Assessment of brain aneurysms by using high-resolution magnetic resonance angiography after endovascular coil delivery

John H. Wong M.D., M.SC., Alim P. Mitha M.D., Morgan Willson M.D., Mark E. Hudon M.D., Robert J. Sevick M.D., and Richard Frayne Ph.D.
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Object

Digital subtraction (DS) angiography is the current gold standard of assessing intracranial aneurysms after coil placement. Magnetic resonance (MR) angiography offers a noninvasive, low-risk alternative, but its accuracy in delineating coil-treated aneurysms remains uncertain. The objective of this study, therefore, is to compare a high-resolution MR angiography protocol relative to DS angiography for the evaluation of coil-treated aneurysms.

Methods

In 2003, the authors initiated a prospective protocol of following up patients with coil-treated brain aneurysms using both 1.5-tesla gadolinium-enhanced MR angiography and biplanar DS angiography. Using acquired images, the subject aneurysm was independently scored for degree of remnant identified (complete obliteration, residual neck, or residual aneurysm) and the surgeon's ability to visualize the parent vessel (excellent, fair, or poor).

Results

Thirty-seven patients with 42 coil-treated aneurysms were enrolled for a total of 44 paired MR angiography–DS angiography tests (median 9 days between tests). An excellent correlation was found between DS and MR angiography for assessing any residual aneurysm, but not for visualizing the parent vessel (κ = 0.86 for residual aneurysm and 0.10 for parent vessel visualization). Paramagnetic artifact from the coil mass was minimal, and in some cases MR angiography identified contrast permeation into the coil mass not revealed by DS angiography. An intravascular microstent typically impeded proper visualization of the parent vessel on MR angiography.

Conclusions

Magnetic resonance angiography is a noninvasive and safe means of follow-up review for patients with coil-treated brain aneurysms. Compared with DS angiography, MR angiography accurately delineates residual aneurysm necks and parent vessel patency (in the absence of a stent), and offers superior visualization of contrast filling within the coil mass. Use of MR angiography may obviate the need for routine diagnostic DS angiography in select patients.

Abbreviations used in this paper:DS = digital subtraction; MIP = maximum intensity projection; MR = magnetic resonance; SAH = subarachnoid hemorrhage; TOF = time-of-flight.

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Contributor Notes

Address reprint requests to: John H. Wong, M.D., M.Sc., Division of Neurosurgery, University of Calgary, Foothills Medical Centre, 1403–29th Street N.W., Calgary, Alberta, Canada T2N 2T9. email: jwong@ucalgary.ca.
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