MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis

Abstract

BackgroundTreated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed.MethodsComprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond–Roy occlusion grading scale.ResultsThe literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%.ConclusionMRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.

Outcome Study of the Pipeline Embolization Device with Shield Technology in Unruptured Aneurysms (PEDSU)

“…Studies such as PFLEX 20 , PITA 1 and PUFS 5 employed DSA as the follow-up modality for PED-treated aneurysms. There has been widespread adoption of flow-diverter devices with a range of follow-up methods and time points and a recent meta-analysis that compared MRA and DSA concluded that both 3D-TOF-MRA and contrast-enhanced MRA can be used reliably to follow up flow-diverter devices 30 . The sensitivity and specificity of TOF-MRA were 86% and 95%, respectively.…”

The Role of Long Non-Coding RNAs in Intracranial Aneurysms and Subarachnoid Hemorrhage

“…Diagnosis of IAs mainly depends on imaging diagnostic methods, such as magnetic resonance angiogram (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA) [49]. Despite the fact that preoperative diagnosis has improved in recent years, overall prognosis remains poor, and SAH remains a serious health problem.…”

Woven Endobridge (WEB) Device as a Retreatment Strategy After Unsuccessful Surgical Clipping

“…Other limitations are that follow-up was relatively short (mean follow-up 5 months and 15 months) and 3D TOF MRA was used for follow-up in two cases. Whilst a recent metaanalysis has shown that MRA (whether using TOF MRA or CEMRA) is a reliable modality for the follow-up of aneurysms treated using a variety of endovascular techniques (including stent-assisted coiling and flow diverters), 23 it is possible that there was a reduction in sensitivity compared to DSA in detecting aneurysmal remnants according two small retrospective studies where WEB susceptibility was described. 24,25 It is conceivable that the adequate occlusion rates observed in our series could be lower.…”