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MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis

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Abstract

Introduction

The aim of this study was to systematically review published data on the diagnostic performance of magnetic resonance angiography (MRA) compared with digital subtraction angiography as reference standard in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils.

Methods

A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Two reviewers independently assessed the methodological quality of each study. A meta-analysis of the reported sensitivity and specificity of each study was performed.

Results

The inclusion criteria were met by 16 studies. The studies had moderate methodological quality. Pooled sensitivity and specificity of nonenhanced time-of-flight MRA (TOF-MRA) for the detection of residual flow (within the aneurysmal neck and/or coil mesh) were 83.3% (95% CI 70.3–91.3%) and 90.6% (95% CI 80.4–95.8%), respectively. Pooled sensitivity and specificity of contrast-enhanced MRA (CE-MRA) for the detection of residual flow were 86.8% (95% CI 71.4–94.5%) and 91.9% (95% CI 79.8–97.0%), respectively. All pooled estimates were subject to heterogeneity. There were no statistically significant differences in pooled sensitivity and specificity between TOF-MRA and CE-MRA.

Conclusion

The results of this study suggest that both TOF-MRA and CE-MRA achieve a moderate to high diagnostic performance. However, the findings should be interpreted with caution because the included studies were of moderate methodological quality and all pooled estimates were subject to heterogeneity. More well-designed studies are required to confirm the current results and MRA at higher field strength (>1.5 T) needs to be further explored.

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References

  1. Rinkel GJ, Djibuti M, Algra A, Van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256

    PubMed  CAS  Google Scholar 

  2. Guglielmi G, Vinuela F, Sepetka I, Macellari V (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electrochemical basis, technique, and experimental results. J Neurosurg 75:1–7

    PubMed  CAS  Google Scholar 

  3. Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75:8–14

    PubMed  CAS  Google Scholar 

  4. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  5. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2005) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817

    Article  PubMed  Google Scholar 

  6. Koebbe CJ, Veznedaroglu E, Jabbour P, Rosenwasser RH (2006) Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery 59:S93–S102

    Article  PubMed  Google Scholar 

  7. Van Rooij WJ, Sprengers ME, Sluzewski M, Beute GN (2007) Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome. Neuroradiology 49:343–349

    Article  PubMed  Google Scholar 

  8. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356

    PubMed  CAS  Google Scholar 

  9. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966

    PubMed  Google Scholar 

  10. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403

    Article  PubMed  Google Scholar 

  11. Gallas S, Pasco A, Cottier JP, Gabrillargues J, Drouineau J, Cognard C, Herbreteau D (2005) A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 26:1723–1731

    PubMed  Google Scholar 

  12. Earnest F, Forbes G, Sandok BA, Piepgras DG, Faust RJ, Ilstrup DM, Arndt LJ (1984) Complications of cerebral angiography: prospective assessment of risk. AJR Am J Roentgenol 142:247–253

    PubMed  Google Scholar 

  13. Dion JE, Gates PC, Fox AJ, Barnett HJ, Blom RJ (1987) Clinical events following neuroangiography: a prospective study. Stroke 18:997–1004

    PubMed  CAS  Google Scholar 

  14. Grzyska U, Freitag J, Zeumer H (1990) Selective cerebral intraarterial DSA. Complication rate and control of risk factors. Neuroradiology 32:296–299

    Article  PubMed  CAS  Google Scholar 

  15. Heiserman JE, Dean BL, Hodak JA, Flom RA, Bird CR, Drayer BP, Fram EK (1994) Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 15:1401–1407

    PubMed  CAS  Google Scholar 

  16. Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W (2003) Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 227:522–528

    Article  PubMed  Google Scholar 

  17. Hartman J, Nguyen T, Larsen D, Teitelbaum GP (1997) MR artifacts, heat production, and ferromagnetism of Guglielmi detachable coils. AJNR Am J Neuroradiol 18:497–501

    PubMed  CAS  Google Scholar 

  18. Shellock FG, Detrick MS, Brant-Zawadski MN (1997) MR compatibility of Guglielmi detachable coils. Radiology 203:568–570

    PubMed  CAS  Google Scholar 

  19. Hennemeyer CT, Wicklow K, Feinberg DA, Derdeyn CP (2001) In vitro evaluation of platinum Guglielmi detachable coils at 3 T with a porcine model: safety issues and artifacts. Radiology 219:732–737

    PubMed  CAS  Google Scholar 

  20. Shellock FG (2002) Biomedical implants and devices: assessment of magnetic field interactions with a 3.0-Tesla MR system. J Magn Reson Imaging 16:721–732

    Article  PubMed  Google Scholar 

  21. Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25

    Article  PubMed  Google Scholar 

  22. Whiting PF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2006) Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 6:9

    Article  PubMed  Google Scholar 

  23. Brennan P, Silman A (1992) Statistical methods for assessing observer variability in clinical measures. BMJ 304:1491–1494

    Article  PubMed  CAS  Google Scholar 

  24. Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990

    Article  PubMed  Google Scholar 

  25. Papke K, Brassel F (2006) Modern cross-sectional imaging in the diagnosis and follow-up of intracranial aneurysms. Eur Radiol 16:2051–2066

    Article  PubMed  Google Scholar 

  26. Pierot L, Delcourt C, Bouquigny F, Breidt D, Feuillet B, Lanoix O, Gallas S (2006) Follow-up of intracranial aneurysms selectively treated with coils: prospective evaluation of contrast-enhanced MR angiography. AJNR Am J Neuroradiol 27:744–749

    PubMed  CAS  Google Scholar 

  27. Gauvrit JY, Leclerc X, Caron S, Taschner CA, Lejeune JP, Pruvo JP (2006) Intracranial aneurysms treated with Guglielmi detachable coils: imaging follow-up with contrast-enhanced MR angiography. Stroke 37:1033–1037

    Article  PubMed  Google Scholar 

  28. Saguchi T, Murayama Y, Ishibashi T, Ebara M, Irie K, Takao H, Abe T (2006) Efficacy of 3-D reconstructed time of flight MRA follow-up of the embolized cerebral aneurysms. Intervent Neuroradiol 12(S1):45–48

    Google Scholar 

  29. Westerlaan HE, van der Vliet AM, Hew JM, Meiners LC, Metzemaekers JD, Mooij JJ, Oudkerk M (2005) Time-of-flight magnetic resonance angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils. Neuroradiology 47:622–629

    Article  PubMed  CAS  Google Scholar 

  30. Farb RI, Nag S, Scott J, Willinsky RA, Marotta TR, Montanera WJ, Tomlinson G, Terbrugge KG (2005) Surveillance of intracranial aneurysms treated with detachable coils: a comparison of MRA techniques. Neuroradiology 47:507–515

    Article  PubMed  Google Scholar 

  31. Majoie CB, Sprengers ME, van Rooij WJ, Lavini C, Sluzewski M, van Rijn JC, den Heeten GJ (2005) MR angiography at 3T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol 26:1349–1356

    PubMed  Google Scholar 

  32. Gauvrit JY, Leclerc X, Pernodet M, Lubicz B, Lejeune JP, Leys D, Pruvo JP (2005) Intracranial aneurysms treated with Guglielmi detachable coils: usefulness of 6-month imaging follow-up with contrast-enhanced MR angiography. AJNR Am J Neuroradiol 26:515–521

    PubMed  Google Scholar 

  33. Yamada N, Hayashi K, Murao K, Higashi M, Iihara K (2004) Time-of-flight MR angiography targeted to coiled intracranial aneurysms is more sensitive to residual flow than is digital subtraction angiography. AJNR Am J Neuroradiol 25:1154–1157

    PubMed  Google Scholar 

  34. Okahara M, Kiyosue H, Hori Y, Yamashita M, Nagatomi H, Mori H (2004) Three-dimensional time-of-flight MR angiography for evaluation of intracranial aneurysms after endosaccular packing with Guglielmi detachable coils: comparison with 3D digital subtraction angiography. Eur Radiol 14:1162–1168

    Article  PubMed  Google Scholar 

  35. Hochmuth A, Vougioukas VI, Ziyeh S, Van Velthoven V, Berlis A (2004) MRA versus DSA in the follow-up of endovascular and surgically treated intracranial aneurysms. Klin Neuroradiol 14:187–193

    Google Scholar 

  36. Cottier JP, Bleuzen-Couthon A, Gallas S, Vinikoff-Sonier CB, Bertrand P, Domengie F, Barantin L, Herbreteau D (2003) Follow-up of intracranial aneurysms treated with detachable coils: comparison of plain radiographs, 3D time-of-flight MRA and digital subtraction angiography. Neuroradiology 45:818–824

    Article  PubMed  CAS  Google Scholar 

  37. Cottier JP, Bleuzen-Couthon A, Gallas S, Vinikoff-Sonier CB, Bertrand P, Domengie F, Barantin L, Herbreteau D (2003) Intracranial aneurysms treated with Guglielmi detachable coils: is contrast material necessary in the follow-up with 3D time-of-flight MR angiography? AJNR Am J Neuroradiol 24:1797–1803

    PubMed  Google Scholar 

  38. Leclerc X, Navez JF, Gauvrit JY, Lejeune JP, Pruvo JP (2002) Aneurysms of the anterior communicating artery treated with Guglielmi detachable coils: follow-up with contrast-enhanced MR angiography. AJNR Am J Neuroradiol 23:1121–1127

    PubMed  Google Scholar 

  39. Nome T, Bakke SJ, Nakstad PH (2002) MR angiography in the follow-up of coiled cerebral aneurysms after treatment with Guglielmi detachable coils. Acta Radiol 43:10–14

    Article  PubMed  Google Scholar 

  40. Weber W, Yousry TA, Felber SR, Henkes H, Nahser HC, Roer N, Kuhne D (2001) Noninvasive follow-up of GDC-treated saccular aneurysms by MR angiography. Eur Radiol 11:1792–1797

    Article  PubMed  CAS  Google Scholar 

  41. Boulin A, Pierot L (2001) Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium-enhanced 3D time-of-flight MR angiography and digital subtraction angiography. Radiology 219:108–113

    PubMed  CAS  Google Scholar 

  42. Michardiere R, Bensalem D, Martin D, Baudouin N, Binnert D (2001) Comparison of MRA and angiography in the follow-up of intracranial aneurysms treated with GDC. J Neuroradiol 28:75–83

    PubMed  CAS  Google Scholar 

  43. Hayashi T, Asai J, Sugimoto H, Honda M, Satoh K, Nagashima G, Suzuki R, Fujimoto T (2001) 2D fast spoiled gradient echo (2D-FSPGR) Gd-DTPA enhanced dynamic MR angiography in cerebral aneurysms after treatment with platinum detachable coils. Intervent Neuroradiol 7(S1):65–72

    Google Scholar 

  44. Anzalone N, Righi C, Simionato F, Scomazzoni F, Pagani G, Calori G, Santino P, Scotti G (2000) Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 21:746–752

    PubMed  CAS  Google Scholar 

  45. Kahara VJ, Seppanen SK, Ryymin PS, Mattila P, Kuurne T, Laasonen EM (1999) MR angiography with three-dimensional time-of-flight and targeted maximum-intensity-projection reconstructions in the follow-up of intracranial aneurysms embolized with Guglielmi detachable coils. AJNR Am J Neuroradiol 20:1470–1475

    PubMed  CAS  Google Scholar 

  46. Brunereau L, Cottier JP, Sonier CB, Medioni B, Bertrand P, Rouleau P, Sirinelli D, Herbreteau D (1999) Prospective evaluation of time-of-flight MR angiography in the follow-up of intracranial saccular aneurysms treated with Guglielmi detachable coils. J Comput Assist Tomogr 23:216–223

    Article  PubMed  CAS  Google Scholar 

  47. Adams WM, Laitt RD, Jackson A (1999) Time of flight 3D magnetic resonance angiography in the follow-up of coiled cerebral aneurysms. Intervent Neuroradiol 5:127–137

    Google Scholar 

  48. Gonner F, Heid O, Remonda L, Nicoli G, Baumgartner RW, Godoy N, Schroth G (1998) MR angiography with ultrashort echo time in cerebral aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 19:1324–1328

    PubMed  CAS  Google Scholar 

  49. Derdeyn CP, Graves VB, Turski PA, Masaryk AM, Strother CM (1997) MR angiography of saccular aneurysms after treatment with Guglielmi detachable coils: preliminary experience. AJNR Am J Neuroradiol 18:279–286

    PubMed  CAS  Google Scholar 

  50. Wilcock DJ, Jaspan T, Evans S (1994) 3D TOF MRA: role in evaluation of intracranial aneurysms following embolization with platinum coils. Magn Reson Mater Phys Biol Med 2:327–334

    Article  Google Scholar 

  51. Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR (1991) Publication bias in clinical research. Lancet 337:867–872

    Article  PubMed  CAS  Google Scholar 

  52. Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004

    PubMed  CAS  Google Scholar 

  53. Costalat V, Lebars E, Sarry L, Defasque A, Barbotte E, Brunel H, Bourbotte G, Bonafe A (2006) In vitro evaluation of 2D-digital subtraction angiography versus 3D-time-of-flight in assessment of intracranial cerebral aneurysm filling after endovascular therapy. AJNR Am J Neuroradiol 27:177–184

    PubMed  CAS  Google Scholar 

  54. Ozsarlak O, Van Goethem JW, Maes M, Parizel PM (2004) MR angiography of the intracranial vessels: technical aspects and clinical applications. Neuroradiology 46:955–972

    Article  PubMed  Google Scholar 

  55. Liu K, Margosian P (2001) Multiple contrast fast spin-echo approach to black-blood intracranial MRA: use of complementary and supplementary information. Magn Reson Imaging 19:1173–1181

    Article  PubMed  CAS  Google Scholar 

  56. Lee YJ, Kim DJ, Suh SH, Lee SK, Kim J, Kim DI (2005) Stent-assisted coil embolization of intracranial wide-necked aneurysms. Neuroradiology 47:680–689

    Article  PubMed  Google Scholar 

  57. Nehra A, Moran CJ, Cross DT 3rd, Derdeyn CP (2004) MR safety and imaging of neuroform stents at 3T. AJNR Am J Neuroradiol 25:1476–1478

    PubMed  Google Scholar 

  58. Lovblad KO, Yilmaz H, Chouiter A, San Millan Ruiz D, Abdo G, Bijlenga P, de Tribolet N, Ruefenacht DA (2006) Intracranial aneurysm stenting: follow-up with MR angiography. J Magn Reson Imaging 24:418–422

    Article  PubMed  Google Scholar 

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  1. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Thomas C. Kwee

  2. Department of Radiology, Academic Hospital Maastricht, Maastricht, The Netherlands

    Robert M. Kwee

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Kwee, T.C., Kwee, R.M. MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis. Neuroradiology 49, 703–713 (2007). https://doi.org/10.1007/s00234-007-0266-5

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