Discrepancy between MRA and DSA in identifying the shape of small intracranial aneurysms

Youngseok Kwak MD1, Wonsoo Son MD2, Yong-Sun Kim MD, PhD3, Jaechan Park MD, PhD2, and Dong-Hun Kang MD2
View More View Less
  • 1 Department of Neurosurgery, School of Medicine, Catholic University of Daegu; and
  • | 2 Departments of Neurosurgery and
  • | 3 Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The authors evaluated the sensitivity and accuracy of MRA in identifying the shape of small-sized unruptured intracranial aneurysms.

METHODS

Small (< 7 mm) unruptured intracranial aneurysms initially detected by MRA and confirmed by DSA between January 2017 and December 2018 were morphologically reviewed by neuroradiologists. Regularity or irregularity of aneurysm shape was analyzed by two independent reviewers using MRA without DSA results. DSA findings served as the reference standard for aneurysm shape. Irregular shape, which in small aneurysms is associated with a higher likelihood of rupture, was defined as positive, and MRA sensitivity, specificity, and accuracy were determined by using evaluations based on location, size, and MRA magnetic strength (1.5T vs 3T MRA). Multivariate analysis was performed to determine risk factors for false-negative MRA results for irregularly shaped aneurysms.

RESULTS

In total, 652 unruptured intracranial aneurysms in 530 patients were reviewed for this study. For detecting aneurysm shape irregularity, the overall MRA sensitivity was 60.4% for reviewer 1 and 60.9% for reviewer 2. Anterior cerebral artery aneurysms had the lowest sensitivity for location (36.7% for reviewer 1, 46.9% for reviewer 2); aneurysms sized < 3 mm had the lowest sensitivity for size (26.7% for both reviewers); and 1.5T MRA had lower sensitivity and accuracy than 3T MRA. In multivariate analysis, location, size, and magnetic strength of MRA were independent risk factors for false-negative MRA results for irregularly shaped aneurysms.

CONCLUSIONS

MRA had a low sensitivity for detecting the irregular shape of small intracranial aneurysms. In particular, anterior cerebral artery location, aneurysm size < 3 mm, and detection with 1.5T MRA were associated with a higher risk of irregularly shaped aneurysms being misjudged as regular.

ABBREVIATIONS

ACA = anterior cerebral artery; AUC = area under the ROC curve; ICA = internal carotid artery; MCA = middle cerebral artery; NPV = negative predictive value; PPV = positive predictive value; ROC = receiver operating characteristic.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Dong-Hun Kang: Kyungpook National University Hospital, Daegu, Republic of Korea. kdhdock@gmail.com.

INCLUDE WHEN CITING Published online July 24, 2020; DOI: 10.3171/2020.4.JNS20128.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Atlas SW , Sheppard L , Goldberg HI , et al. Intracranial aneurysms: detection and characterization with MR angiography with use of an advanced postprocessing technique in a blinded-reader study . Radiology . 1997 ;203 (3 ):807 814 .

    • Search Google Scholar
    • Export Citation
  • 2

    Cirillo M , Scomazzoni F , Cirillo L , et al. Comparison of 3D TOF-MRA and 3D CE-MRA at 3T for imaging of intracranial aneurysms . Eur J Radiol . 2013 ;82 (12 ):e853 e859 .

    • Search Google Scholar
    • Export Citation
  • 3

    Hiratsuka Y , Miki H , Kiriyama I , et al. Diagnosis of unruptured intracranial aneurysms: 3T MR angiography versus 64-channel multi-detector row CT angiography . Magn Reson Med Sci . 2008 ;7 (4 ):169 178 .

    • Search Google Scholar
    • Export Citation
  • 4

    Mallouhi A , Felber S , Chemelli A , et al. Detection and characterization of intracranial aneurysms with MR angiography: comparison of volume-rendering and maximum-intensity-projection algorithms . AJR Am J Roentgenol . 2003 ;180 (1 ):55 64 .

    • Search Google Scholar
    • Export Citation
  • 5

    Hademenos GJ , Massoud TF , Turjman F , Sayre JW . Anatomical and morphological factors correlating with rupture of intracranial aneurysms in patients referred for endovascular treatment . Neuroradiology . 1998 ;40 (11 ):755 760 .

    • Search Google Scholar
    • Export Citation
  • 6

    Lindgren AE , Koivisto T , Björkman J , et al. Irregular shape of intracranial aneurysm indicates rupture risk irrespective of size in a population-based cohort . Stroke . 2016 ;47 (5 ):1219 1226 .

    • Search Google Scholar
    • Export Citation
  • 7

    Sailer AM , Wagemans BA , Nelemans PJ , et al. Diagnosing intracranial aneurysms with MR angiography: systematic review and meta-analysis . Stroke . 2014 ;45 (1 ):119 126 .

    • Search Google Scholar
    • Export Citation
  • 8

    Kleinloog R , de Mul N , Verweij BH , et al. Risk factors for intracranial aneurysm rupture: a systematic review . Neurosurgery . 2018 ;82 (4 ):431 440 .

    • Search Google Scholar
    • Export Citation
  • 9

    Schwab KE , Gailloud P , Wyse G , Tamargo RJ . Limitations of magnetic resonance imaging and magnetic resonance angiography in the diagnosis of intracranial aneurysms . Neurosurgery . 2008 ;63 (1 ):29 35 .

    • Search Google Scholar
    • Export Citation
  • 10

    Takhtani D , Dundamadappa S , Puri AS , Wakhloo A . Flow artifact in the anterior communicating artery resembling aneurysm on the time of flight MR angiogram . Acta Radiol . 2014 ;55 (10 ):1253 1257 .

    • Search Google Scholar
    • Export Citation
  • 11

    Korogi Y , Takahashi M , Mabuchi N , et al. Intracranial aneurysms: diagnostic accuracy of three-dimensional, Fourier transform, time-of-flight MR angiography . Radiology . 1994 ;193 (1 ):181 186 .

    • Search Google Scholar
    • Export Citation
  • 12

    Deutschmann HA , Augustin M , Simbrunner J , et al. Diagnostic accuracy of 3D time-of-flight MR angiography compared with digital subtraction angiography for follow-up of coiled intracranial aneurysms: influence of aneurysm size . AJNR Am J Neuroradiol . 2007 ;28 (4 ):628 634 .

    • Search Google Scholar
    • Export Citation
  • 13

    Li MH , Li YD , Gu BX , et al. Accurate diagnosis of small cerebral aneurysms ≤5 mm in diameter with 3.0-T MR angiography . Radiology . 2014 ;271 (2 ):553 560 .

    • Search Google Scholar
    • Export Citation
  • 14

    Al-Kwifi O , Emery DJ , Wilman AH . Vessel contrast at three Tesla in time-of-flight magnetic resonance angiography of the intracranial and carotid arteries . Magn Reson Imaging . 2002 ;20 (2 ):181 187 .

    • Search Google Scholar
    • Export Citation
  • 15

    Gibbs GF , Huston J III , Bernstein MA , et al. Improved image quality of intracranial aneurysms: 3.0-T versus 1.5-T time-of-flight MR angiography . AJNR Am J Neuroradiol . 2004 ;25 (1 ):84 87 .

    • Search Google Scholar
    • Export Citation
  • 16

    Tanabe S , Ohtaki M , Uede T , et al. Diagnosis of ruptured and unruptured cerebral aneurysms with three-dimensional CT angiography (3D-CTA). Article in Japanese . No Shinkei Geka . 1995 ;23 (9 ):787 795 .

    • Search Google Scholar
    • Export Citation
  • 17

    Villablanca JP , Jahan R , Hooshi P , et al. Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography . AJNR Am J Neuroradiol . 2002 ;23 (7 ):1187 1198 .

    • Search Google Scholar
    • Export Citation
  • 18

    Hoh BL , Cheung AC , Rabinov JD , et al. Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team . Neurosurgery . 2004 ;54 (6 ):1329 1342 .

    • Search Google Scholar
    • Export Citation
  • 19

    Kouskouras C , Charitanti A , Giavroglou C , et al. Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings . Neuroradiology . 2004 ;46 (10 ):842 850 .

    • Search Google Scholar
    • Export Citation
  • 20

    Li Q , Lv F , Yao G , et al. 64-section multidetector CT angiography for evaluation of intracranial aneurysms: comparison with 3D rotational angiography . Acta Radiol . 2014 ;55 (7 ):840 846 .

    • Search Google Scholar
    • Export Citation
  • 21

    Pechlivanis I , Schmieder K , Scholz M , et al. 3-Dimensional computed tomographic angiography for use of surgery planning in patients with intracranial aneurysms . Acta Neurochir (Wien) . 2005 ;147 (10 ):1045 1053 .

    • Search Google Scholar
    • Export Citation
  • 22

    Franklin B , Gasco J , Uribe T , et al. Diagnostic accuracy and inter-rater reliability of 64-multislice 3D-CTA compared to intra-arterial DSA for intracranial aneurysms . J Clin Neurosci . 2010 ;17 (5 ):579 583 .

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 86 86 86
Full Text Views 69 69 69
PDF Downloads 93 93 93
EPUB Downloads 0 0 0