MR angiographic follow-up of intracranial aneurysms treated with detachable coils: Is there a need for blood-pool agents?

Ziele: In the follow-up of coiled intracranial aneurysms, blood pool contrast-enhanced magnetic resonance angiography (BPCE-MRA) using Gadofosveset trisodium (Vasovist®) was compared to 3D time-of-flight (TOF)-MRA. Methode: Thirty-two consecutive patients after coiling of 37 aneurysms were included in this retrospective study. MRAs in the steady-state phase were performed with a 1.5T scanner within eight days of digital subtraction angiography (DSA). Two experienced radiologists independently analyzed TOF sequences and Vasovist® CE-MRA images. Consensus was reached by review involving a third neuroradiologist. DSA images were interpreted separately by an interventional radiologist. Findings were assigned to one of three categories: complete occlusion (1), residual neck (2), and residual aneurysm (3). Ergebnis: Follow-up DSA demonstrated 13 complete obliterations (class 1), 13 residual necks (class 2), and eleven residual aneurysms (class 3). Interobserver agreement was substantial for CE-MRA (weighted Kappa [wK]=0.687), while intrarater reliability was excellent (wK=0.811) and substantial (wK=0.746), respectively. Kappa statistics showed substantial concordance of TOF-MRA and DSA (wK=0.664) as well as CE-MRA and DSA (wK=0.724) ratings. Interestingly, comparison between TOF-MRA and CE-MRA found excellent agreement (wK=0.818) with only six (16.2%) discrepancies. For detecting residual flow, the difference in accuracy of both MRA techniques (83.8% versus 91.9%) was not significant (McNemar, p=1.000). Schlussfolgerung: Classifying the completeness of endovascular intracranial aneurysm therapy, Vasovist® CE-MRA and 3D TOF-MRA showed excellent agreement. The use of blood pool contrast agent did not lead to significantly increased diagnostic accuracy in MR angiographic follow-up.

Korrespondierender Autor: Kau T

Landeskrankenhaus Klagenfurt, Institut für Diagnostische und Interventionelle Radiologie, St. Veiter Straße 47, 9020, Klagenfurt

E-Mail: [e-mail]

intracranial aneurysms - MR angiography - blood pool contrast media