MR Angiographic Follow-Up of Intracranial Aneurysms Treated with Detachable Coils: Evaluation of a Blood-Pool Contrast Medium

• Published in: American journal of neuroradiology : AJNR 2009-09, Vol.30 (8), p.1524-1530
• Main Authors: Kau, T, Gasser, J, Celedin, S, Rabitsch, E, Eicher, W, Uhl, E, Hausegger, K.A
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiovascular system; Contrast Media; Device Removal; Embolization, Therapeutic - instrumentation; Female; Follow-Up Studies; Gadolinium; Gated Blood-Pool Imaging - methods; Humans; Image Enhancement - methods; Interventional; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - surgery; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Angiography - methods; Male; Medical sciences; Middle Aged; Nervous system; Organometallic Compounds; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Reproducibility of Results; Sensitivity and Specificity
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1622

Blood-pool agents are promising in the imaging of small vessels with slow or complex flow. Our aim was to compare blood-pool contrast-enhanced MR angiography (BPCE-MRA) using gadofosveset trisodium (Vasovist) with 3D time-of-flight MRA (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular therapy. We included 32 patients with a total of 37 coiled aneurysms. MRAs in the early steady-state phase were performed on a 1.5T scanner within 8 days of digital subtraction angiography (DSA). Two radiologists independently analyzed TOF-MRA and BPCE-MRA images. Consensus was reached by review involving a third neuroradiologist. DSA images were interpreted separately by an interventional radiologist. Findings were assigned to 1 of 3 categories: 1) complete occlusion, 2) residual neck, and 3) residual aneurysm. Follow-up DSA demonstrated 13 complete obliterations (class 1), 13 residual necks (class 2), and 11 residual aneurysms (class 3). Weighted kappa statistics showed substantial concordance of TOF-MRA and DSA (0.664) as well as BPCE-MRA and DSA (0.724) ratings. Comparison between TOF-MRA and BPCE-MRA found excellent agreement (0.818) with only 6 (16.2%) discrepancies. For detecting residual flow, the difference in accuracy of both MRA techniques (83.8% versus 91.9%) was not significant (McNemar, P = 1.000). BPCE-MRA showed a tendency towards higher sensitivity and specificity (91.7% and 92.3%, respectively) compared with TOF-MRA (87.5% and 76.9%). In classifying the completeness of endovascular cerebral aneurysm therapy, we found that BPCE-MRA and 3D TOF-MRA showed very good agreement. The use of Vasovist did not lead to a significantly increased accuracy of MRA follow-up.