Diagnostic Performance of Pointwise Encoding Time Reduction with Radial Acquisition Subtraction-based MR Angiography in the Follow-up of Intracranial Aneurysms after Clipping.

Abstract

While follow-up assessment of clipped aneurysms (CAs) using magnetic resonance angiography (MRA) can be challenging due to susceptibility artifacts, anovel MRA sequence pointwise encoding time reduction with radial acquisition (PETRA) subtraction-based MRA, has been developed to reduce these artifacts. The aim of the study was to validate the diagnostic performance of PETRA-MRA by comparing it with digital subtraction angiography (DSA) as areference for follow-up of CAs using a 3T MR scanner. Patients with clipping who underwent both PETRA-MRA and DSA between September 2019 and December 2021 were retrospectively included. Two neuroradiologists independently reviewed with the reconstructed images of PETRA-MRA to assess the visibility of the arteries around the clips and aneurysm recurrence or remnants of CA using a3-point scale. The diagnostic accuracy of PETRA-MRA was evaluated in comparison to DSA. The study included 34patients (28females, mean age 59 ± 9.6years) with 48CAs. The PETRA-MRA allowed visualization of the parent vessels around the clips in 98% of cases, compared to 39% with time-of-flight (TOF) MRA (p < 0.0001). The DSA confirmed 14 (29.2%) residual or recurrent aneurysms. The PETRA-MRA demonstrated a high accuracy, specificity, positive predictive value, and negative predictive value of 99.2%, 100%, 100%, and 97.8%, respectively, while the sensitivity was 66.7%. This retrospective study demonstrates that PETRA-MRA provides excellent visibility of adjacent vessels near clips and has ahigh diagnostic accuracy in detecting aneurysm remnants or recurrences in CAs. Further prospective studies are warranted to establish its utility as areliable alternative for follow-up after clipping.