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Intracranial aneurysms treated with stent-assisted coil embolization: evaluation with four-dimensional ultrashort-TE MR angiography

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Abstract

Objectives

As a novel follow-up method for intracranial aneurysms treated with stent-assisted coil embolization (SACE), we developed four-dimensional magnetic resonance angiography (MRA) with minimized acoustic noise utilizing ultrashort-echo time (4D mUTE-MRA). We aimed to assess whether 4D mUTE-MRA is useful for the evaluation of intracranial aneurysms treated with SACE.

Methods

This study included 31 consecutive patients with intracranial aneurysm treated with SACE who underwent 4D mUTE-MRA at 3 T and digital subtraction angiography (DSA). For 4D mUTE-MRA, five dynamic MRA images with a spatial resolution of 0.5 × 0.5 × 0.5 mm3 were obtained every 200 ms. Two readers independently reviewed the 4D mUTE-MRA images to evaluate the aneurysm occlusion status (total occlusion, residual neck, and residual aneurysm) and the flow in the stent using a 4-point scale (from 1 [not visible] to 4 [excellent]). The interobserver and intermodality agreement was assessed using κ statistics.

Results

On DSA images, 10 aneurysms were classified as total occlusion, 14 as residual neck, and 7 as residual aneurysm. In terms of aneurysm occlusion status, the intermodality and interobserver agreement was excellent (κ = 0.92 and κ = 0.96, respectively). For the flow in the stents on 4D mUTE-MRA, the mean score was significantly higher for single stents than multiple stents (p < .001) and for open-cell type stents than closed-cell type (p < .01).

Conclusions

4D mUTE-MRA is a useful tool with a high spatial and temporal resolution for the evaluation of intracranial aneurysms treated with SACE.

Key Points

• In the evaluation of intracranial aneurysms treated with SACE on 4D mUTE-MRA and DSA, the intermodality and interobserver agreement in aneurysm occlusion status was excellent.

• 4D mUTE-MRA shows good to excellent visualization of flow in the stents, especially for cases treated with a single or open-cell stent.

• 4D mUTE-MRA can provide hemodynamic information related to embolized aneurysms and the distal arteries to stented parent arteries.

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Abbreviations

ASL:

Arterial spin-labeling

DSA:

Digital subtraction angiography

IC-PC:

Internal carotid-posterior communicating artery

MRA:

Magnetic resonance angiography

mUTE-MRA:

Minimized acoustic noise utilizing UTE combined with an ASL technique

LVIS:

Low-profile Visualized Intraluminal Support

PETRA:

Pointwise encoding time reduction with radial acquisition

SACE:

Stent-assisted coil embolization

TI:

Inversion time

TOF:

Time-of-flight

UTE:

Ultrashort-echo time

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Acknowledgements

The authors would like to thank Kentaro Haraoka and Takumi Saito for their technical support.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan

    Hiroyuki Uetani, Mika Kitajima, Takeshi Nakaura, Akira Sasao, Goh Sasaki, Soichiro Ishiuchi & Toshinori Hirai

  2. Department of Medical Image Sciences, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan

    Mika Kitajima

  3. Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan

    Yuki Ohmori, Yasuyuki Kaku & Akitake Mukasa

  4. Central Radiology Section, Kumamoto University Hospital, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan

    Kosuke Morita

  5. Canon Medical Systems Corporation, MRI Sales Department, Sales Engineer Group, 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-0015, Japan

    Yuichi Yamashita

  6. Joint Research Course of Imaging Dynamics Applied Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan

    Akira Sasao

Authors
  1. Hiroyuki Uetani
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Corresponding author

Correspondence to Hiroyuki Uetani.

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Guarantor

The scientific guarantor of this publication is Toshinori Hirai.

Conflict of interest

Yuichi Yamashita is an employee of Canon Medical Systems. Toshinori Hirai has received research support from Canon Medical Systems. Akira Sasao is a specially appointed lecturer in the Joint Research Course of Imaging Dynamics Applied Medicine, which is financially supported by CANON MEDICAL SYSTEMS. The Canon Medical Systems had no control over the interpretation, writing, or publication of this work. The other authors declare that they have no conflicts of interest.

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Uetani, H., Kitajima, M., Ohmori, Y. et al. Intracranial aneurysms treated with stent-assisted coil embolization: evaluation with four-dimensional ultrashort-TE MR angiography. Eur Radiol 33, 7923–7933 (2023). https://doi.org/10.1007/s00330-023-09755-1

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