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Enhanced vessel wall magnetic resonance imaging in the follow-up of intracranial aneurysms treated with flow diversion

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

This study aimed to compare the efficacy of enhanced 3D T1-weighted black-blood fast-spin-echo vessel wall magnetic resonance imaging (eVW-MRI) and time-of-flight magnetic resonance angiography (TOF MRA) for follow-up evaluation of aneurysms treated with flow diversion (FD).

Methods

Our study enrolled 77 patients harboring 84 aneurysms treated with FD. Follow-up was by MRI (eVW-MRI and TOF MRA) and digital subtraction angiography (DSA). Two radiologists, blinded to DSA examination results, independently evaluated the images of aneurysm occlusion and parent artery patency using the Kamran-Byrne Scale. Interobserver diagnostic agreement and intermodality diagnostic agreement were acquired. Pretreatment and follow-up aneurysm wall enhancement (AWE) patterns were collected.

Results

Based on the Kamran-Byrne Scale, the intermodality agreement between eVW-MRI and DSA was better than TOF MRA versus DSA for aneurysm remnant detection (weighted ĸ = 0.891 v. 0.553) and parent artery patency (ĸ = 0.950 v. 0.221). Even with the coil artifact, the consistency of eVW-MRI with DSA for aneurysm remnant detection was better than that of TOF MRA (weighted ĸ = 0.891 v. 0.511). The artifact of adjunctive coils might be more likely to affect the accuracy in evaluating parent artery patency with TOF MRA than with eVW-MRI (ĸ = 0.077 v. 0.788). The follow-up AWE patterns were not significantly associated with pretreatment AWE patterns and aneurysm occlusion.

Conclusions

The eVW-MRI outperforms TOF MRA as a reliable noninvasive and nonionizing radioactive imaging method for evaluating aneurysm remnants and parent artery patency after FD. The significance of enhancement patterns on eVW-MRI sequences needs more exploration.

Clinical relevance statement

The application of enhanced vessel wall magnetic resonance imaging has proven to be a promising tool to depict aneurysm remnant and parent artery stenosis in order to tailor the antiplatelet therapy strategy in patients after flow diversion.

Key Points

• Enhanced vessel wall magnetic resonance imaging has an emerging role in depicting aneurysm remnant and parent artery patency after flow diversion.

• With or without the artifact from adjunctive coils, enhanced vessel wall magnetic resonance imaging was better than TOF MRA in detecting aneurysm residual and parent artery stenosis by using DSA imaging as the standard.

• Enhanced vessel wall magnetic resonance imaging holds potential to be used as an alternative to DSA for routine aneurysm follow-up after flow diversion.

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Abbreviations

AWE:

Aneurysm wall enhancement

CE MRA:

Contrast-enhanced magnetic resonance angiography

CI:

Confidence interval

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

eVW-MRI:

Enhanced vessel wall magnetic resonance imaging

FD:

Flow diversion

ĸ :

Kappa value

PED:

Pipeline embolization device

SD:

Standard deviation

TOF MRA:

Time-of-flight magnetic resonance angiography

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Acknowledgements

The authors are grateful to Dr. Jingliang Cheng for his kind instruction on VW-MRI.

Funding

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

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China

    Tao Quan, Jinyi Li, Xiaojie Fu, Yazhou Jin, Sheng Guan & Haowen Xu

  2. Departments of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China

    Yanan Ren, Yuncai Ran & Jingliang Cheng

Authors
  1. Tao Quan
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  2. Yanan Ren
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  3. Jinyi Li
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  4. Xiaojie Fu
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  5. Yazhou Jin
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  6. Yuncai Ran
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  7. Sheng Guan
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  9. Haowen Xu
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Corresponding authors

Correspondence to Tao Quan or Haowen Xu.

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Guarantor

The scientific guarantor of this publication is Sheng Guan.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has statistical expertise and provided statistical advice.

Informed consent

Written informed consent was obtained from all patients in this study.

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Institutional review board approval was obtained.

Study subjects or cohorts overlap

No study subject has been previously reported.

Methodology

• retrospective

• observational

• performed at one institution

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Quan, T., Ren, Y., Li, J. et al. Enhanced vessel wall magnetic resonance imaging in the follow-up of intracranial aneurysms treated with flow diversion. Eur Radiol 34, 833–841 (2024). https://doi.org/10.1007/s00330-023-10094-4

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  • DOI: https://doi.org/10.1007/s00330-023-10094-4

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