Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils? |
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Authors: | Boris Lubicz Carine Neugroschl Laurent Collignon Olivier François Danielle Balériaux |
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Institution: | (1) Department of Neuroradiology, Erasme University Hospital, 808 route de Lennik, 1070 Brussels, Belgium |
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Abstract: | Introduction Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation.
The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography
(DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up.
Materials and methods From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if
a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers
1 and 2) and two other reviewed DSA images.
Results Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in
one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation
in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity
of CE-MRA to detect aneurysm recanalisation was 95.5%.
Conclusion CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention
imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences
may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up. |
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Keywords: | Intracranial aneurysm Digital substraction angiography Magnetic resonance angiography |
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