Abstract
PurposeTo prospectively evaluate 7 Tesla time-of-flight (TOF) magnetic resonance angiography (MRA) in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE) for delineation of unruptured intracranial aneurysms (UIA).Material and MethodsSixteen neurosurgical patients (male n = 5, female n = 11) with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla MRI utilizing dedicated head coils. The following sequences were obtained: 7 Tesla TOF MRA, 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced MPRAGE. Image analysis was performed by two radiologists with regard to delineation of aneurysm features (dome, neck, parent vessel), presence of artifacts, vessel-tissue-contrast and overall image quality. Interobserver accordance and intermethod comparisons were calculated by kappa coefficient and Lin's concordance correlation coefficient.ResultsA total of 20 intracranial aneurysms were detected in 16 patients, with two patients showing multiple aneurysms (n = 2, n = 4). Out of 20 intracranial aneurysms, 14 aneurysms were located in the anterior circulation and 6 aneurysms in the posterior circulation. 7 Tesla MPRAGE imaging was superior over 1.5 and 7 Tesla TOF MRA in the assessment of all considered aneurysm and image quality features (e.g. image quality: mean MPRAGE7T: 5.0; mean TOF7T: 4.3; mean TOF1.5T: 4.3). Ratings for 7 Tesla TOF MRA were equal or higher over 1.5 Tesla TOF MRA for all assessed features except for artifact delineation (mean TOF7T: 4.3; mean TOF1.5T 4.4). Interobserver accordance was good to excellent for most ratings.Conclusion7 Tesla MPRAGE imaging demonstrated its superiority in the detection and assessment of UIA as well as overall imaging features, offering excellent interobserver accordance and highest scores for all ratings. Hence, it may bear the potential to serve as a high-quality diagnostic tool for pretherapeutic assessment and follow-up of untreated UIA.
Highlights
Rupture of intracranial aneurysm is associated with high morbidity and mortality rates, as it is known to be accountable for 80% of all subarachnaoid hemorrhages (SAH), causing 25% of all cerebrovascular-related deaths, [1]
Size and shape of unruptured intracranial aneurysms (UIA) are known to be significantly affiliated with rupture rates, high-quality assessment of UIA and its related features displays an important role on potential aneurysm treatment [2–4]
There were no significant differences between 7 Tesla TOF magnetic resonance angiography (MRA) and 7 Tesla
Summary
Rupture of intracranial aneurysm is associated with high morbidity and mortality rates, as it is known to be accountable for 80% of all subarachnaoid hemorrhages (SAH), causing 25% of all cerebrovascular-related deaths, [1]. Size and shape of unruptured intracranial aneurysms (UIA) are known to be significantly affiliated with rupture rates, high-quality assessment of UIA and its related features displays an important role on potential aneurysm treatment [2–4]. Digital subtraction angiography (DSA) is considered the gold standard for detection of UIA. Due to the application of ionizing radiation and iodinated contrast agent as well as the general risk affiliated to invasive interventional procedures, DSA is associated with a 0.2%–0.5% risk for severe permanent neurological complications [5,6]. Aneurysm subject sex age location Tesla TOF side 1.5 Tesla TOF Tesla MRA MPRAGE Ø in mm* female.
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