Intracranial aneurysms treated with stent-assisted coil embolization: evaluation with four-dimensional ultrashort-TE MR angiography

• Published in: European radiology Vol. 33; no. 11; pp. 7923 - 7933
• Main Authors: Uetani, Hiroyuki, Kitajima, Mika, Ohmori, Yuki, Morita, Kosuke, Yamashita, Yuichi, Kaku, Yasuyuki, Nakaura, Takeshi, Sasao, Akira, Sasaki, Goh, Ishiuchi, Soichiro, Mukasa, Akitake, Hirai, Toshinori
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2023; Springer Nature B.V
• Subjects: Acoustic noise; Acoustic resonance; Aneurysm; Aneurysms; Angiography; Angiography, Digital Subtraction - methods; Arteries; Diagnostic Radiology; Digital imaging; Embolization; Embolization, Therapeutic - methods; Endovascular coiling; Evaluation; Follow-Up Studies; Head and Neck; Hemodynamics; Humans; Imaging; Implants; Internal Medicine; Interventional Radiology; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Magnetic resonance; Magnetic Resonance Angiography - methods; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Occlusion; Radiology; Spatial discrimination; Spatial resolution; Stents; Temporal resolution; Treatment Outcome; Ultrasound; Magnetic resonance imaging; Stents; Intracranial aneurysm; Magnetic resonance angiography
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09755-1

Objectives As a novel follow-up method for intracranial aneurysms treated with stent-assisted coil embolization (SACE), we developed four-dimensional magnetic resonance angiography (MRA) with minimized acoustic noise utilizing ultrashort-echo time (4D mUTE-MRA). We aimed to assess whether 4D mUTE-MRA is useful for the evaluation of intracranial aneurysms treated with SACE. Methods This study included 31 consecutive patients with intracranial aneurysm treated with SACE who underwent 4D mUTE-MRA at 3 T and digital subtraction angiography (DSA). For 4D mUTE-MRA, five dynamic MRA images with a spatial resolution of 0.5 × 0.5 × 0.5 mm 3 were obtained every 200 ms. Two readers independently reviewed the 4D mUTE-MRA images to evaluate the aneurysm occlusion status (total occlusion, residual neck, and residual aneurysm) and the flow in the stent using a 4-point scale (from 1 [not visible] to 4 [excellent]). The interobserver and intermodality agreement was assessed using κ statistics. Results On DSA images, 10 aneurysms were classified as total occlusion, 14 as residual neck, and 7 as residual aneurysm. In terms of aneurysm occlusion status, the intermodality and interobserver agreement was excellent ( κ  = 0.92 and κ  = 0.96, respectively). For the flow in the stents on 4D mUTE-MRA, the mean score was significantly higher for single stents than multiple stents ( p  < .001) and for open-cell type stents than closed-cell type ( p  < .01). Conclusions 4D mUTE-MRA is a useful tool with a high spatial and temporal resolution for the evaluation of intracranial aneurysms treated with SACE. Key Points • In the evaluation of intracranial aneurysms treated with SACE on 4D mUTE-MRA and DSA, the intermodality and interobserver agreement in aneurysm occlusion status was excellent. • 4D mUTE-MRA shows good to excellent visualization of flow in the stents, especially for cases treated with a single or open-cell stent. • 4D mUTE-MRA can provide hemodynamic information related to embolized aneurysms and the distal arteries to stented parent arteries.