scholarly journals Usefulness of contrast-enhanced and TOF MR angiography for follow-up after low-profile stent-assisted coil embolization of intracranial aneurysms

2018 ◽  
Vol 24 (6) ◽  
pp. 655-661 ◽  
Author(s):  
Selcuk Akkaya ◽  
Onur Akca ◽  
Anıl Arat ◽  
Ahmet Peker ◽  
Sinan Balci
Keyword(s):  
Coil Embolization ◽  
Imaging Modality ◽  
Stent Patency ◽  
Total Occlusion ◽  
Stent Occlusion ◽  
Tof Mra ◽  
Low Profile ◽  
Contrast Enhanced ◽  
Aneurysm Occlusion

Background Low-profile, self-expandable stents are used to treat wide-neck aneurysms located on the smaller distal intracranial arteries. This study aimed to assess the usefulness of time-of-flight (TOF) and contrast-enhanced (CE) magnetic resonance angiography (MRA) for follow-up after LEO Baby stent (LBS)-assisted coil embolization. Methods Twenty-four aneurysms treated with LBS-assisted coil embolization were evaluated. Researchers reviewed TOF MRA and CE MRA images in terms of occlusion and stent patency. Aneurysm occlusion was graded according to Raymond–Roy classification as follows: total occlusion (grade 1), residual neck (grade 2), and residual aneurysm (grade 3). Stent patency was scored as follows: occlusion (1), stenosis (2), and normal (3). Interobserver and intermodality agreement values were determined by weighted kappa (κ) statistics. Results Intermodality and interobserver values of TOF MRA and CE MRA with digital subtraction angiography (DSA) were perfect (κ = 1.00, p < 0.001) in terms of aneurysm occlusion. Rate of stent occlusion and stenosis in DSA, TOF, and MRA, respectively, were as follows: 0 and 12.5%, 16.6 and 70.8%, and 0 and 62.5%. Intermodality agreement values of TOF MRA and CE MRA with DSA were insignificant in terms of stent patency (κ = 0.065, p = 0.27; κ = 0.158, p = 0.15, respectively). Interobserver agreement was substantial in both TOF MRA (κ = 0.71, p < 0.001) and CE MRA (κ = 0.64, p = 0.001). Conclusions Both TOF and CE MRA techniques have strong concordance with DSA for the detection of aneurysm occlusion status. CE MRA can be used as a first-line noninvasive imaging modality due to its superiority to TOF MRA with respect to the visualization of in-stent signals.

scholarly journals Usefulness of 3D T1-SPACE in Combination With 3D-TOF MRA for Follow-Up Evaluation of Intracranial Aneurysms Treated With Pipeline Embolization Devices

2020 ◽  
Vol 11 ◽  
Author(s):  
Qiuji Shao ◽  
Qiaowei Wu ◽  
Qiang Li ◽  
Tianxiao Li ◽  
Li Li ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Coincidence Rate ◽  
Space Sequence ◽  
Stent Patency ◽  
Tof Mra ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion ◽  
Imaging Artifacts

Object: Follow-up evaluation of intracranial aneurysms treated by flow-diverting stents using MRI is challenging due to the presence of imaging artifacts. This study evaluated 3D T1-SPACE in combination with 3D-TOF sequence for follow-up evaluation of intracranial aneurysms treated with Pipeline embolization devices.Methods: Forty patients with 53 intracranial aneurysms who were treated with Pipeline Embolization Devices from October 2018 to July 2019 were enrolled in this study. All patients were evaluated for aneurysm occlusion and stent patency 4 to 7 months post-treatment using 3D T1-SPACE sequence, 3D-TOF MRA, and DSA examinations.Results: With regards to aneurysm occlusion, the intermodality (DSA and 3D-TOF MRA) agreement was good (κ = 0.755). The specificity of 3D-TOF MRA was 94.4% (34/36), the sensitivity was 76.5% (13/17), the total coincidence rate was 88.7% (47/53). With regards to the patency of the stented arteries after PED treatment, 3D T1-SPACE sequence was more accurate compared to 3D-TOF MRA (Z = −6.283, P &lt; 0.001), with a no-artifact rate of 95.7% (44/46).Conclusions: 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. 3D-TOF MRA may be valuable in the evaluation of aneurysm occlusion. The combination of these two modalities may be used for long-term follow-up of intracranial aneurysms treated with Pipeline Embolization Devices.

scholarly journals MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis

2019 ◽  
Vol 11 (10) ◽  
pp. 1009-1014 ◽  
Author(s):  
Syed Uzair Ahmed ◽  
J Mocco ◽  
Xiangnan Zhang ◽  
Michael Kelly ◽  
Amish Doshi ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Clinical Factors ◽  
Endovascular Techniques ◽  
Non Invasive ◽  
Tof Mra ◽  
Contrast Enhanced ◽  
Grading Scale ◽  
Aneurysm Occlusion

BackgroundTreated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed.MethodsComprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond–Roy occlusion grading scale.ResultsThe literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%.ConclusionMRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.

Follow-up of intracranial aneurysms treated by flow diverter: comparison of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MR angiography (CE-MRA) sequences with digital subtraction angiography as the gold standard

2014 ◽  
Vol 8 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Jonathan Attali ◽  
Azzedine Benaissa ◽  
Sébastien Soize ◽  
Krzysztof Kadziolka ◽  
Christophe Portefaix ◽  
...  
Keyword(s):  
Gold Standard ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Flow Diverter ◽  
Parent Artery ◽  
Digital Subtraction ◽  
Tof Mra ◽  
Contrast Enhanced ◽  
Aneurysm Occlusion

Background and purposeFollow-up of intracranial aneurysms treated by flow diverter with MRI is complicated by imaging artifacts produced by these devices. This study compares the diagnostic accuracy of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3 T for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment, with digital subtraction angiography (DSA) as the gold standard.Materials and methodsPatients treated with flow diverters between January 2009 and January 2013 followed by MRA at 3 T (3D-TOF-MRA and CE-MRA) and DSA within a 48 h period were included in a prospective single-center study. Aneurysm occlusion was assessed with full and simplified Montreal scales and parent artery patency with three-grade and two-grade scales.ResultsTwenty-two patients harboring 23 treated aneurysms were included. Interobserver agreement using simplified scales for occlusion (Montreal) and parent artery patency were higher for DSA (0.88 and 0.61) and CE-MRA (0.74 and 0.55) than for 3D-TOF-MRA (0.51 and 0.02). Intermodality agreement was higher for CE-MRA (0.88 and 0.32) than for 3D-TOF-MRA (0.59 and 0.11). CE-MRA yielded better accuracy than 3D-TOF-MRA for aneurysm remnant detection (sensitivity 83% vs 50%; specificity 100% vs 100%) and for the status of the parent artery (specificity 63% vs 32%; sensitivity 100% vs 100%).ConclusionsAt 3 T, CE-MRA is superior to 3D-TOF-MRA for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment. However, intraluminal evaluation remains difficult with MRA regardless of the sequence used.

Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

2021 ◽  
pp. 197140092110269
Author(s):  
Tomoko Hayashi ◽  
Hiroyuki Ikeda ◽  
Ryota Ishibashi ◽  
Toshio Fujiwara ◽  
Ryosuke Kaneko ◽  
...  
Keyword(s):  
Case Report ◽  
Coil Embolization ◽  
Cell Design ◽  
Open Cell ◽  
Aneurysm Neck ◽  
Low Profile ◽  
Closed Cell ◽  
High Metal ◽  
Silicon Tube ◽  
Aneurysm Occlusion

Low-profile visualized intraluminal support deployment in an Enterprise has been reported; however, that in an Atlas has yet to be in detail. Enterprise has a closed-cell design, while Atlas has an open-cell design. We detail here a case of a large wide-necked aneurysm treated by coil embolization with low-profile visualized intraluminal support Blue deployment within a Neuroform Atlas and a bench-top experiment using a silicon tube to test low-profile visualized intraluminal support, Atlas, Enterprise, and their combinations. A better low-profile visualized intraluminal support expansion was achieved by simultaneously pushing the wire and the system within the Atlas placed at the aneurysm neck, which resulted in an increased metal coverage of the aneurysm neck and a shorter transition zone with low metal coverage at both ends of the aneurysm neck. This technique may enable a high metal coverage by low-profile visualized intraluminal support expansion without restriction by the Atlas and contribute to aneurysm occlusion by increasing the flow-diverting effect.

Follow-Up Imaging in Patients with Blunt Splenic or Hepatic Injury Managed Nonoperatively

2018 ◽  
Vol 84 (2) ◽  
pp. 208-214 ◽  
Author(s):  
R. Viola Mebert ◽  
Beat SchnÜRiger ◽  
Daniel Candinas ◽  
Tobias Haltmeier
Keyword(s):  
Nonoperative Management ◽  
Imaging Modality ◽  
Ct Scans ◽  
Lower Grade ◽  
Contrast Enhanced Ultrasound ◽  
Promising Alternative ◽  
Contrast Enhanced ◽  
Pubmed Database ◽  
Hepatic Injuries

Nonoperative management of blunt splenic and hepatic injuries has become the standard of care for hemodynamically stable patients. However, nonoperative management may lead to delayed complications and appropriate follow-up is therefore crucial. The aim of this systematic literature review was to assess the role of different imaging modalities in the follow-up assessment of patients with blunt splenic or hepatic injuries using the PubMed database. Eighteen studies were found to be relevant to the topic. A total of 2725 patients were enrolled in the included studies. Both retrospective and prospective studies, but no randomized controlled trials were found. In these studies, CT, ultrasound, and contrast-enhanced ultrasound were discussed. CT was the most commonly used imaging modality. Taking into account all studies included, only one patient underwent intervention due to a complication diagnosed by follow-up CTscan in the absence of clinical signs and symptoms. This equates to a total of 920 CT scans performed to diagnose one clinically nonevident complication that required intervention. Based on the reviewed literature, routine imaging follow-up CT scans may not be indicated in asymptomatic patients with lower grade blunt splenic or hepatic injuries. Contrast-enhanced ultrasound is a promising alternative imaging modality for the follow-up of these patients.

scholarly journals Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diversion ◽  
Total Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Radiological Features ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

Evaluation of contrast-enhanced MR angiography in the follow-up of visceral arterial aneurysms after coil embolization

2013 ◽  
Vol 54 (5) ◽  
pp. 493-497 ◽  
Author(s):  
Yasuhiko Iryo ◽  
Ichiro Ikushima ◽  
Toshinori Hirai ◽  
Kazuchika Yonenaga ◽  
Yasuyuki Yamashita
Keyword(s):  
Coil Embolization ◽  
Mr Angiography ◽  
Contrast Enhanced ◽  
Arterial Aneurysms

scholarly journals Pipeline-assisted coil embolization of a large middle cerebral artery pseudoaneurysm in a 9-month-old infant: experience from the youngest flow diversion case

2018 ◽  
Vol 22 (5) ◽  
pp. 532-540 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Bowen Jiang ◽  
Matthew T. Bender ◽  
Narlin B. Beaty ◽  
Erick M. Westbroek ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Pediatric Population ◽  
Flow Diversion ◽  
Left Middle Cerebral Artery ◽  
Artery Pseudoaneurysm ◽  
First Case ◽  
Aneurysm Occlusion

Intracranial aneurysms in the pediatric population are rare entities. The authors recently treated a 9-month-old infant with a 19-mm recurrent, previously ruptured, and coil-embolized left middle cerebral artery (MCA) pseudoaneurysm, which was treated definitively with single-stage Pipeline-assisted coil embolization. The patient was 5 months old when she underwent resection of a left temporal Grade 1 desmoplastic infantile ganglioglioma at an outside institution, which was complicated by left MCA injury with a resultant 9-mm left M1 pseudoaneurysm. Within a month, the patient had two aneurysmal rupture events and underwent emergency craniectomy for decompression and evacuation of subdural hematoma. The pseudoaneurysm initially underwent coil embolization; however, follow-up MR angiography (MRA) revealed aneurysm recanalization with saccular enlargement to 19 mm. The patient underwent successful flow diversion–assisted coil embolization at 9 months of age. At 7 months after the procedure, follow-up MRA showed complete aneurysm occlusion without evidence of in-stent thrombosis or stenosis. Experience with flow diverters in the pediatric population is still in its early phases, with the youngest reported patient being 22 months old. In this paper the authors report the first case of such a technique in an infant, whom they believe to be the youngest patient to undergo cerebral flow diversion treatment.

scholarly journals Utility of Contrast-Enhanced Magnetic Resonance Angiography for Delayed Intracranial In-Stent Stenosis in Nonatherosclerotic Cerebral Vascular Diseases

2017 ◽  
Vol 01 (02) ◽  
pp. 085-088
Author(s):  
Santhosh Kannath ◽  
Jayadevan Rajan ◽  
Kamble Harsha
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Vascular Diseases ◽  
Source Image ◽  
Tof Mra ◽  
Contrast Enhanced ◽  
Long Term Follow Up ◽  
Image Set ◽  
Stent Stenosis

AbstractNoninvasive imaging modalities are being used for long-term follow-up of intracranial stented patients of nonatherosclerotic etiology. The aim of this study is to determine the utility of contrast-enhanced magnetic resonance angiography (CE-MRA) source images in delayed intracranial in-stent stenosis. A total of 18 stented patients for nonatherosclerotic etiology were reviewed; all had follow-up digital subtraction angiography (DSA) and CE- and time-of-flight (TOF)-MRA. Four sets of MR images (TOF-MRA reformatted images, TOF-MRA source images, CE-MRA reformatted images, and CE-MRA source images) were reviewed for detection of ≥ 50% stenosis. Accuracy of each image set was calculated comparing to DSA. Overall delayed in-stent stenosis during follow-up DSA was 10%. The sensitivity of TOF reformatted image, TOF source image, CE-MRA reformatted image, CE-MRA source image are 33% (6/18), 55.6% (10/18), 77.8% (14/18), and 100% (18/18), respectively, while negative predictive value are 14.3% (2/14), 20% (2/10), 33% (2/6), and 100% (2/2), respectively. CE-MRA source images are equally efficacious as DSA to detect significant (≥ 50%) delayed in-stent stenosis.

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