Usefulness of Silent Magnetic Resonance Angiography in the Follow-Up of Endovascular-Treated Intracranial Aneurysm: A Prospective Study

Tan, Song; Lu, Yuzhao; Li, Bin; Wu, Qin; Zhou, Xiaobing; Wang, Yang

doi:10.1016/j.jstrokecerebrovasdis.2021.106256

Cited by 5 publications

(6 citation statements)

References 14 publications

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Section: Discussionmentioning

confidence: 99%

“…Multiple studies have reported the clinical usefulness of silent MRA in the follow-up of endovascularly-treated aneurysms 1 3–9. However, most studies had limited generalizability because they only included aneurysms treated by one intervention method or had small sample sizes 1 3–6 8 9. Ryu et al 7 published a retrospective study that included 126 aneurysms treated by different methods, and demonstrated good diagnostic performance of silent MRA.…”

Section: Discussionmentioning

confidence: 99%

“…TOF-MRA adopts the inflow effect for blood flow depiction, so it is vulnerable to hemodynamic fluctuations. By contrast, the arterial spin-labeling technique adopted in silent MRA is not affected by the hemodynamic fluctuations and can achieve a better background suppression 9. Meanwhile, the zero echo time technique adopted in silent MRA can minimize the sensitivity to eddy current and field heterogeneity by avoiding dephasing during echo time, thereby reducing the artifacts caused by metal implants.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have demonstrated that silent MRA has higher diagnostic performance than TOF MRA in the follow-up of aneurysms treated by different intervention approaches (figure 1). 1 3–9 Nevertheless, most previous studies were retrospective or had small sample sizes.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of silent magnetic resonance angiography for endovascularly-treated intracranial aneurysm follow-up: a prospective study

Tan

et al. 2022

J NeuroIntervent Surg

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BackgroundMultiple studies have reported the clinical usefulness of silent magnetic resonance angiography (MRA) in the follow-up of endovascularly-treated aneurysms. However, most previous studies were retrospective or with small sample sizes. The objective of this study was to prospectively evaluate the diagnostic performance of silent MRA in the follow-up of intracranial aneurysms treated by different interventional approaches.MethodsPatients with endovascularly-treated intracranial aneurysms and followed by silent MRA and digital subtraction angiography (DSA) were enrolled. The visualization of treated sites on silent MRA was rated on a 5-point scale. The aneurysm occlusion status was evaluated using the Raymond Scale and a simplified two-grade scale.ResultsA total of 155 patients with 175 treated aneurysms were enrolled. The average score for the visualization of treated sites was 3.92±0.94, and 93.7% (164/175) had a score ≥3. In the subgroup analysis, except for the simple coiling group which had an obviously higher score (4.95±0.21), there was no significant difference among the stent-assisted coiling group (3.51±0.77), flow diversion group (3.74±0.80), and flow diversion with coiling group (3.40±1.17). Regarding aneurysm occlusion status, silent MRA and DSA were discordant for only one aneurysm using the Raymond Scale, and the inter-modality consistency was almost perfect (κ=0.992, 95% CI 0.977 to 1.000).ConclusionsSilent MRA showed an excellent diagnostic performance in the follow-up of endovascularly-treated intracranial aneurysms, and may be an ideal option for repeated examinations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of silent magnetic resonance angiography for endovascularly-treated intracranial aneurysm follow-up: a prospective study

Tan

et al. 2022

J NeuroIntervent Surg

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“…On TOF-MRA, aneurysm size has been reported to affect visuality. 16,17 According to a package insert of coil materials for aneurysms, all coils are made of platinum (92%) and tungsten (8%). These are paramagnetic materials that distort the magnetic field.…”

Section: Discussionmentioning

confidence: 99%

Ultrashort Echo Time Magnetic Resonance Angiography as an Alternative Tool to Digital Subtraction Angiography in the Follow-up of Stent-Assisted Coil Embolization Outcomes

et al. 2022

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BACKGROUND: Follow-up of aneurysms treated with stent-assisted coil embolization has been performed using digital subtraction angiography (DSA) because in time-of-flight magnetic resonance angiography, metal artifacts from the stent often affect visualization. OBJECTIVE: To confirm whether ultrashort echo time (TE) MRA may be an alternative for DSA during follow-up. METHODS: Patients with unruptured aneurysms initially treated with stent-assisted coil embolization between April 2019 and March 2021 were enrolled. After 3 months of treatment, follow-up DSA and ultrashort TE MRA were performed. All images were independently reviewed by neurosurgeons to evaluate in-stent flow and rated from 1 (not visible) to 4 (excellent). Aneurysmal embolization status was assessed as complete obliteration, residual neck, or residual aneurysm. Ultrashort TE MRA findings were classified as evaluative or nonevaluative state based on the presence of metal artifacts. We investigated the types of aneurysms that were evaluative and the agreement between ultrashort TE and DSA. RESULTS: Overall, 89 aneurysms were examined, of which 74% (n = 66) were classified as evaluative on ultrashort TE. Significant differences were observed in size and stent type. Evaluative cases had an aneurysm size of <7 mm (P = .0007) and a higher rate of Neuroform Atlas (P = .0006). The rate of agreement between ultrashort TE with evaluative state and DSA was 95%. CONCLUSION: Ultrashort TE MRA could evaluate an embolization status treated with stenting, and the findings are in excellent agreement with those of DSA. Aneurysms measuring <7 mm and treated with Neuroform Atlas are evaluative on ultrashort TE, and DSA might not be necessary.

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Usefulness of silent magnetic resonance angiography for intracranial aneurysms treated with a flow re-direction endoluminal device

et al. 2023

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Purpose Flow re-direction endoluminal device (FRED) is a novel dual-layer flow-diverting stent to treat cerebral aneurysms with high obliteration rates, however, it induces inevitable metal-related artifacts. We compared silent magnetic resonance angiography (MRA), a new MRA method using ultra-short time of echo and arterial spin-labeling, with conventional time-of-flight (TOF)-MRA for imaging aneurysms treated using FRED. Methods Between May 2020 and September 2022, 16 patients with unruptured internal carotid aneurysms treated using FRED simultaneously underwent silent MRA and TOF-MRA after treatment, with 36 follow-up sessions in total. Two observers independently graded the quality of intra-aneurysmal flow and stented parent arteries under both types of MRA from 1 (not visible) to 4 (nearly equal to digital subtraction angiography [DSA]), with reference to DSA images as a standard criterion. Results The mean scores for intra-aneurysmal flow and stented parent arteries were significantly better for silent MRA (3.93 ± 0.21 and 3.82 ± 0.32, respectively) than for TOF-MRA (2.08 ± 0.99 and 1.92 ± 0.79, respectively) ( P < 0.01). Intermodality agreements for intra-aneurysmal flow and stented parent arteries were 0.87 and 0.90, respectively. Conclusion Silent MRA is superior to TOF-MRA for assessing patients treated with FRED, with potential as an alternative imaging modality to DSA.

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Usefulness of Silent Magnetic Resonance Angiography in the Follow-Up of Endovascular-Treated Intracranial Aneurysm: A Prospective Study

Cited by 5 publications

References 14 publications

Diagnostic performance of silent magnetic resonance angiography for endovascularly-treated intracranial aneurysm follow-up: a prospective study

Diagnostic performance of silent magnetic resonance angiography for endovascularly-treated intracranial aneurysm follow-up: a prospective study

Ultrashort Echo Time Magnetic Resonance Angiography as an Alternative Tool to Digital Subtraction Angiography in the Follow-up of Stent-Assisted Coil Embolization Outcomes

Usefulness of silent magnetic resonance angiography for intracranial aneurysms treated with a flow re-direction endoluminal device

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