Vessel wall imaging with advanced flow suppression in the characterization of intracranial aneurysms following flow diversion with Pipeline embolization device

Abstract

BackgroundHigh-resolution vessel wall MRI (VWI) is increasingly used to characterize intramural disorders of the intracranial vasculature unseen by conventional arteriography.ObjectiveTo evaluate the use of VWI for surveillance of flow diverter (FD) treated aneurysms.Materials and methodsRetrospective study of 28 aneurysms (in 21 patients) treated with a FD (mean 57 years; 14 female). All examinations included VWI and a contemporaneously obtained digital subtraction angiogram. Multiplanar pre- and post-gadolinium 3D, variable flip-angle T1 black-blood VWI was obtained using delay alternating nutation for tailored excitation (DANTE) at 3T. 3D time-of-flight MR angiography (MRA) was also carried out. Images were assessed for in-stent stenosis, aneurysm occlusion, presence and pattern/distribution of aneurysmal or parent vessel gadolinium enhancement.ResultsThe VWI-MRI was performed on average at 361±259 days after the intervention. Follow-up DSA was performed at 338±254 days postintervention. Good or excellent black-blood angiographic quality was recorded in 22/28 (79%) pre-contrast and 21/28 (75%) post-contrast VWI, with no cases excluded for image quality. Aneurysm enhancement was noted in 24/28 (85.7%) aneurysms, including in 79% of angiographically occluded aneurysms and 100% of angiographically non-occluded aneurysms. Enhancement of the stented parent-vessel wall occurred significantly more often when aneurysm enhancement was present (92% vs 33%, p=0.049).ConclusionAdvanced VWI produces excellent depiction of FD-treated aneurysms, with robust evaluation of the parent vessel and aneurysm wall to an extent not achievable with conventional MRI/MRA. Gadolinium enhancement may, however, continue even after enduring catheter angiographic occlusion, confounding interpretation, and requiring cognizance of this potentially prolonged effect in such patients.

Intimal hyperplasia detection after aneurysm treatment by flow diversion using magnetic resonance vessel wall imaging

“…Of note, post-angioplasty MR-VWI follow-up was able to demonstrate increased vessel lumen and reduction of the previously seen vessel wall enhancement. Persistence of focal mural enhancement is in line with prior findings reported by Raz E et al 10…”

“…Of note, post-angioplasty MR-VWI follow-up was able to demonstrate increased vessel lumen and reduction of the previously seen vessel wall enhancement. Persistence of focal mural enhancement is in line with prior findings reported by Raz E et al 10 In conclusion, MR-VWI, even with a 1.5 T scanner, can provide comparable results to CBCT and DSA for artery stent patency assessment on follow-up. This non-invasive imaging technique may also allow for additional identification of NIH-related mural inflammatory changes.…”

“…5,7 However, in the follow-up of intracranial stent-assisted coil embolization or flow diverter treated aneurysms, only few studies have so far analyzed the role of MR-VWI in evaluating in-stent patency. 8–10 In detail, in a prior study which evaluated stent-assisted coil embolization of intracranial aneurysms, MR-VWI was helpful in the identification of the 3 stenosis cases, providing similar results of DSA. 8 However, in this study, only baseline pre-contrast MR-VWI was performed, thus not allowing the possibility to evaluate vessel wall inflammatory changes.…”

The application of infrared thermography technology in flap: A perspective from bibliometric and visual analysis

“…However, it has limited penetration capabilities, and the operator's skill level can impact the accuracy of results 12,56 . MRA, as another commonly employed technique, utilizes magnetic resonance technology to acquire high‐resolution vascular imaging, offering advantages such as non‐invasiveness and multiplanar imaging 57 . Nevertheless, it is costly and susceptible to artefacts caused by overlapping vessels, making it unsuitable for patients with internal metallic implants.…”

“…12,56 MRA, as another commonly employed technique, utilizes magnetic resonance technology to acquire high-resolution vascular imaging, offering advantages such as non-invasiveness and multiplanar imaging. 57 Nevertheless, it is costly and susceptible to artefacts caused by overlapping vessels, making it unsuitable for patients with internal metallic implants. Comparably, Computed Tomography Angiography (CTA) employs X-ray and computer reconstruction techniques to provide detailed vascular imaging with wide coverage.…”