Usefulness of 3D T1-SPACE in Combination With 3D-TOF MRA for Follow-Up Evaluation of Intracranial Aneurysms Treated With Pipeline Embolization Devices.

Qiuji Shao,Qiaowei Wu,Qiang Li,Tianxiao Li,Kaitao Chang,Li Li,Meiyun Wang

doi:10.3389/fneur.2020.542493

Qiuji Shao, Qiaowei Wu + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2020.542493

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Abstract

Object: Follow-up evaluation of intracranial aneurysms treated by flow-diverting stents using MRI is challenging due to the presence of imaging artifacts. This study evaluated 3D T1-SPACE in combination with 3D-TOF sequence for follow-up evaluation of intracranial aneurysms treated with Pipeline embolization devices.Methods: Forty patients with 53 intracranial aneurysms who were treated with Pipeline Embolization Devices from October 2018 to July 2019 were enrolled in this study. All patients were evaluated for aneurysm occlusion and stent patency 4 to 7 months post-treatment using 3D T1-SPACE sequence, 3D-TOF MRA, and DSA examinations.Results: With regards to aneurysm occlusion, the intermodality (DSA and 3D-TOF MRA) agreement was good (κ = 0.755). The specificity of 3D-TOF MRA was 94.4% (34/36), the sensitivity was 76.5% (13/17), the total coincidence rate was 88.7% (47/53). With regards to the patency of the stented arteries after PED treatment, 3D T1-SPACE sequence was more accurate compared to 3D-TOF MRA (Z = −6.283, P < 0.001), with a no-artifact rate of 95.7% (44/46).Conclusions: 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. 3D-TOF MRA may be valuable in the evaluation of aneurysm occlusion. The combination of these two modalities may be used for long-term follow-up of intracranial aneurysms treated with Pipeline Embolization Devices.

Highlights

Endovascular treatment for cerebral aneurysms has significantly changed from intrasaccular embolization to endovascular reconstruction and flow diversion [1]
The inclusion criteria were as follows: patients who had intracranial aneurysms treated with Pipeline Embolization Devices (PED) and obtained the two MR imaging techniques (3D-TOF MRA and 3D T1SPACE) and DSA in the follow-up, both MRI sequences and DSA performed within 3 days apart
Thirty-three patients (82.5%) with 37 aneurysms were treated using a single PED for one aneurysm, two patients (5%) with large aneurysms were treated with double overlapping PEDs for one aneurysm and 5 patients (12.5%) with tandem aneurysms were treated with a single PED

Summary

Introduction

Endovascular treatment for cerebral aneurysms has significantly changed from intrasaccular embolization to endovascular reconstruction and flow diversion [1]. Pipeline Embolization Devices (PED) has gained widespread acceptance in treating intracranial aneurysms, especially large and giant internal carotid artery (ICA) aneurysms and has been demonstrated to be safe and effective in numerous clinical studies [2, 3]. Some evidence-based studies have supported broadening the use of PED for the treatment of indications such as unruptured, small, and saccular aneurysms (

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