İntrakraniyal anevrizmaların tedavisi için uygulanan endovasküler koil embolizasyonunun manyetik rezonans anjiyografi ile takibi

Year 2021, Volume: 14 Issue: 4, 812 - 817, 01.10.2021

Murat Dökdök Kutlay Karaman Selcuk Gocmen

https://doi.org/10.31362/patd.854579

Abstract

Amaç: Manyetik rezonans anjiyografinin (MRA) endovasküler koil ile tedavi edilen intrakraniyal anevrizmaların takiplerinde kullanışlılığını ve tekrarlanabilirliğini değerlendirmek.

Gereç ve Yöntem: Platin koil ile tedavi edilen 51 hasta (18 erkek, 33 kadın; yaş 21-86 yıl, ort. yaş 50.2 yıl) bu çalışmaya alındı. Hastalara, endovasküler tedaviden 3-6 ay sonra takip MRA planlandı. İki girişimsel nöroradyolog, TOF-MRA görüntülerini körleme değerlendirdi. Bu amaçla, maksimum yoğunluk projeksiyonu (MIP) ve multiplanar reformasyon (MPR) gibi 3D TOF görüntülerinin kaynak MR görüntüleri ve hacimsel işleme teknikleri kullanılmıştır. Altı ay ile birinci yılda hastanın özelliklerine bağlı olarak biplanar anjiografi ünitesinde bir referans testi olarak takip dijital subtraksiyon anjiyografi (DSA) yapılmıştır.

Bulgular: Tedavi edilen 54 serebral anevrizmalı hastadan, 5’inde rezidü veya rekürren anevrizma olduğu DSA ile doğrulandı; ikisi baziler tepe , biri sol MCA bifurkasyosu, biri anterior komünikan arter ve biri sağ supraklinoid internal karotid arterdi. Daha sonra DSA, MRA verileriyle karşılaştırıldı. MRA için toplam uzlaşma 0,94 idi. MRA için, okuyucuların iyi uyumunu göstermek için Kappa katsayısı 0.74 idi (%95 CI 0.44 ile 1.04 idi).

Sonuç: MRA, endovasküler koil embolizasyonundan sonra anevrizmaların takibi için tekrarlanabilir bir tekniktir. Altın standart bir test olarak konvansiyonel kateter anjiyografi şüpheli olguları göstermek için kullanılabilir.

Keywords

Serebral anevrizma, Endovasküler tedavi, Koil embolizasyon, manyetik rezonans anjiyografi, Dijital subtraksiyon anjiyografi, rezonans anjiyografi

Follow-Up of endovascular coil embolization applied for the treatment of intracranial aneurysms by magnetic resonance angiography

Abstract

Purpose: To assess the usefulness and reproducibility of magnetic resonance angiography (MRA) for the evaluation of intracranial aneurysms treated by endovascular coiling.

Materials and Methods: 51 patients (18 men, 33 women; 21-86 year-old, mean age 50.2) with 54 aneurysms treated by detachable platinum coils were included in this study. The patients were scheduled for follow-up MRA imaging at three to six months after endovascular treatment. Two interventional neuroradiologists, evaluated the TOF-MRA images blindly. Source MR images and volume rendering techniques of 3D TOF images such as maximum intensity projection (MIP) and multiplanar reformation (MPR) were utilized for this purpose. Follow-up digital subtraction angiography (DSA) was performed as a reference test on a biplane angiographic unit on the sixth month and the first year depending on the patient's characteristics.

Results: DSA confirmed residual or recurrent aneurysmal flow in 5 patients out of 54 treated cerebral aneurysms; two with tip of basilary artery, one with left MCA bifurcation, one with anterior communicating artery and one with right supraclinoid internal carotid artery. Then the DSA images were compared with the MRA data. Total agreement was 0.94 for MRA. Kappa coefficient was 0.74 for indicating good concordance of the readers for MRA (95 % CI was 0.44 to 1.04).

Conclusion: MRA is a reproducible technique for the follow-up of aneurysms after endovascular coil embolization. Conventional catheter angiography as a gold standard test could be used to solve uncertain cases.

Keywords

Cerebral aneurysm, endovascular treatment, coil embolization, magnetic resonance angiography, digital subtraction angiography

References

• 1. Molyneux AJ, Kerr RS, Birks J, et al. Risk of recurrent subarachnoid hemorrhage, death, or dependence and standardized mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009;8:427-433.
• 2. Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005;366:809-817.
• 3. Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227:522–588.
• 4. Anzalone N, Righi C, Simionato F, et al. Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 2000;21:746–752.
• 5. Boulin A, Pierot L. Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium-enhanced 3D time-of-flight MR angiography and digital subtraction angiography. Radiology 2001;219:108–113.
• 6. Derdeyn CP, Graves VB, Turski PA, et al. MR angiography of saccular aneurysms after treatment with Guglielmi detachable coils: preliminary experience. AJNR Am J Neuroradiol 1997;18:279–286.
• 7. Kahara VJ, Seppanen SK, Ryymin PS, et al. 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 1999;20:1470–1475.
• 8. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-1403.
• 9. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159–174.
• 10. Schaafsma JD, Velthuis BK, Majoie CB, et al. Intracranial aneurysms treated with coil placement: test characteristics of follow-up MR angiography--multicenter study. Radiology 2010;256:209-218.
• 11. Soize S, Gawlitza M, Raoult H, Pierot L. Imaging Follow-Up of Intracranial Aneurysms Treated by Endovascular Means: Why, When, and How? Stroke 2016 May;47(5):1407-12.
• 12. Piotin M, Spelle L, Mounayer C, et al. Intracranial aneurysms: treatment with bare platinum coils--aneurysm packing, complex coils, and angiographic recurrence. Radiology 2007;243:500-508.
• 13. Sprengers ME, Schaafsma J, et al. Stability of Intracranial Aneurysms Adequately Occluded 6 Months after Coiling: A 3T MR Angiography Multicenter Long-Term Follow-Up Study. AJNR Am J Neuroradiol 2008;29:1768-1774.
• 14. Tsurumi A, Tsurumi Y, Negoro M, et al. Delayed rupture of a basilar artery aneurysm treated with coils: case report and review of the literature. J Neuroradiol 2013;40:54-61.
• 15. Yamada N, Hayashi K, Murao K, Higashi M, Iihara K. 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 2004;25:1154–1157.
• 16. Grunwald IQ, Papanagiotou P, Struffert T, et al. Recanalization after endovascular treatment of intracerebral aneurysms. Neuroradiology 2007;49:41–47.
• 17. Brunereau L, Cottier JP, Sonier CB, et al. 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 1999;23:216–223.
• 18. Gonner F, Heid O, Remonda L, et al. MR angiography with ultra short echo time in cerebral aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 1998;19:1324–1328.
• 19. Kang HS, Moon WJ, Roh HG, et al. MR angiographic evaluation is limited in intracranial aneurysms embolized with Nexus coils. Neuroradiology 2008;50(2):171–178.
• 20. Majoie CB, Sprengers ME, van Rooij WJ, et al. MR angiography at 3T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol. 2005;26:1349-1356.
• 21. Urbach H, Dorenbeck U, von Falkenhausen M, et al. Three-dimensional time-of-flight MR angiography at 3T compared to digital subtraction angiography in the follow-up of ruptured and coiled intracranial aneurysms: a prospective study. Neuroradiology 2008;50:383-389.
• 22. Buhk JH, Kallenberg K, Mohr A, Dechent P, Knauth M. No advantage of time-of-flight magnetic resonance angiography at 3 Tesla compared to 1.5 Tesla in the follow-up after endovascular treatment of cerebral aneurysms. Neuroradiology 2008;50:855-861.
• 23. Ferre JC, Carsin-Nicol B, Morandi X, et al. Time-of-flight MR angiography at 3T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils. Eur J Radiol 2009;72:365-369.
• 24. Kwee TC, Kwee RM. MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis. Neuroradiology 2007;49:703-713.