/S0140-6736(14)60975-2CrossRefPubMedPubMedCentral

Pierot L, Spelle L, Vitry F, ATENA Investigators (2008) Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 39(9):2497–2504. https://doi.org/10.1161/STROKEAHA.107.512756

Ferns SP, Sprengers ME, van Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40(8):e523–e529. https://doi.org/10.1161/STROKEAHA.109.553099CrossRefPubMed

Lecler A, Raymond J, Rodriguez-Regent C et al (2015) Intracranial aneurysms: recurrences more than 10 years after endovascular treatment-a prospective cohort study, systematic review, and meta-analysis. Radiology 277(1):173–180. https://doi.org/10.1148/radiol.2015142496CrossRefPubMed

Yeon EK, Cho YD, Yoo DH et al(2020) Delayed progression to major recanalization in coiled aneurysms with minor recanalization at 36-month follow-up: incidence and related risk factors. Clin Neuroradiol. https://doi.org/10.1007/s00062-020-00887-1

10.

Soize S, Gawlitza M, Raoult H, Pierot L (2016) Imaging follow-up of intracranial aneurysms treated by endovascular means: why, when, and how? Stroke 47(5):1407–1412. https://doi.org/10.1161/STROKEAHA.115.011414CrossRefPubMed

11.

Hacein-Bey L, Provenzale JM (2011) Current imaging assessment and treatment of intracranial aneurysms. AJR Am J Roentgenol 196(1):32–44. https://doi.org/10.2214/AJR.10.5329CrossRefPubMed

12.

Cloft HJ, Joseph GJ, Dion JE (1999) Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 30(2):317–320. https://doi.org/10.1161/01.str.30.2.317CrossRefPubMed

13.

Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W (2003) Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 227(2):522–528. https://doi.org/10.1148/radiol.2272012071CrossRefPubMed

14.

Agid R, Willinsky RA, Lee SK, Terbrugge KG, Farb RI (2008) Characterization of aneurysm remnants after endovascular treatment: contrast-enhanced MR angiography versus catheter digital subtraction angiography. AJNR Am J Neuroradiol 29(8):1570–1574. https://doi.org/10.3174/ajnr.A1124CrossRefPubMedPubMedCentral

15.

Gramsch C, Zulow S, Nensa F et al (2016) Can we now dispense with DSA in the evaluation of aneurysm occlusion even in the most crucial first follow-up after endovascular treatment? Clin Neurol Neurosurg 149:136–142. https://doi.org/10.1016/j.clineuro.2016.08.005CrossRefPubMed

16.

Pierot L, Portefaix C, Boulin A, Gauvrit JY (2012) Follow-up of coiled intracranial aneurysms: comparison of 3D time-of-flight and contrast-enhanced magnetic resonance angiography at 3T in a large, prospective series. Eur Radiol 22(10):2255–2263. https://doi.org/10.1007/s00330-012-2466-6CrossRefPubMed

17.

van Amerongen MJ, Boogaarts HD, de Vries J et al (2014) MRA versus DSA for follow-up of coiled intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol 35(9):1655–1661. https://doi.org/10.3174/ajnr.A3700CrossRefPubMedPubMedCentral

18.

Menke J, Schramm P, Sohns JM, Kallenberg K, Staab W (2014) Diagnosing flow residuals in coiled cerebral aneurysms by MR angiography: meta-analysis. J Neurol 261(4):655–662. https://doi.org/10.1007/s00415-013-7053-5CrossRefPubMed

19.

Ahmed SU, Mocco J, Zhang X et al (2019) MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis. J Neurointerv Surg 11(10):1009–1014. https://doi.org/10.1136/neurintsurg-2019-014936CrossRefPubMed

20.

Kwee TC, Kwee RM (2007) MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis. Neuroradiology 49(9):703–713. https://doi.org/10.1007/s00234-007-0266-5CrossRefPubMed

21.

Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32(9):1998–2004. https://doi.org/10.1161/hs0901.095600CrossRefPubMed

22.

Mascitelli JR, Moyle H, Oermann EK et al (2015) An update to the Raymond-Roy occlusion classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 7(7):496–502. https://doi.org/10.1136/neurintsurg-2014-011258CrossRefPubMed

23.

Stapleton CJ, Torok CM, Rabinov JD et al (2016) Validation of the modified Raymond-Roy classification for intracranial aneurysms treated with coil embolization. J Neurointerv Surg 8(9):927–933. https://doi.org/10.1136/neurintsurg-2015-012035CrossRefPubMed

24.

Meyers PM, Schumacher HC, Higashida RT et al (2010) Reporting standards for endovascular repair of saccular intracranial cerebral aneurysms. J Neurointerv Surg 2(4):312–323. https://doi.org/10.1136/jnis.2010.002337CrossRefPubMed

25.

Rouchaud A, Brinjikji W, Gunderson T et al (2016) Validity of the Meyer scale for assessment of coiled aneurysms and aneurysm recurrence. AJNR Am J Neuroradiol 37(5):844–848. https://doi.org/10.3174/ajnr.A4616CrossRefPubMedPubMedCentral

26.

Kaufmann TJ, Huston J 3rd, Cloft HJ et al (2010) A prospective trial of 3T and 1.5T time-of-flight and contrast-enhanced MR angiography in the follow-up of coiled intracranial aneurysms. AJNR Am J Neuroradiol 31(5):912–918. https://doi.org/10.3174/ajnr.A1932CrossRefPubMedPubMedCentral

27.

Schaafsma JD, Velthuis BK, Majoie CB et al (2010) Intracranial aneurysms treated with coil placement: test characteristics of follow-up MR angiography--multicenter study. Radiology 256(1):209–218. https://doi.org/10.1148/radiol.10091528CrossRefPubMed

28.

Lavoie P, Gariepy JL, Milot G et al (2012) Residual flow after cerebral aneurysm coil occlusion: diagnostic accuracy of MR angiography. Stroke 43(3):740–746. https://doi.org/10.1161/STROKEAHA.111.635300CrossRefPubMed

29.

Eskridge JM, Song JK (1998) Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 89(1):81–86. https://doi.org/10.3171/jns.1998.89.1.0081CrossRefPubMed

30.

Kuether TA, Nesbit GM, Barnwell SL (1998) Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. Neurosurgery 43(5):1016–1025. https://doi.org/10.1097/00006123-199811000-00007CrossRefPubMed

31.

Schaafsma JD, Velthuis BK, van den Berg R et al (2012) Coil-treated aneurysms: decision making regarding additional treatment based on findings of MR angiography and intraarterial DSA. Radiology 265(3):858–863. https://doi.org/10.1148/radiol.12112608CrossRefPubMed

32.

Lubicz B, Neugroschl C, Collignon L, Francois O, Baleriaux D (2008) Is digital subtraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils? Neuroradiology 50(10):841–848. https://doi.org/10.1007/s00234-008-0450-2CrossRefPubMed

33.

Marciano D, Soize S, Metaxas G, Portefaix C, Pierot L (2017) Follow-up of intracranial aneurysms treated with stent-assisted coiling: comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography. J Neuroradiol 44(1):44–51. https://doi.org/10.1016/j.neurad.2016.10.004CrossRefPubMed

34.

Cloft HJ, Kaufmann T, Kallmes DF (2007) Observer agreement in the assessment of endovascular aneurysm therapy and aneurysm recurrence. AJNR Am J Neuroradiol 28(3):497–500PubMedPubMedCentral

35.

Zuckerman SL, Lakomkin N, Magarik JA et al (2018) Evaluation of previously embolized intracranial aneurysms: inter-and intra-rater reliability among neurosurgeons and interventional neuroradiologists. J Neurointerv Surg 10(5):462–466. https://doi.org/10.1136/neurintsurg-2017-013231CrossRefPubMed

Titel: The clinical value of ceMRA versus DSA for follow-up of intracranial aneurysms treated by coil embolization: an assessment of occlusion classifications and impact on treatment decisions
verfasst von: Maximilian Patzig
Robert Forbrig
Margaretha Gruber
Thomas Liebig
Franziska Dorn
Publikationsdatum: 21.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 6/2021
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07492-3

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

The clinical value of ceMRA versus DSA for follow-up of intracranial aneurysms treated by coil embolization: an assessment of occlusion classifications and impact on treatment decisions

Abstract

Objective

Methods

Results

Conclusions

Key Points

Neu im Fachgebiet Radiologie

Akuter Schwindel: Wann lohnt sich eine MRT?

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Radiologie

Springer Medizin

Abstract

Objective

Methods

Results

Conclusions

Key Points

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2021

Operator’s eye lens dose in computed tomography–guided interventions

Evaluation of a novel deep learning–based classifier for perifissural nodules

Correction to: CT volume of enhancement of disease (VED) can predict the early response to treatment and overall survival in patients with advanced HCC treated with sorafenib

Prognostic relevance of temporal muscle thickness as a marker of sarcopenia in patients with glioblastoma at diagnosis

Correction to: A susceptibility-weighted imaging qualitative score of the motor cortex may be a useful tool for distinguishing clinical phenotypes in amyotrophic lateral sclerosis

Correction to: CT and clinical assessment in asymptomatic and pre-symptomatic patients with early SARS-CoV-2 in outbreak settings

Neu im Fachgebiet Radiologie

Akuter Schwindel: Wann lohnt sich eine MRT?

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Radiologie