Abstract
PurposeThe location of paraclinoid aneurysms is determinant for evaluation of its intradural compartment and risk of SAH after rupture. Advanced MRI techniques have provided clear visualization of the distal dural ring (DDR) to determine whether an aneurysm is intracavernous, transitional or intradural for decision-making. We analyzed the diagnostic accuracy of MRI in predicting whether a paraclinoid aneurysm is intracavernous, transitional or intradural.MethodsWe conducted a prospective cohort between January 2014 and December 2018. Patients with paraclinoid aneurysms underwent 3D fast spin-echo MRI sequence before surgical treatment. The DDR was the landmark for MRI characterization of the aneurysms as follow: (i) Intradural; (ii) Transitional; and (iii) Intracavernous. The MRI sensitivity, specificity, positive and negative likelihood ratios were determined compared to the intraoperative findings. We also evaluated the intertechnique agreement using the Cohen’s kappa coefficient (κ) for dichotomous classifications (cavernous vs non-cavernous).ResultsTwenty patients were included in the cohort. The accuracy of MRI showed a sensitivity of 86.7% (95%CI:59.5–98.3) and specificity of 90.0% (95%CI:55.5–99.8). Analyzing only patients without history of SAH, accuracy test improved with a sensitivity of 92.3% (95%CI:63.9–99.8) and specificity reached 100% (95%CI: 63–100). Values of Cohen’s kappa (κ), intertechnique agreement was considered substantial for dichotomous classifications (κ = 0.754; p < 0.001). For patients without previous SAH, intertechnique agreement was even more coincident for the dichotomous classification (κ = 0.901; p < 0.001).Conclusion3D fast spin-echo MRI sequence is a reliable and useful technique for determining the location of paraclinoid aneurysms in relation to the cavernous sinus, particularly for patients with no history of SAH.
Highlights
Cerebral aneurysms located in the intradural compartment are at higher risk of rupture and often require endovascular/microsurgical treatment
A Non-cavernous aneurysms comprised the intradural and transitional types b Not significant according to Student's t test (p > 0.05) c Not significant according to χ2 test (p > 0.05) d Not significant according to Mann–Whitney test (p > 0.05) e Classified as described by Krisht and Hsu
magnetic resonance imaging (MRI) was efficient in ruling out the occurrence of non-cavernous aneurysms
Summary
Cerebral aneurysms located in the intradural compartment are at higher risk of rupture and often require endovascular/microsurgical treatment. It is not always possible to achieve an accurate topographic diagnosis of brain aneurysms located in this segment of the ICA regarding their relationship with the carotid collar, the proximal dural ring (PDR) and the distal dural ring (DDR), or to determine if the aneurysm is intracavernous, transitional or intradural [9, 13,14,15,16,17,18]. Several studies have suggested that complementary MRI is effective in predicting the location of paraclinoid aneurysms [11, 13, 15, 16, 18, 19]. Most studies have not provided sufficient evidence regarding the agreement between MRI and intraoperative findings. On this basis, we analyzed the diagnostic accuracy of MRI in predicting whether a paraclinoid aneurysm is intracavernous, transitional or intradural
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