European Radiology

, Volume 22, Issue 10, pp 2255–2263 | Cite as

Follow-up of coiled intracranial aneurysms: comparison of 3D time-of-flight and contrast-enhanced magnetic resonance angiography at 3T in a large, prospective series

  • Laurent PierotEmail author
  • Christophe Portefaix
  • Anne Boulin
  • Jean-Yves Gauvrit



To compare 3D-TOF magnetic resonance angiography (MRA) and contrast-enhanced MRA (CE-MRA) sequences at 3T in the follow-up of coiled aneurysms with digital subtracted angiography (DSA) as the gold standard.


DSA, 3D-TOF and CE-MRA were performed in a prospective series of 126 aneurysms in 96 patients (57 female, 39 male; age: 25–75 years, mean: 51.3 ± 11.3 years). The quality of aneurysm occlusion was assessed independently and anonymously by a core laboratory.


Using DSA (gold standard technique), total occlusion was depicted in 57 aneurysms (45.2%), neck remnant in 34 aneurysms (27.0%) and aneurysm remnant in 35 aneurysms (27.8%). Sensitivity, specificity, positive predictive value and negative predictive value were very similar with 3D-TOF and CE-MRA. Visibility of coils was much better with 3D-TOF (95.2%) than with CE-MRA (23.0%) (P < 0.001). Also, substantial artefacts were less frequent with 3D-TOF (4.0%) than with CE-MRA (11.9%; P = 0.012).


In this large prospective series of patients with coiled aneurysms, at 3T 3D-TOF MRA was equivalent to CE-MRA for the evaluation of aneurysm occlusion, but coil visibility was superior at 3D-TOF. Thus the use of 3D-TOF at 3T is recommended for the follow-up of coiled intracranial aneurysms.

Key Points

• Different Magnetic Resonance (MR) imaging techniques are used to evaluate intracranial aneurysms.

At 3T MR, 3D-TOF and CE-MRA appear equivalent for evaluating coiled aneurysms..

Coils are better visualised on 3D-TOF than on CE-MRA.

Combined analysis of 3D-TOF and CE-MRA does not seem helpful.

At 3T, 3D-TOF techniques are recommended for monitoring patients with coiled aneurysms.


Intracranial aneurysms Coiling MRA DSA 3T MRI 



Anterior cerebral artery


Anterior communicating artery


Contrast-enhanced magnetic resonance angiography


Digital subtraction angiography


Internal carotid artery


Middle cerebral artery


Maximum intensity projection


Magnetic resonance angiography




Conflict of interest

The authors declare that they have no conflict of interest in relation to the topic of the manuscript.


  1. 1.
    Molyneux AJ, Kerr RSC, Stratton I et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1262–1263CrossRefGoogle Scholar
  2. 2.
    Pierot L, Spelle L, Vitry F, ATENA Investigators (2008) Clinical outcome of patients harbouring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA trial. Stroke 39:2497–2504PubMedCrossRefGoogle Scholar
  3. 3.
    Ferns SP, Sprengers MES, von Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523–e529PubMedCrossRefGoogle Scholar
  4. 4.
    Kaufmann TJ, Huston J, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF (2007) Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology 243:812–819PubMedCrossRefGoogle Scholar
  5. 5.
    Boulin A, Pierot L (2001) Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium 3D time-of-flight MR angiography and digital subtraction angiography. Radiology 219:108–113PubMedGoogle Scholar
  6. 6.
    Pierot L, Delcourt C, Bouquigny F et al (2006) Follow-up of intracranial aneurysms selectively treated with coils: prospective evaluation of contrast-enhanced MR angiography. AJNR Am J Neuroradiol 27:744–749PubMedGoogle Scholar
  7. 7.
    Kwee TC, Kwee RM (2007) MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis. Neuroradiology 49:703–713PubMedCrossRefGoogle Scholar
  8. 8.
    Urbach H, Dorenbeck U, von Falken hausen M et al (2008) Three-dimensional time-of-flight MR angiography at 3T compared to digital subtraction angiography in the follow-up of ruptured and coiled aneurysms. Neuroradiology 50:383–389PubMedCrossRefGoogle Scholar
  9. 9.
    Anzalone N, Scomazzoni F, Cirillo M et al (2008) Follow-up of coiled aneurysms at 3T: comparison of 3D time-of-flight MR angiography and contrast-enhanced MR angiography. AJNR Am J Neuroradiol 29:1530–1536PubMedCrossRefGoogle Scholar
  10. 10.
    Buhk JH, Kallenberg K, Mohr A, Dechent P, Knauth M (2008) No advantage of time-of-flight magnetic resonance angiography at 3 Tesla compared to 1.5T in the follow-up after endovascular treatment of cerebral aneurysms. Neuroradiology 50:855–861PubMedCrossRefGoogle Scholar
  11. 11.
    Ramgren B, Siemund R, Cronqvist M et al (2008) Follow-up of intracranial aneurysms treated with detachable coils: comparison of 3D inflow MRA at 3T and 1.5T and contrast-enhanced MRA at 3T with DSA. Neuroradiology 50:947–954PubMedCrossRefGoogle Scholar
  12. 12.
    Kau T, Gasser J, Celedin S et al (2009) MR angiographic follow-up of intracranial aneurysms treated with detachable coils: evaluation of a blood-pool contrast medium. AJNR Am J Neuroradiol 30:1524–1530PubMedCrossRefGoogle Scholar
  13. 13.
    Sprengers MES, Schaafsma JD, van Rooij WJ et al (2009) Evaluations of the occlusion status of coiled aneurysms with MR angiography at 3T: is contrast enhancement necessary? AJNR Am J Neuroradiol 30:1665–1671PubMedCrossRefGoogle Scholar
  14. 14.
    Kaufmann TJ, Huston J, Cloft HJ et al (2010) A prospective trial of 3T and 1.5T time-of-flight and contrast-enhanced MR angiography in the follow-up of coiled intracranial aneurysms. AJNR Am J Neuroradiol 31:912–918PubMedCrossRefGoogle Scholar
  15. 15.
    Schaafsma JD, Velthuis BK, Majoie CBLM et al (2010) Intracranial aneurysms treated with coil placement: test characteristics of follow-up MR angiography—multicenter study. Radiology 256:209–218PubMedCrossRefGoogle Scholar
  16. 16.
    Raymond J, Guilbert F, Weill A et al (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403PubMedCrossRefGoogle Scholar
  17. 17.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  18. 18.
    Kovacs A, Möhlenbruch M, Hadizadeh DR et al (2011) Noninvasive imaging after stent-assisted coiling of intracranial aneurysms: comparison of 3-T magnetic resonance imaging and 64-row multidetector computed tomography: a pilot study. J Comput Assist Tomogr 35:573–582PubMedCrossRefGoogle Scholar
  19. 19.
    Buhk JH, Kallenberg K, Mohr A, Dechent P, Knauth M (2009) Evaluation of angiographic computed tomography in the follow-up after endovascular treatment of cerebral aneurysms—a comparative study with DSA and TOF-MRA. Eur Radiol 19:430–436PubMedCrossRefGoogle Scholar
  20. 20.
    Johnston SC, Dowd CF, Higashida RT et al (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39:120–125PubMedCrossRefGoogle Scholar
  21. 21.
    Sluzewski M, van Rooij WJ, Beute GN, Nijssen PC (2005) Late rebleeding of ruptured intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol 26:2542–2549PubMedGoogle Scholar
  22. 22.
    Kuo PH, Kanal E, Abu-Alfa CSE (2007) Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 27:2118–2120Google Scholar
  23. 23.
    Agid R, Willinsky RA, Lee SK, TerBrugge KG, Farb RI (2008) Characterization of aneurysm remnants after endovascular treatment: contrast-enhanced MR angiography versus catheter digital subtraction angiography. AJNR Am J Neuroradiol 29:1570–1574PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Laurent Pierot
    • 1
    • 5
    Email author
  • Christophe Portefaix
    • 1
    • 2
  • Anne Boulin
    • 3
  • Jean-Yves Gauvrit
    • 4
  1. 1.Department of Radiology, Maison Blanche HospitalUniversity of ReimsReimsFrance
  2. 2.CReSTIC SIC EA3804University of ReimsReimsFrance
  3. 3.Department of NeuroradiologyFoch HospitalSuresnesFrance
  4. 4.Department of Radiology, CHU RennesUniversity of RennesRennesFrance
  5. 5.Service de radiologieHopital de la Maison Blanche - CHUReimsFrance

Personalised recommendations