Added diagnostic values of three-dimensional high-resolution proton density-weighted magnetic resonance imaging for unruptured intracranial aneurysms in the circle-of-Willis: Comparison with time-of-flight magnetic resonance angiography

• Published in: PloS one 2020-12, Vol.15 (12), p.e0243235-e0243235
• Main Authors: Yim, Younghee, Jung, Seung Chai, Kim, Jung Youn, Kim, Seon-Ok, Kim, Byung Jun, Lee, Deok Hee, Park, Wonhyoung, Park, Jung Cheol, Ahn, Jae Sung
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm; Aneurysms; Angiography; Angiography, Digital Subtraction - methods; Biology and Life Sciences; Blood vessels; Carotid arteries; Catheters; Cerebral Angiography - methods; Circle of Willis - diagnostic imaging; Circle of Willis - pathology; Diagnosis; Diagnostic systems; Female; Field strength; Humans; Imaging, Three-Dimensional - methods; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - pathology; Lesions; Magnetic resonance; Magnetic Resonance Angiography - methods; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical diagnosis; Medical imaging; Medical schools; Medicine; Medicine and Health Sciences; Middle Aged; Movement disorders; Neurosurgery; Patient outcomes; Physical Sciences; Population studies; Proton density (concentration); Research and Analysis Methods; Resonance; Retrospective Studies; Sensitivity and Specificity; Statistical analysis; Statistical tests; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243235

Advanced imaging methods can enhance the identification of aneurysms of the infundibula, which can reduce unnecessary follow-ups or further work-up, fear, and anxiety in patients. This study aimed to evaluate the added diagnostic value of three-dimensional proton density-weighted vessel wall magnetic resonance imaging (3D-PD MRI) in identifying aneurysms from index lesions refer to vascular bulging lesions without vessels arising from the apex, observed using volume-rendered TOF-MRA in the circle-of-Willis compared with time-of-flight magnetic resonance angiography (TOF-MRA). Retrospective. A total of 299 patients who underwent 3D-PD MRI, digital subtraction angiography (DSA), and TOF-MRA between January 2012 and December 2016 were retrospectively enrolled in this study. 3 Tesla, 3D-PD MRI. Three neuroradiologists independently evaluated TOF-MRA and 3D-PD MRI combined with TOF-MRA for the determination of intracranial aneurysms in patients with index lesions within the circle of Willis. Final diagnoses were made by another neuroradiologist and neurointerventionist in consensus using DSA as the reference standard. The diagnostic performance and proportions of undetermined lesions on TOF-MRA and 3D-PD MRI with TOF-MRA were assessed based on the final diagnoses. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of unruptured intracranial aneurysms were calculated for each imaging modality. Of 452 lesions identified on volume-rendered TOF-MRA images, 173 (38%) aneurysms and 276 (61%) infundibula were finally diagnosed on DSA. 3D-PD MRI with TOF-MRA showed superior diagnostic performance (p = .001; accuracy, 85.5% versus 95.4%), superior area under the receiver operating characteristic curve over TOF-MRA (p = .001; 0.837 versus 0.947), and a lower proportion of undetermined lesions than TOF-MRA (p = .001; 25.1% versus 2.3%). For unruptured intracranial aneurysms in the circle of Willis, 3D-PD MRI can complement TOF-MRA to improve diagnostic performance and lower the proportion of undetermined lesions.