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Diagnostic Performance of Pointwise Encoding Time Reduction with Radial Acquisition Subtraction-based MR Angiography in the Follow-up of Intracranial Aneurysms after Clipping

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Abstract

Purpose

While follow-up assessment of clipped aneurysms (CAs) using magnetic resonance angiography (MRA) can be challenging due to susceptibility artifacts, a novel MRA sequence pointwise encoding time reduction with radial acquisition (PETRA) subtraction-based MRA, has been developed to reduce these artifacts. The aim of the study was to validate the diagnostic performance of PETRA-MRA by comparing it with digital subtraction angiography (DSA) as a reference for follow-up of CAs using a 3T MR scanner.

Methods

Patients with clipping who underwent both PETRA-MRA and DSA between September 2019 and December 2021 were retrospectively included. Two neuroradiologists independently reviewed with the reconstructed images of PETRA-MRA to assess the visibility of the arteries around the clips and aneurysm recurrence or remnants of CA using a 3-point scale. The diagnostic accuracy of PETRA-MRA was evaluated in comparison to DSA.

Results

The study included 34 patients (28 females, mean age 59 ± 9.6 years) with 48 CAs. The PETRA-MRA allowed visualization of the parent vessels around the clips in 98% of cases, compared to 39% with time-of-flight (TOF) MRA (p < 0.0001). The DSA confirmed 14 (29.2%) residual or recurrent aneurysms. The PETRA-MRA demonstrated a high accuracy, specificity, positive predictive value, and negative predictive value of 99.2%, 100%, 100%, and 97.8%, respectively, while the sensitivity was 66.7%.

Conclusion

This retrospective study demonstrates that PETRA-MRA provides excellent visibility of adjacent vessels near clips and has a high diagnostic accuracy in detecting aneurysm remnants or recurrences in CAs. Further prospective studies are warranted to establish its utility as a reliable alternative for follow-up after clipping.

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Authors and Affiliations

  1. Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Inyoung Kim, Sung Jun Ahn, Mina Park, Bio Joo & Sang Hyun Suh

  2. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Junhyung Kim

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Contributions

I. Kim: material preparation, data collection and analysis, writing of the first draft of the manuscript; S.J. Ahn: material preparation, data collection and analysis. M. Park: material preparation, data collection and analysis. B. Joo: material preparation, data collection and analysis. J. Kim: material preparation, data collection and analysis. S.H. Suh: material preparation, data collection and analysis, writing of the first draft of the manuscript. All authors contributed to the study’s conception and design. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sang Hyun Suh.

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Conflict of interest

I. Kim, S.J. Ahn, M. Park, B. Joo, J. Kim and S.H. Suh 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 mentioned were in accordance with the ethical standards indicated in each case. The ethics approval (3-2022-0486) was obtained from the institutional review board of Gangnam Severance Hospital and the informed consent was waived.

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Kim, I., Ahn, S.J., Park, M. et al. Diagnostic Performance of Pointwise Encoding Time Reduction with Radial Acquisition Subtraction-based MR Angiography in the Follow-up of Intracranial Aneurysms after Clipping. Clin Neuroradiol (2024). https://doi.org/10.1007/s00062-024-01399-y

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