Follow-up after embolization of ruptured intracranial aneurysms: A prospective comparison of two-dimensional digital subtraction angiography, three-dimensional digital subtraction angiography, and time-of-flight magnetic resonance angiography

Serafin, Zbigniew; Strześniewski, Piotr; Lasek, Władysław; Beuth, Wojciech

doi:10.1007/s00234-012-1030-z

Cited by 21 publications

(19 citation statements)

References 30 publications

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“…Seven studies additionally analyzed intraobserver agreement, and raters were blinded to their own previous findings. 8,10,17,[27][28][29]42 Only 8 studies mentioned that the readers were blinded to all patient information other than the images to be read. 10,12,14,[23][24][25]29,31 A single study pointed out that readers had not participated in the treatment of any of the aneurysms included in the study.…”

Section: Methodological Characteristics Of the Included Studiesmentioning

confidence: 99%

“…21,26 Two studies were both included despite the use of the same 72 patients because 1 study provided additional agreement data on a new modality timeresolved imaging of contrast kinetics. 27,28 Twenty-six studies met our inclusion criteria providing a total of 77 reliability estimates and were included in our analysis. No new articles were found by screening their references.…”

Section: Identification and Inclusion Of Studiesmentioning

confidence: 99%

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Is Visual Evaluation of Aneurysm Coiling a Reliable Study End Point?

Ernst

Yoo

Kriston

et al. 2015

Stroke

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Background and Purpose-Angiographic occlusion as a surrogate marker of satisfactory aneurysm treatment is commonly used in clinical trials although some pitfalls have to be considered. To investigate the inter-rater reliability of visual rating of aneurysm occlusion as study end point, we performed a systematic review and meta-analysis. Methods-Electronic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library) were searched up to June 2014. Assessment of risk for bias was based on the Quality Appraisal Tool for Studies of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement studies. Inter-rater reliability estimates were pooled across studies using meta-analysis, and the influence of several factors (eg, imaging methods, grading scales, and occlusion rate) was tested with meta-regression. Results-From 1193 titles, 644 abstracts and 87 full-text versions were reviewed. Twenty-six articles met the inclusion criteria and provided 77 reliability estimates. Twenty-one different rating scales were used, and statistical analysis varied. Mean inter-rater agreement of the pooled studies was substantial (κ=0.65; 95% confidence interval, 0.60-0.69).Reliability varied significantly as a function of imaging methods, grading scales, occlusion rates, and their interaction. Observer agreement substantially increased with increasing occlusion rate in digital subtraction angiography but not in MR angiography. Reliability was higher in studies using 2-or 3-value grading scales than in studies with 4-value grading scales. Conclusions-There is significant heterogeneity between studies evaluating the reliability of visual evaluation of aneurysm coiling. On the basis of our analysis, we found that the combination of magnetic resonance angiography, 3-value grading scale, and 2 trained raters seems most promising for usage as surrogate study end points. Ernst et al Reliability of Visual Evaluation of Aneurysm Coiling 1575 Data Sources and Study SelectionStudies were identified by searching electronic databases (Ovid MEDLINE and EMBASE, PubMed, and the Cochrane Library) up to June 2014. The full electronic search strategy for all databases is presented in Table I in the online-only Data Supplement. In addition, we handsearched systematic reviews and high-impact journals in the field of interventional neuroradiology (Stroke, American Journal of Neuroradiology, and Neuroradiology).The reference lists of all retrieved articles were checked for other relevant articles. Duplicates were removed, and the titles and abstracts of the retrieved articles were reviewed for appropriateness to the study question. Case reports, conference abstracts, reviews, editorials, meta-analysis, guidelines, and animal studies were excluded. Only articles in English, German, French, and Spanish were screened.From the remaining articles, full-text versions were reviewed in detail. Studies were eligible for inclusion if they evaluated the reliability of MRA or DSA of patients with intracranial aneurysms treated with endovascular c...

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Section: Methodological Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Identification and Inclusion Of Studiesmentioning

confidence: 99%

Is Visual Evaluation of Aneurysm Coiling a Reliable Study End Point?

Ernst

Yoo

Kriston

et al. 2015

Stroke

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“…2 Rotational 2D DSA images in which the mean diameter was calculated as a true value by syngo AX vessel analysis software at thresholds of 4500 (a), 2500 (b), and 500 (c) Fig. 3 In the region of the 620×620 area at the center of the rotational 2D DSA image (a), the contrast-enhanced area was extracted (b) [5][6][7][8][9][10]. These injection parameters are considered not optimal and seem to be excessive in order to ensure examination success.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, recent angiographic suites offer threedimensional (3D) DSA combining 2D DSA and gantry rotation, which was proven to be a useful technique [1][2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Relationship Between the Contrast Effects of Raw Data Projection Images from Three-Dimensional Digital Subtraction Angiography and the Optimal Volume Rendering Parameters

2014

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Volume rendering (VR) is a technique commonly used for the reconstruction of three-dimensional (3D) digital subtraction angiography (DSA) images, and the rendering parameters greatly affect the characteristics of the 3D image. This study aimed to test whether the optimal VR parameters for 3D DSA could be estimated from the contrast effects in rotational two-dimensional (2D) DSA images acquired using 3D DSA. Simulated blood vessels filled with various concentrations of contrast medium were scanned, and the 3D DSA data sets were reconstructed. The syngo AX vessel analysis software that was able to analyze 3D DSAVR image was used for objective measures. Raw data projection images of the 3D DSA data sets in which the mean diameter was calculated as a true value by the software at nine different thresholds for vessel segmentation were selected. In each image set, five images of all 133 rotational 2D DSA images were selected, and the contrast-enhanced area was extracted using a regiongrowing algorithm. Mean values and standard deviations of each contrast-enhanced area were calculated, and as the thresholds for vessel segmentation of the software increased by 500 every time, significant differences were observed in the mean values (P<0.01). This optimal threshold can be applied to the window settings of the VR technique. Therefore, the optimal VR parameters for 3D DSA may be determined by analyzing the contrast effects of the raw data projection images, and user-dependent over-and underestimations of 3D DSA VR images also may be prevented.

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Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA

et al. 2012

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IntroductionThe possibility of recanalization and the need for retreatment are the most important limitations of intracranial aneurysm embolization. The purpose of the study was to compare the size of aneurysm remnants measured at follow-up with three-dimensional digital subtracted angiography (3D-DSA) and magnetic resonance angiography (MRA).MethodsTwenty-six aneurysms were found incompletely occluded in 72 consecutively examined patients at a follow-up after 3 months. The diameters and volume of aneurysm remnants were compared between 3D-DSA, time-of-flight MRA (TOF-MRA), contrast-enhanced TOF-MRA (CE-TOF-MRA), and contrast-enhanced MRA (CE-MRA) at 1.5 T.ResultsThere was a significant correlation between remnant volumes calculated based on 3D-DSA and all MRA modalities. The intraobserver variability of the measurements ranged from 3.4 to 4.1 % and the interobserver variability from 5.8 to 7.3 %. There were no significant differences in the variability between the techniques. The mean residual filling volume ranged from 16.3 ± 19.0 mm3 in TOF-MRA to 30.5 ± 44.6 mm3 in 3D-DSA (P < 0.04). Significant differences were found in the volumes measured with 3D-DSA and CE-MRA as compared to TOF-MRA and CE-TOF-MRA (P < 0.01). There was a moderate significant correlation between the residual filling and the relative error of measurement in the case of TOF-MRA and CE-TOF-MRA.ConclusionsTOF-MRA seems to underestimate the size of aneurysm remnants detected at follow-up and should not be used as a sole imaging method to decide on re-embolization.

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Follow-up after embolization of ruptured intracranial aneurysms: A prospective comparison of two-dimensional digital subtraction angiography, three-dimensional digital subtraction angiography, and time-of-flight magnetic resonance angiography

Cited by 21 publications

References 30 publications

Is Visual Evaluation of Aneurysm Coiling a Reliable Study End Point?

Is Visual Evaluation of Aneurysm Coiling a Reliable Study End Point?

Relationship Between the Contrast Effects of Raw Data Projection Images from Three-Dimensional Digital Subtraction Angiography and the Optimal Volume Rendering Parameters

Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA

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