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

Introduction

The 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).

Methods

Twenty-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.

Results

There 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.

Conclusions

TOF-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.