Prospective Evaluation of Time-of-Flight MR Angiography in the Follow-Up of Intracranial Saccular Aneurysms Treated with Guglielmi Detachable Coils

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Abstract
The purpose of our study was to prospectively evaluate 3D time-of-flight (TOF) MR angiography (MRA) in the follow-up of 27 intracranial aneurysms treated with Guglielmi detachable coils (GDCs). From February 1997 to June 1998, 26 patients with 27 aneurysms were included in this prospective study. Aneurysms were located in the anterior circulation in 23 cases and in the posterior circulation in 4 cases. All patients underwent 3D TOF MRA and digital subtraction angiography (DSA) in the same week within 4 months after aneurysmal treatment with GDCs. No clinical events occurred during the follow-up. We analyzed residual flow within the coil mass and within the aneurysmal neck and the patency of the parent and adjacent arteries on MRA and DSA. MRA analysis was based upon MIPPED and source images. DSA was our gold standard. In all cases, the quality of MRA was good enough to be informative. In aneurysmal analysis, the sensitivity, specificity, positive predictive value, and negative predictive value of MRA were, respectively, 80, 100, 100, and 96% to diagnose residual flow within the coil mass (one false-negative case) and 83, 100, 100, and 95.5% to diagnose residual flow within the aneurysmal neck (one false-negative case). In arterial analysis, sensitivity and positive predictive value of MRA were 89 and 100% to diagnose patency of the parent artery (three false-negative cases) and 83 and 100% to diagnose patency of adjacent arteries (seven false-negative cases). In the follow-up of intracranial aneurysms treated with GDCs, 3D TOF MRA could be used as a screening test to select patients that should undergo DSA and thus could improve patient follow-up in terms of risk-benefit.