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Diagnostic Performance of MRA for UnrupturedAneurysms at the Distal ICA

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Abstract

Purpose

Unruptured intracranial aneurysms (UIAs) at the distal internal carotid artery (ICA) (segments C5–C7) are difficult to accurately display on computed tomography angiography (CTA) due to the influences of bone structures and vessel curvature. We investigated the utility of three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) at 3.0‑T for the detection of morphologic features compared to digital subtraction angiography (DSA).

Methods

This retrospective study included 2398 patients between January 2015 and May 2020 who underwent 3D-TOF-MRA and DSA within 3 months. Morphologic features including aneurysm size, neck width, shape and relation to adjacent arteries and other diagnostic parameters were recorded. Three observers blinded to the clinical and DSA results independently analyzed MRA data sets. The statistical difference of each aneurysm-specific variable was performed using χ2-tests and multivariate logistic regression analysis.

Results

A total of 551 aneurysms in 514 patients were confirmed at the distal ICA by DSA. Patient-based, aneurysm-based and location-based evaluations with 3D-TOF-MRA yielded high diagnostic accuracy in the detection of target UIAs. The accuracy of displayed morphologic features was 94.9% for size, 97.2% for neck width, 92.6% for shape, and 96.4% for relationship to adjacent vessels. Multivariate logistic regression showed that tiny (P < 0.001) or giant (P = 0.039) size and a lobulated shape (P = 0.006) significantly affected the morphologic assessment on 3D-TOF-MRA.

Conclusion

Three-dimensional TOF-MRA can accurately depict and display morphologic features of distal ICA UIAs. Tiny or giant-sized distal ICA aneurysms and with lobulation tend to carry a great risk of misdiagnosis in morphologic assessments.

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Abbreviations

3D-TOF-MRA:

Three-dimensional time-of-flight magnetic resonance angiography

C5:

Clinoid segment

C6:

Ophthalmic segment

C7:

Communicating segment

CI:

Confidence interval

CVD:

Cardiovascular disease

ICA:

Internal carotid artery

MIP:

Maximum intensity projection

OR:

Odds ratio

UIAs:

Unruptured intracranial aneurysms

VR:

Volume-rendering

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Funding

This study received funding by 1) National Key Research and Development Program (No. 2017YFC0109204); 2) Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (No.20152528); 3) Shanghai Jiao Tong University “Medical and Research” Program (ZH2018ZDA19).

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Authors and Affiliations

  1. Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, 200233, Shanghai, China

    Guangchen He, Jienan Wang, Yiran Zhang, Minghua Li, Haitao Lu, Yingsheng Cheng & Yueqi Zhu

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  1. Guangchen He
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  2. Jienan Wang
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  3. Yiran Zhang
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  4. Minghua Li
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  5. Haitao Lu
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  7. Yueqi Zhu
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Corresponding author

Correspondence to Yueqi Zhu.

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Conflict of interest

G. He, J. Wang, Y. Zhang, M. Li, H. Lu, Y. Cheng and Y. Zhu declare that they have no competing interests.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. Institutional Review Board approval was obtained. Informed consent: written informed consent was waived.

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He, G., Wang, J., Zhang, Y. et al. Diagnostic Performance of MRA for UnrupturedAneurysms at the Distal ICA. Clin Neuroradiol 32, 507–515 (2022). https://doi.org/10.1007/s00062-021-01076-4

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  • DOI: https://doi.org/10.1007/s00062-021-01076-4

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