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Kim J, Kim JJ, Kim SW, Choi J, Kim H, Kim J, Chung J. Safety and efficacy of the novel Alpha stent for the treatment of intracranial wide-necked aneurysm. Sci Rep 2024; 14:8723. [PMID: 38622273 PMCID: PMC11018798 DOI: 10.1038/s41598-024-59363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
The Alpha stent is an intracranial closed-cell stent with a unique mesh design to enhance wall apposition. It recently underwent structural modifications to facilitate easier stent deployment. This study aimed to evaluate the safety and efficacy of stent-assisted coil embolization for unruptured intracranial aneurysms using the Alpha stent. Between January 2021 and November 2021, 35 adult patients with 35 unruptured intracranial aneurysms in the distal internal carotid artery were prospectively enrolled. For efficacy outcomes, magnetic resonance angiography at the 6-month follow-up was evaluated using the Raymond-Roy occlusion classification (RROC). The safety outcome evaluated the occurrence of symptomatic procedure-related neurological complications up to 6 months postoperatively. Technical success was achieved in 34/35 (97.1%). Six months postoperatively, aneurysm occlusion showed RROC I in 32/35 (91.4%) and RROC II in 3/35 (8.6%) patients. Procedure-related neurologic complications occurred in one patient (2.9%) who experienced hemiparesis due to acute lacunar infarction, which resulted in a 6-month mRS score of 1. The Alpha stent demonstrated excellent efficacy and safety outcomes in stent-assisted coil embolization of unruptured distal ICA aneurysms. The recent structural modifications allowed for easier stent delivery and deployment.Clinical trial registration number: KCT0005841; registration date: 28/01/2021.
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Affiliation(s)
- Junhyung Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Jae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-Ro 63-Gil, Gangnam-Gu, Seoul, 06229, Republic of Korea
| | - Jinyoung Choi
- Severance Hospital, Yonsei University Healthcare System, Seoul, Republic of Korea
| | - Hanki Kim
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Republic of Korea
| | - Jinwoo Kim
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Jeonju, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-Ro 63-Gil, Gangnam-Gu, Seoul, 06229, Republic of Korea.
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Uetani H, Kitajima M, Ohmori Y, Morita K, Yamashita Y, Kaku Y, Nakaura T, Sasao A, Sasaki G, Ishiuchi S, Mukasa A, Hirai T. Intracranial aneurysms treated with stent-assisted coil embolization: evaluation with four-dimensional ultrashort-TE MR angiography. Eur Radiol 2023; 33:7923-7933. [PMID: 37284863 DOI: 10.1007/s00330-023-09755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES As a novel follow-up method for intracranial aneurysms treated with stent-assisted coil embolization (SACE), we developed four-dimensional magnetic resonance angiography (MRA) with minimized acoustic noise utilizing ultrashort-echo time (4D mUTE-MRA). We aimed to assess whether 4D mUTE-MRA is useful for the evaluation of intracranial aneurysms treated with SACE. METHODS This study included 31 consecutive patients with intracranial aneurysm treated with SACE who underwent 4D mUTE-MRA at 3 T and digital subtraction angiography (DSA). For 4D mUTE-MRA, five dynamic MRA images with a spatial resolution of 0.5 × 0.5 × 0.5 mm3 were obtained every 200 ms. Two readers independently reviewed the 4D mUTE-MRA images to evaluate the aneurysm occlusion status (total occlusion, residual neck, and residual aneurysm) and the flow in the stent using a 4-point scale (from 1 [not visible] to 4 [excellent]). The interobserver and intermodality agreement was assessed using κ statistics. RESULTS On DSA images, 10 aneurysms were classified as total occlusion, 14 as residual neck, and 7 as residual aneurysm. In terms of aneurysm occlusion status, the intermodality and interobserver agreement was excellent (κ = 0.92 and κ = 0.96, respectively). For the flow in the stents on 4D mUTE-MRA, the mean score was significantly higher for single stents than multiple stents (p < .001) and for open-cell type stents than closed-cell type (p < .01). CONCLUSIONS 4D mUTE-MRA is a useful tool with a high spatial and temporal resolution for the evaluation of intracranial aneurysms treated with SACE. KEY POINTS • In the evaluation of intracranial aneurysms treated with SACE on 4D mUTE-MRA and DSA, the intermodality and interobserver agreement in aneurysm occlusion status was excellent. • 4D mUTE-MRA shows good to excellent visualization of flow in the stents, especially for cases treated with a single or open-cell stent. • 4D mUTE-MRA can provide hemodynamic information related to embolized aneurysms and the distal arteries to stented parent arteries.
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Affiliation(s)
- Hiroyuki Uetani
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan.
| | - Mika Kitajima
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
- Department of Medical Image Sciences, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Kosuke Morita
- Central Radiology Section, Kumamoto University Hospital, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Yuichi Yamashita
- Canon Medical Systems Corporation, MRI Sales Department, Sales Engineer Group, 70-1, Yanagi-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-0015, Japan
| | - Yasuyuki Kaku
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Takeshi Nakaura
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Akira Sasao
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
- Joint Research Course of Imaging Dynamics Applied Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Goh Sasaki
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Soichiro Ishiuchi
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
| | - Toshinori Hirai
- Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuou-ku, Kumamoto, Japan
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Jung JY, Seo DK, Lee YB, Kang CK. MRI-Compatible Microcirculation System Using Ultrasonic Pumps for Microvascular Imaging on 3T MRI. SENSORS (BASEL, SWITZERLAND) 2022; 22:6191. [PMID: 36015953 PMCID: PMC9415701 DOI: 10.3390/s22166191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
The diagnosis of small vessel disease is attracting interest; however, it remains difficult to visualize the microvasculature using 3 Tesla (T) magnetic resonance imaging (MRI). Therefore, this study aimed to visualize the microvascular structure and measure a slow flow on 3T MRI. We developed a microcirculation system using piezoelectric pumps connected to small tubes (0.4, 0.5, 0.8, and 1.0 mm) and evaluated various MR sequences and imaging parameters to identify the most appropriate acquisition parameters. We found that the system could image small structures with a diameter of 0.5 mm or more when using a 1 m-long tube (maximal signal intensity of 241 in 1 mm, 199 in 0.8 mm, and 133 in 0.5 mm). We also found that the highest signal-to-noise ratio (SNR) appeared on 2-dimensional time-of-flight low-resolution imaging and that the flow velocity (10.03 cm/s) was similar to the actual velocity (11.01 cm/s in a flowmeter) when velocity encoding of 30 cm/s was used in a 0.8 mm-diameter tube. In conclusion, this study demonstrates that a microcirculation system can be used to image small vessels. Therefore, our results could serve as a basis for research on vessels' anatomical structure and pathophysiological function in small vessel disease.
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Affiliation(s)
- Ju-Yeon Jung
- Department of Health Science, Gachon University Graduate School, Gachon University, Incheon 21936, Korea
| | - Dong-Kyu Seo
- Department of Radiological Science, College of Health Science, Gachon University, Incheon 21936, Korea
| | - Yeong-Bae Lee
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
| | - Chang-Ki Kang
- Department of Health Science, Gachon University Graduate School, Gachon University, Incheon 21936, Korea
- Department of Radiological Science, College of Health Science, Gachon University, Incheon 21936, Korea
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Kim YN, Choi JW, Lim YC, Song J, Park JH, Jung WS. Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization. Korean J Radiol 2022; 23:246-255. [PMID: 35029075 PMCID: PMC8814699 DOI: 10.3348/kjr.2021.0332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. MATERIALS AND METHODS Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. RESULTS The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively (p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). CONCLUSION Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.
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Affiliation(s)
- You Na Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jihye Song
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Hyun Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.,Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea.
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Tan S, Lu Y, Li B, Wu Q, Zhou X, Wang Y. Usefulness of Silent Magnetic Resonance Angiography in the Follow-Up of Endovascular-Treated Intracranial Aneurysm: A Prospective Study. J Stroke Cerebrovasc Dis 2021; 31:106256. [PMID: 34923434 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To prospectively evaluate the clinical usefulness of Silent magnetic resonance angiography (Silent MRA) in the follow-up of endovascular-treated intracranial aneurysms by comparing it with time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA). METHODS Patients with endovascular-treated saccular aneurysms and followed with Silent MRA, TOF MRA, and DSA in our center were included. The visualization of the treated sites in the two MRA sequences was assessed using a 5-point scale. The aneurysm occlusion status according to each of the three imaging modalities was assessed using a 3-point scale. RESULTS Forty-one patients with 46 saccular aneurysms were recruited. The image quality score of Silent MRA was significantly higher than that of TOF MRA (4.32 ± 0.87 vs. 3.08 ± 1.48, P < 0.001). In the aneurysms treated by simple coiling, the maximal aneurysm diameter showed a strong negative correlation with image quality score in TOF MRA (Spearman's r = -0.519, P = 0.033), while it showed no significant correlation in Silent MRA (r = -0.037, P = 0.887). For the aneurysm occlusion status, inter-modality agreement was excellent (κ = 0.845) between DSA and Silent MRA, but poor (κ = 0.185) between DSA and TOF MRA. CONCLUSIONS Silent MRA was superior to TOF MRA in the follow-up of endovascular-treated intracranial aneurysms and showed excellent consistency with DSA in the evaluation of aneurysm occlusion. Therefore, Silent MRA is useful for the follow-up of endovascular-treated aneurysms.
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Affiliation(s)
- Song Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Bin Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Qin Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi province, China; Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Murayama D, Sakai T, Yoneyama M, Nose K, Hatakeyama H, Watanabe K, Ochi S. [Imaging Parameter Optimization of 3D Radial Stack-of-stars MRA with FID Sampling after Treatment of Cerebral Aneurysms with Metallic Devices]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:572-580. [PMID: 34148899 DOI: 10.6009/jjrt.2021_jsrt_77.6.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Magnetic resonance angiography (MRA) using ultra-short TE (uTE) is known to be used for the evaluation of cerebral aneurysm after treatment such as clipping and coiling. However, conventional uTE sequences are not appropriate as an additional imaging sequence for 3D time-of-flight (TOF)-MRA because it is not possible to shorten scan time and acquire selective-volume imaging. To solve the problem, we focused on the combination of uTE sampling and 3D radial scan sequences. In this study, we examined the optimal imaging parameters of the proposed uTE-MRA. A simulated blood flow phantom with stents (Enterprise) and titanium clips (YASARGIL) was used for optimizing the TR, flip angle (FA), and radial percentage. The signal intensity in the simulated vessel was measured in each imaging condition, and the ratio of the presence or absence of a stent was evaluated as a relative in-stent signal (RIS). In addition, the diameter of the signal loss of the simulated artery was measured for each imaging condition, and signal loss length (SLL) of a clip was calculated from the average value. The RIS improved with increasing the FA and shortening the TR, but it did not change by changing the radial percentage. The SLL became smaller at the coil as the FA increased, but there was no significant difference between the intersection and the blade. There was also no significant difference between TR and radial percentage. The effective imaging conditions for uTE-MRA to improve the vascular description of the evaluation after treatment of cerebral aneurysms with metallic devices were those with large FA and short TR.
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Affiliation(s)
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
| | | | - Kiichi Nose
- Department of Radiology, Eastern Chiba Medical Center
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Shao Q, Li Q, Wu Q, Li T, Li L, Chang K, He Y. Application of 3D T1-SPACE combined with 3D-TOF sequence for follow-up evaluation of stent-assisted coil embolization for intracranial aneurysm. J Interv Med 2021; 4:71-76. [PMID: 34805951 PMCID: PMC8562288 DOI: 10.1016/j.jimed.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess 3D T1-SPACE combined with 3D-TOF sequence for follow-up evaluation of stent-assisted coil embolization for intracranial aneurysm. MATERIALS AND METHODS Between Oct 2018 and May 2019, we enrolled 25 patients with intracranial aneurysm who underwent stent-assisted coil embolization. All patients were followed up for 6 to10 months after endovascular treatment (EVT) using 3D-TOF MRA, 3D T1-SPACE and DSA to evaluate aneurysm occlusion and parent artery patency. RESULTS With regards to aneurysm occlusion, the specificity of 3D-TOF MRA was 86.9% (20/23) and the accuracy was 84% (21/25). There was no statistical significance (P = 0.409) compared with the DSA. The parent artery by 3D-TOF MRA showed that there were 14 patients with grade 3, 8 patients with grade 2 and 3 patients with grade 1. However, 3D T1-SPACE showed that all 25 patients were grade 4, and were clearly displayed without metal artifacts. The comparison of the two MR techniques demonstrated that 3D T1-SPACE was superior to 3D-TOF MRA in the evaluation of parent artery (P<0.001). CONCLUSIONS 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. This study also shows that 3D-TOF MRA has a merit to evaluate aneurysm occlusion. The combination of these two modalities can be used as an optional follow-up evaluation after EVT of intracranial aneurysms.
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Affiliation(s)
- Qiuji Shao
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Qiang Li
- Department of Radiology, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Qiaowei Wu
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Li Li
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Kaitao Chang
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Yingkun He
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
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Shao Q, Li Q, Wu Q, Li T, Li L, Chang K. Comparison of 3D T1-SPACE and DSA in evaluation of intracranial in-stent restenosis. Br J Radiol 2020; 94:20190950. [PMID: 33259233 DOI: 10.1259/bjr.20190950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In-stent restenosis (ISR) after stenting for intracranial stenosis is a significant issue. This study aimed to evaluate the usefulness of the 3D T1-SPACE technique in the follow-up of patients after stent implantation. METHODS Fifteen patients with intracranial arterial stenosis were prospectively enrolled 6-8 months after stenting. Digital subtraction angiography (DSA) and 3D T1-SPACE imaging were performed to evaluate the degree of stenosis and the enhancement of the vessel wall. Bland-Altman plots were used to assess the agreement between the two imaging methods, and the Pearson correlation coefficient was calculated as a measure of the linear correlation. RESULTS Eight Enterprise stents and seven Wingspan stents were used in 15 patients. The follow-up DSA after 6-8 months showed that the degree of stenosis was 40% (range, 30-72%), and ISR occurred in 4 of 15 (26.7%) lesions. The degree of stenosis assessed using the 3D T1-SPACE imaging technique was 35% (range, 30-75%). All four patients with ISR demonstrated significant enhancement. The Pearson correlation coefficient between the two methods was 0.959 (p < 0.05), and the Bland-Altman plot showed that all data points were within the consistency limits ([Formula: see text] ± 1.96 s). CONCLUSION As a non-invasive imaging modality, 3D T1-SPACE showed great consistency with DSA in measuring the degree of stenosis after intracranial stenting. It may be used as an optional method for detecting ISR. ADVANCES IN KNOWLEDGE This study evaluated the usefulness of 3D T1-SPACE technique in the follow-up of patients after stent implantation, which could be used as an optional and non-invasive method in detection of in-stent restenosis.
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Affiliation(s)
- Qiuji Shao
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Qiang Li
- Department of Radiology, Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Qiaowei Wu
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Li Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Kaitao Chang
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
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Ryu KH, Baek HJ, Moon JI, Choi BH, Park SE, Ha JY, Park H, Kim SS, Kim JS, Cho SB, Carl M. Usefulness of Noncontrast-Enhanced Silent Magnetic Resonance Angiography (MRA) for Treated Intracranial Aneurysm Follow-up in Comparison with Time-of-Flight MRA. Neurosurgery 2019; 87:220-228. [DOI: 10.1093/neuros/nyz421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Flow visualization in time-of-flight magnetic resonance angiography (TOF MRA) is limited for treated intracranial aneurysms owing to magnetic susceptibility and radiofrequency shielding.
OBJECTIVE
To assess the clinical usefulness of noncontrast-enhanced magnetic resonance angiography (MRA) using a silent scan (silent MRA) as a follow-up imaging modality in patients with treated intracranial aneurysms.
METHODS
A total of 119 patients with 126 treated aneurysms underwent silent MRA and TOF MRA during the same scan session. Two neuroradiologists independently assessed overall image quality and visualization of the treated site using a 5-point Likert scale to compare the 2 image sets. We used receiver operating characteristic (ROC) curve analysis to investigate the diagnostic performance of the 2 MRA methods in evaluating aneurysm occlusion. Interobserver reliability was also assessed using weighted kappa statistics.
RESULTS
The overall image quality scores of silent MRA and TOF MRA were 4.04 ± 0.22 and 4.64 ± 0.48, respectively (P < .001), and interobserver agreement was substantial (P < .001). For the treated site, the score of flow visualization on silent MRA was higher than that on TOF MRA, 3.94 ± 0.94 vs 2.59 ± 1.37 (P < .001), with substantial interobserver agreement (P < .001). ROC curve analysis showed that silent MRA was superior to TOF MRA in diagnostic performance (area under the curve [AUC] = 0.962; 95% CI: 0.931-0.982 vs AUC = 0.843; 95% CI: 0.792-0.886; P < .001).
CONCLUSION
Silent MRA can be useful to evaluate treated intracranial aneurysms during follow-up without radiation exposure and use of contrast material. It is characterized by higher diagnostic performance and superior visualization for the treated site.
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Affiliation(s)
- Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seung Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jung-Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Michael Carl
- Applied Science Lab, GE Healthcare, San Diego, CA, United States
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11
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Heo YJ, Jeong HW, Baek JW, Kim ST, Jeong YG, Lee JY, Jin SC. Pointwise Encoding Time Reduction with Radial Acquisition with Subtraction-Based MRA during the Follow-Up of Stent-Assisted Coil Embolization of Anterior Circulation Aneurysms. AJNR Am J Neuroradiol 2019; 40:815-819. [PMID: 30975655 DOI: 10.3174/ajnr.a6035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Time-of-flight MR angiography, though widely used after coil embolization, is associated with limitations owing to magnetic susceptibility and radiofrequency shielding following stent-assisted coil embolization. We evaluated the pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA (qMRA) using an ultrashort TE relative to TOF-MRA during the follow-up of stent-assisted coil embolization for anterior circulation aneurysms. MATERIALS AND METHODS Twenty-five patients (3 men and 22 women; mean age, 59.1 ± 14.0 years) underwent stent-assisted coil embolization for anterior circulation aneurysms and were retrospectively evaluated using TOF-MRA and PETRA qMRA data from the same follow-up session. Two neuroradiologists independently reviewed both MRA findings and subjectively graded flow within the stents (relative to the latest DSA findings) and occlusion status (complete occlusion or neck/aneurysm remnant). Interobserver and intermodality agreement for TOF-MRA and PETRA qMRA were evaluated. RESULTS The mean score for flow visualization within the stents was significantly higher in PETRA qMRA than in TOF-MRA (P < .001 for both observers), and good interobserver agreement was reported (κ = 0.63). The aneurysm occlusion status of PETRA qMRA (observer 1, 92.0%; observer 2, 88.0%) was more consistent with DSA than with TOF-MRA (observer 1, 76.0%; observer 2, 80.0%), and there was a better intermodality agreement between DSA and PETRA qMRA than between DSA and TOF-MRA. CONCLUSIONS These findings indicate that PETRA qMRA is a useful follow-up technique for patients who have undergone stent-assisted coil embolization for anterior circulation aneurysms.
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Affiliation(s)
- Y J Heo
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - H W Jeong
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - J W Baek
- From the Departments of Radiology (Y.J.H., H.W.J., J.W.B.)
| | - S T Kim
- Neurosurgery (S.T.K., Y.G.J.)
| | | | - J Y Lee
- Internal Medicine (J.Y.L.), Inje University Busan Paik Hospital, Busan, Korea
| | - S-C Jin
- Department of Neurosurgery (S.-C.J.), Inje University Haeundae Paik Hospital, Busan, Korea
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12
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Kiriki M, Jomoto W, Ikeda T, Kotoura N. [Imaging Parameter Optimization of 3D Phase Contrast-MRA to Reduce Susceptibility-artifact and Radiofrequency-shielding around the Intracranial Stent]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 74:1293-1301. [PMID: 30464097 DOI: 10.6009/jjrt.2018_jsrt_74.11.1293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to evaluate the degree of signal attenuation generated around the stent by the susceptibility artifacts and radiofrequency (RF) shielding in phase contrast-magnetic resonance angiography (PCA) images and construct optimal PCA imaging parameters for intracranial stent lumen images. The two types of PCA images of stents (Neuroform, Enterpraise II) placed in the vascular flow phantom were imaged with different the flip angle (FA) and echo time (TE). Each original image of the vascular flow phantom was reconstructed into a coronal multiplanar reconstruction (MPR) image and a profile curve along the long axis of the stent was calculated. The reduction of in-stent signal was assessed by relative in-stent signal (RIS) calculated by comparing intra-stent signal intensity to the reference tube in the original images. When the TE was 2.3 ms, the profile curve was the highest signal intensity. However, RIS had not changed by the extension of TE. When the FA was high, the RIS showed a high value, but when it exceeded 25 degrees, the signal attenuated in the distal part of the slab.The susceptibility artifacts and RF shielding generated around the stent can be reduced by the shortest TbE (2.3 ms) and 20 degrees of FA in the PCA imaging.
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Affiliation(s)
- Masato Kiriki
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Wataru Jomoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Takashi Ikeda
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Noriko Kotoura
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
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13
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Akatsu T, Ishimori Y, Kobayashi T, Miyamoto K. [Imaging Parameter Optimization of Non-contrast Three-dimensional Time-of-flight Magnetic Resonance Angiography for Patients with Intracranial Stents Using a 1.5 T Magnetic Resonance Imaging System]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:1437-1445. [PMID: 31866642 DOI: 10.6009/jjrt.2019_jsrt_75.12.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The imaging parameters of non-contrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) were optimized to improve the image quality for patients treated using stent-assisted coiling. A simulated blood flow phantom with three types of stents (Enterprise 2, Neuroform Atlas, and LVIS) was imaged by changing echo time (TE), band width (BW), flip angle (FA), and matrix (phase, frequency). The difference between the signal intensity in the simulated vessel and the background was measured at each imaging condition. The ratio of this difference with and without the stent was evaluated as the relative in-stent signal (RIS). In addition, the error ratio of the stent lumen diameter was assessed by comparing the full width at half maximum (FWHM) to that measured by 3D X-ray angiography. The RIS was higher in order of LVIS, Neuroform Atlas, and Enterprise 2 in all conditions. The RIS was higher in imaging conditions with short TE, narrow BW, high FA, and large phase matrix. The highest RIS was seen with a frequency matrix of 320 in the Enterprise 2 and 256 in the others. FWHM error ratio was smaller in the same order as the RIS. FWHM error ratio was smaller in imaging conditions with short TE, large frequency matrix (>384), large phase matrix (>224), and high FA (>20°). Imaging conditions of 3D TOF-MRA that were effective to improve the image quality for stent lumen evaluation were short TE and high spatial resolution.
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Affiliation(s)
- Toshiya Akatsu
- Department of Radiological Technology, Tsukuba Medical Center Hospital
- Department of Radiological Sciences, Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences
| | - Yoshiyuki Ishimori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences
| | - Tomoya Kobayashi
- Department of Radiological Technology, Tsukuba Medical Center Hospital
| | - Katsumi Miyamoto
- Department of Radiological Technology, Tsukuba Medical Center Hospital
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14
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Hayashi T, Fukuda A. [Visualization of Four Intracranial Stents and In-stent Stenosis with Stenotic Models by 3D-TOF-MRA]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:747-754. [PMID: 31434846 DOI: 10.6009/jjrt.2019_jsrt_75.8.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In recent years, various types of stents are deployed for the treatment of intracranial artery stenosis and aneurysms. Digital subtraction angiography has been considered to be the gold standard for the follow-up study. However, magnetic resonance angiography (MRA) is less invasive and the recent advances may contribute to the imaging of patients with intracranial stents. Then, a phantom study was carried out to evaluate the MR lumen visibility with these stents. Four stents [low-profile visualized intraluminal support (LVIS), Neuroform Atlas, Neuroform EZ, and Enterprise 2] were placed into plastic tubes with 3 mm inner diameter, and fixed in a container filled with agar. Time-of-flight MRA (TOF-MRA) was performed for these stents, and the signal intensities inside and outside the stents were measured on ImageJ software. Furthermore, 25%, 50%, and 75% stenosis models were created and passed through these stents to evaluate the diagnostic accuracy of in-stent stenosis. The signal intensity inside the LVIS stent was the highest among the four stents (P<0.001), and no significant difference was found between the signal intensities inside and outside the LVIS stent. The diagnostic accuracy with LVIS was also higher than that of Enterprise 2 (P<0.001). In conclusion, the visibility with LVIS indicates that TOF-MRA could be reliably utilized as a diagnostic tool for the detection of in-stent stenosis.
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Affiliation(s)
| | - Atsushi Fukuda
- Virginia Commonwealth University Medical Center (Current address: Preparing Section for New Faculty of Medical Science, Fukushima Medical University)
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15
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Kim S, Kang M, Kim DW, Choi JH. Usefulness of Vessel Wall MR Imaging for Follow-Up after Stent-Assisted Coil Embolization of Intracranial Aneurysms. AJNR Am J Neuroradiol 2018; 39:2088-2094. [PMID: 30262640 DOI: 10.3174/ajnr.a5824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Follow-up with MRA for intracranial aneurysms after stent-assisted coiling is complicated by imaging artifacts. We evaluated the usefulness of an alternative method: vessel wall MR imaging. MATERIALS AND METHODS We conducted a single-center, retrospective review of medical records of 47 patients who underwent 3D TOF-MRA, vessel wall MRI, and DSA after stent-assisted coiling between March 2016 and January 2018. We evaluated the mean value of the signal intensity in the stented artery and the contralateral normal artery on vessel wall MRI. The quality of visualization was further compared between TOF-MRA and vessel wall MRI. Furthermore, we evaluated the diagnostic accuracy and concordance rate of TOF-MRA and vessel wall MRI for assessing the patency of the stented parent artery. DSA was used as a reference test. RESULTS The mean signal intensities of the stented and normal arteries on vessel wall MRI were not significantly different (P = .133). The mean scores for the visualization of the stented parent artery on vessel wall MRI were significantly superior to those of TOF-MRA images (P < .001). Vessel wall MRI reached an excellent positive predictive value (100%). However, TOF-MRA had a poor positive predictive value (11%; 95% CI, 9%-12%). The likelihood ratios of vessel wall MRI and TOF-MRA were 27.36 (P < .001) and 2.98 (P = .225), respectively. The concordance rate of vessel wall MRI and TOF-MRA with DSA for evaluating the state of the stented artery was 100% (κ = 1) and 28% (κ = 0.038), respectively. CONCLUSIONS Vessel wall MRI may be useful in evaluating the patency of stented arteries after stent-assisted coil embolization for intracranial aneurysms.
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Affiliation(s)
- S Kim
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - M Kang
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - D W Kim
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - J-H Choi
- Neurosurgery (J.-H.C.), Dong-A University Medical Center, Busan, Korea
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16
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van Rooij S, Peluso JP, Sluzewski M, Kortman HG, Boukrab I, van Rooij WJ. Mid-term 3T MRA follow-up of intracranial aneurysms treated with the Woven EndoBridge. Interv Neuroradiol 2018; 24:601-607. [PMID: 30001648 DOI: 10.1177/1591019918788346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Angiography is the standard follow-up modality for treated aneurysms with the Woven EndoBridge (WEB), and magnetic resonance angiography (MRA) is useful for extended follow-up. We present the results of WEB-treated aneurysms with angiographic follow-up at three months and at least 18 months' 3T MRA follow-up. MATERIALS AND METHODS Included were 52 patients with 53 aneurysms treated with the WEB between February 2015 and July 2016. There were 29 women and 23 men with a mean age of 60 years (median 62, range 23-76). Mean aneurysm size was 6.2 mm (median 6, range 3-16 mm). RESULTS 3T MRA follow-up was mean 19.6 months (median 18, range 18-36 months). One patient had an aneurysm remnant at three-month angiography that was additionally coiled and with stable complete occlusion at 18 months' 3T MRA follow-up. At three-month follow-up angiography, 44 aneurysms were completely occluded and eight had a neck remnant. At latest 3T MRA, stable complete occlusion was present in 43 aneurysms and stable neck remnant in eight. One posterior cerebral artery (PCA) dissection aneurysm was stable at three and six months but was enlarged and reopened at 18 months, confirmed with angiography. Focal signal loss by the proximal marker of the WEB was apparent in four patients without compromising diagnostic evaluation. CONCLUSION WEB-treated aneurysms with adequate occlusion at three-month angiography remained stable during serial 3T MRA follow-up of 18-36 months. One PCA aneurysm reopened during the 6- to 18-month interval. Once the WEB-treated aneurysm is adequately occluded in the short term, later reopening is uncommon.
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Affiliation(s)
- Sbt van Rooij
- 1 Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - J P Peluso
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - M Sluzewski
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - H G Kortman
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - I Boukrab
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - W J van Rooij
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
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17
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Akkaya S, Akca O, Arat A, Peker A, Balci S. Usefulness of contrast-enhanced and TOF MR angiography for follow-up after low-profile stent-assisted coil embolization of intracranial aneurysms. Interv Neuroradiol 2018; 24:655-661. [PMID: 29976108 DOI: 10.1177/1591019918785910] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Low-profile, self-expandable stents are used to treat wide-neck aneurysms located on the smaller distal intracranial arteries. This study aimed to assess the usefulness of time-of-flight (TOF) and contrast-enhanced (CE) magnetic resonance angiography (MRA) for follow-up after LEO Baby stent (LBS)-assisted coil embolization. METHODS Twenty-four aneurysms treated with LBS-assisted coil embolization were evaluated. Researchers reviewed TOF MRA and CE MRA images in terms of occlusion and stent patency. Aneurysm occlusion was graded according to Raymond-Roy classification as follows: total occlusion (grade 1), residual neck (grade 2), and residual aneurysm (grade 3). Stent patency was scored as follows: occlusion (1), stenosis (2), and normal (3). Interobserver and intermodality agreement values were determined by weighted kappa (κ) statistics. RESULTS Intermodality and interobserver values of TOF MRA and CE MRA with digital subtraction angiography (DSA) were perfect (κ = 1.00, p < 0.001) in terms of aneurysm occlusion. Rate of stent occlusion and stenosis in DSA, TOF, and MRA, respectively, were as follows: 0 and 12.5%, 16.6 and 70.8%, and 0 and 62.5%. Intermodality agreement values of TOF MRA and CE MRA with DSA were insignificant in terms of stent patency (κ = 0.065, p = 0.27; κ = 0.158, p = 0.15, respectively). Interobserver agreement was substantial in both TOF MRA (κ = 0.71, p < 0.001) and CE MRA (κ = 0.64, p = 0.001). CONCLUSIONS Both TOF and CE MRA techniques have strong concordance with DSA for the detection of aneurysm occlusion status. CE MRA can be used as a first-line noninvasive imaging modality due to its superiority to TOF MRA with respect to the visualization of in-stent signals.
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Affiliation(s)
- Selcuk Akkaya
- 1 Department of Radiology, Kaçkar State Hospital, Rize, Turkey
| | - Onur Akca
- 2 Department of Radiology, Güven Hospital, Ankara, Turkey
| | - Anıl Arat
- 3 Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Ahmet Peker
- 3 Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Sinan Balci
- 4 Department of Radiology, Artvin State Hospital, Artvin, Turkey
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18
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Bouillot P, Brina O, Delattre BMA, Ouared R, Pellaton A, Yilmaz H, Machi P, Lovblad KO, Farhat M, Pereira VM, Vargas MI. Neurovascular stent artifacts in 3D-TOF and 3D-PCMRI: Influence of stent design on flow measurement. Magn Reson Med 2018; 81:560-572. [DOI: 10.1002/mrm.27352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/22/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Pierre Bouillot
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
- Laboratory for Hydraulic Machines (LMH); École Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
| | - Olivier Brina
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
- Division of Neuroradiology, Department of Medical Imaging; Toronto Western Hospital, University Health Network; Toronto Ontario Canada
| | | | - Rafik Ouared
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Alain Pellaton
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Hasan Yilmaz
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Paolo Machi
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Karl-Olof Lovblad
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Mohamed Farhat
- Laboratory for Hydraulic Machines (LMH); École Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
| | - Vitor Mendes Pereira
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
- Division of Neuroradiology, Department of Medical Imaging; Toronto Western Hospital, University Health Network; Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery; Toronto Western Hospital, University Health Network; Toronto Ontario Canada
| | - Maria Isabel Vargas
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
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19
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Lee J, Cho YD, Yoo DH, Kang HS, Cho WS, Kim JE, Moon J, Han MH. Does stent type impact coil embolization outcomes in extended follow-up of small-sized aneurysms (< 10 mm)? Neuroradiology 2018; 60:747-756. [DOI: 10.1007/s00234-018-2022-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 04/10/2018] [Indexed: 01/20/2023]
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20
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Takano N, Suzuki M, Irie R, Yamamoto M, Teranishi K, Yatomi K, Hamasaki N, Kumamaru KK, Hori M, Oishi H, Aoki S. Non-Contrast-Enhanced Silent Scan MR Angiography of Intracranial Anterior Circulation Aneurysms Treated with a Low-Profile Visualized Intraluminal Support Device. AJNR Am J Neuroradiol 2017; 38:1610-1616. [PMID: 28522664 DOI: 10.3174/ajnr.a5223] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Low-Profile Visualized Intraluminal Support Device comprises a small-cell nitinol structure and a single-wire braided stent that provides greater metal coverage than previously reported intracranial stents, as well as assumed strong susceptibility artifacts. This study aimed to assess the benefits of non-contrast-enhanced MRA by using a Silent Scan (Silent MRA) for intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents. MATERIALS AND METHODS Thirty-one aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents were assessed by using Silent MRA, 3D TOF-MRA, and x-ray DSA. The quality of MRA visualization of the reconstructed artery was graded on a 4-point scale from 1 (not visible) to 4 (excellent). Aneurysm occlusion status was evaluated by using a 2-grade scale (total occlusion/remnant [neck or aneurysm]). Weighted κ statistics were used to evaluate interobserver and intermodality agreement. RESULTS The mean scores ± SDs for Silent MRA and 3D TOF-MRA were 3.16 ± 0.79 and 1.48 ± 0.67 (P < .05), respectively, with substantial interobserver agreement (κ = 0.66). The aneurysm occlusion rates of the 2-grade scale (total occlusion/remnant [neck or aneurysm]) were 69%/31% for DSA, 65%/35% for Silent MRA, and 92%/8% for 3D TOF-MRA, respectively. The intermodality agreements were 0.88 and 0.30 for DSA/Silent MRA and DSA/3D TOF-MRA, respectively. CONCLUSIONS Silent MRA seems to be useful for visualizing intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents.
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Affiliation(s)
- N Takano
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan .,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Suzuki
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - R Irie
- Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Yamamoto
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - K Teranishi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - K Yatomi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - N Hamasaki
- Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K K Kumamaru
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Hori
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - H Oishi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.).,Neuroendovascular Therapy (H.O.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Aoki
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
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Shang S, Ye J, Luo X, Qu J, Zhen Y, Wu J. Follow-up assessment of coiled intracranial aneurysms using zTE MRA as compared with TOF MRA: a preliminary image quality study. Eur Radiol 2017; 27:4271-4280. [PMID: 28382536 DOI: 10.1007/s00330-017-4794-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/15/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To prospectively assess coiled intracranial aneurysms using a novel non-contrast enhanced zero echo time (zTE) MR angiography (MRA) method, and compare its image quality with time-of-flight (TOF) MRA, using digital subtraction angiography (DSA) as reference. METHODS Twenty-five patients (10 males and 15 females; age 53.96 ± 12.46 years) were enrolled in this monocentric study. MRA sequences were performed 24 h before DSA. Susceptibility artefact intensity and flow signal within the parent artery were carried out using a 4-point scale. Occlusion status was assessed using the 3-grade Montreal scale. RESULTS Scores of zTE were higher than TOF for both susceptibility artefact intensity (3.42 ± 0.64, 2.92 ± 0.63, P = 0.01) and flow signal (3.66 ± 0.95, 3.24 ± 1.24, P = 0.01). DSA revealed 17 complete occlusions, five residual neck aneurysms and two residual aneurysms. Inter-observer agreement was excellent (weighted κ: 0.89) for zTE and good (weighted κ: 0.68) for TOF. Intermodality agreement was excellent for zTE (weighted κ: 0.95) and good for TOF (weighted κ: 0.80). Correlations of both MRA sequences with DSA were high (zTE, Spearman's ρ: 0.91; TOF, Spearman's ρ: 0.81). CONCLUSIONS zTE MRA showed promising results for follow-up assessment of coiled intracranial aneurysms and was superior to TOF MRA for visualizing the parent artery and evaluating occlusion status. KEY POINTS • Various MRA sequences were applied for follow-up assessment of coiled intracranial aneurysms. • zTE MRA was less sensitive to susceptibility artefacts and haemodynamics. • In this monocentric study, zTE MRA was equivalent to DSA. • zTE MRA maybe an alternative to TOF MRA for follow-up assessment.
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Affiliation(s)
- Song'an Shang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jianxun Qu
- MR Enhanced Application, GE Healthcare, Beijing, 100176, China
| | - Yong Zhen
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jingtao Wu
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China.
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Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography. J Neuroradiol 2017; 44:44-51. [DOI: 10.1016/j.neurad.2016.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
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Gory B, Spiotta AM, Di Paola F, Mangiafico S, Renieri L, Consoli A, Biondi A, Riva R, Labeyrie PE, Turjman F. PulseRider for Treatment of Wide-Neck Bifurcation Intracranial Aneurysms: 6-Month Results. World Neurosurg 2016; 99:605-609. [PMID: 28017750 DOI: 10.1016/j.wneu.2016.12.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND/OBJECTIVE PulseRider is a new endovascular stent dedicated to treat bifurcation intracranial aneurysms with a wide neck. Our purpose was to evaluate 6-month clinical and anatomic results of the device when used to facilitate endovascular coiling of wide-neck bifurcation aneurysms. METHODS Unruptured intracranial aneurysms coiled with PulseRider, in 6 European centers and 1 U.S. center, were retrospectively reviewed from June 2014 to October 2015. Immediate and 6-month results were evaluated independently by using the Raymond classification scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement on the Raymond scale. RESULTS Nineteen patients (10 women, 9 men; mean age, 63 years) harboring 19 bifurcation aneurysms (mean dome size, 8.8 mm; mean neck size, 5.8 mm) were included. Immediate angiographic outcome showed 11 complete aneurysm occlusions, 6 neck remnants, and 2 residual aneurysms. Follow-up at 6 months, obtained in all patients, included 12 complete aneurysm occlusions (63.1%), 6 neck remnants (31.6%), and 1 residual aneurysm (5.3%). Adequate occlusion (defined as complete occlusion and neck remnant combined) was observed in 94.7%. Progressive thrombosis was observed in 2 cases (10.6%) and recanalization in 1 case (5.3%). There was no in-stent stenosis or jailed branch occlusion. No bleeding was observed during the follow-up period. Permanent morbidity rate was 5.3% (1/19), and the mortality rate was 0% at 6 months. CONCLUSIONS The PulseRider allows endovascular treatment of wide-neck bifurcation intracranial aneurysms. Larger series are needed to confirm our preliminary results.
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Affiliation(s)
- Benjamin Gory
- FHU IRIS, Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Leonardo Renieri
- Department of Neuroradiology, Careggi University Hospital, Firenze, Italy
| | - Arturo Consoli
- Department of Neuroradiology, Careggi University Hospital, Firenze, Italy
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapy, Jean-Minjoz Hospital, Franche-Comté University, Besançon, France
| | - Roberto Riva
- FHU IRIS, Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Paul-Emile Labeyrie
- FHU IRIS, Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France
| | - Francis Turjman
- FHU IRIS, Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France
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Takano N, Suzuki M, Irie R, Yamamoto M, Hamasaki N, Kamagata K, Kumamaru KK, Hori M, Oishi H, Aoki S. Usefulness of Non-Contrast-Enhanced MR Angiography Using a Silent Scan for Follow-Up after Y-Configuration Stent-Assisted Coil Embolization for Basilar Tip Aneurysms. AJNR Am J Neuroradiol 2016; 38:577-581. [PMID: 28007767 DOI: 10.3174/ajnr.a5033] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Y-configuration stent-assisted coil embolization is used for treating wide-neck aneurysms. Noninvasive alternatives to x-ray DSA for follow-up after Y-configuration stent-assisted coil embolization treatment are required. This study aimed to assess the usefulness of non-contrast-enhanced MRA by using a Silent Scan (silent MRA) for follow-up after Y-configuration stent-assisted coil embolization for basilar tip aneurysms. MATERIALS AND METHODS Seven patients treated with Y-configuration stent-assisted coil embolization for basilar tip aneurysms underwent silent MRA, 3D TOF-MRA, and DSA. Silent MRA and 3D TOF-MRA images were obtained during the same scan session on a 3T MR imaging system. Two neuroradiologists independently reviewed both types of MRA images and subjectively scored the flow in the stents on a scale of 1 (not visible) to 5 (nearly equal to DSA) by referring to the latest DSA image as a criterion standard. Furthermore, we evaluated the visualization of the neck remnant. RESULTS In all patients, the 2 observers gave a higher score for the flow in the stents on silent MRA than on 3D TOF-MRA. The average score ± standard deviation was 4.07 ± 0.70 for silent MRA and 1.93 ± 0.80 (P < .05) for 3D TOF-MRA. Neck remnants were depicted by DSA in 5 patients. In silent MRA, neck remnants were depicted in 5 patients, and visualization was similar to DSA; however, in 3D TOF-MRA, neck remnants were depicted in only 1 patient. CONCLUSIONS Silent MRA might be useful for follow-up after Y-configuration stent-assisted coil embolization.
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Affiliation(s)
- N Takano
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan .,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Suzuki
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - R Irie
- Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Yamamoto
- Departments of Neurosurgery (M.Y., H.O.)
| | - N Hamasaki
- Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K Kamagata
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K K Kumamaru
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Hori
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - H Oishi
- Departments of Neurosurgery (M.Y., H.O.).,Neuroendovascular Therapy (H.O.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Aoki
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
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Thamburaj K, Cockroft K, Agarwal AK, Sabat S, Kalapos P. A Comparison of Magnetic Resonance Angiography Techniques for the Evaluation of Intracranial Aneurysms Treated With Stent-assisted Coil Embolization. Cureus 2016; 8:e909. [PMID: 28083453 PMCID: PMC5208631 DOI: 10.7759/cureus.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To identify the effective magnetic resonance angiography (MRA) technique to monitor intracranial aneurysms treated with stent-assisted coiling. MATERIALS AND METHODS Retrospective analysis of various MRA techniques was performed in 42 patients. Three neuroradiologists independently compared non-contrast time of flight (ncTOF) MRA of the head, contrast-enhanced time of flight (cTOF) MRA of the head and dynamic contrast-enhanced MRA (CEMRA) of the head and neck or of the head. Digital subtraction angiography (DSA) was available for comparison in 32 cases. Inter-rater agreement (kappa statistic) was assessed. RESULTS Artifactual in-stent severe stenosis or flow gap was identified by ncTOF MRA in 23 of 42 cases (55%) and by cTOF MRA in 23 of 38 cases (60%). DSA excluded in-stent stenosis or occlusion in all 32 cases. No difference was noted between ncTOF and cTOF in the demonstration of neck remnants or residual aneurysms in three cases each. CEMRA of the head and neck or of the head was rated superior to ncTOF and cTOF MRA by all three investigators in seven out of eight cases. In one case, all three techniques demonstrated signifcant artifacts due to double stent placement during coiling. The kappa statistic revealed 0.8 agreement between investigators. CONCLUSIONS In the assessment of stent-assisted coiling of intracranial aneurysm, both ncTOF and cTOF MRA show similar results. CEMRA tends to show better flow signals in stent and residual aneurysm.
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Affiliation(s)
| | - Kevin Cockroft
- Department of Neurosurgery, Penn State Hershey Medical Center
| | - Amit K Agarwal
- Department of Radiology, Penn State Hershey Medical Center
| | - Shyam Sabat
- Department of Radiology, Penn State Hershey Medical Center
| | - Paul Kalapos
- Department of Radiology, Penn State Hershey Medical Center
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Ikushima Y, Hashido T, Watanabe Y, Doi T. Effects of Imaging Parameters on the Quality of Contrast-Enhanced MR Angiography of Cerebral Aneurysms Treated Using Stent-Assisted Coiling: A Phantom Study. Magn Reson Med Sci 2016; 16:146-151. [PMID: 27599584 PMCID: PMC5600074 DOI: 10.2463/mrms.mp.2016-0042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To quantitatively investigate in vitro the effects of flip angle (FA), receiver bandwidth (BW), echo time (TE), and magnetic field strength (FS) on image noise and artifacts induced by stent-assisted coiling on contrast-enhanced MR angiography (CE-MRA) images, as a first step towards optimization of imaging parameters. Methods: A phantom simulating a cerebral aneurysm treated using stent-assisted coiling was filled with diluted gadolinium contrast medium, and MR angiography were obtained using varied parameters: FA (10°–60°), BW (164–780 Hz/pixel), and FS (1.5 and 3.0T). The TE varied automatically with BW because the TE was set to the smallest value. Three kinds of indices were semi-automatically calculated to quantify the severity of stent- and coil-induced artifacts: artificial lumen narrowing (ALN) representing a decrease in the in-stent luminal area, and relative in-stent signal (RISS) and relative in-coil signal (RISC) representing an increase in the in-stent and in-coil signal intensities, respectively. We also measured the ratio of in-stent signal to noise (IS/N) for each parameter. The variation in these indices with variations in FA, BW (TE), and FS was analyzed. Results: An increase in FA led to an increase of up to 65% in the RISS, while the IS/N increased by up to three times. The 1.5T scanner indicated fewer artifacts (71% lower ALN, two times higher RISS, and 40% higher RISC) than the 3.0T scanner. On the other hand, the 1.5T scanner worsened the IS/N compared with the 3.0T scanner, although the difference was relatively small. Variation in BW (and hence, TE) led to a trade-off between artifact severity and IS/N. Conclusion: A high FA and low FS should be used for improved artifact severity and IS/N on CE-MRA images of a stent-assisted coil. A wide BW (short TE) could improve artifact severity at the expense of the image noise.
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Chiang CH, Tseng YC, Chen AC, Huang YL, Chen DYT, Chen CJ, Lin YK, Hsu HL. In vitro comparison of intracranial stent visibility using various concentrations of gadolinium contrast agent under 1.5 T and 3 T MR angiography. J Neurointerv Surg 2016; 9:399-404. [DOI: 10.1136/neurintsurg-2016-012490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/12/2016] [Accepted: 07/21/2016] [Indexed: 11/03/2022]
Abstract
Background and purposeMR angiography (MRA) is an increasingly used evaluation method following intracranial stenting. However, the various artifacts created by the stent limit this technique. The purpose of this study was to investigate the effects of various concentrations of gadolinium contrast agent on the visibility and signal characteristics of two stents using the a contrast enhanced MRA technique.Material and methodTwo intracranial stents (Enterprise and Helistent) were placed in polyvinyl chloride tubes as vascular phantoms. They were filled with six different doses of gadolinium contrast agent (1.0, 2.0, 4.0, 6.0, 8.0, and 10.0 mmol/L dimeglumine gadopentetate, respectively) and imaged using 3 T and 1.5 T MR systems. Relative in-stent signal (RIS) was calculated and artificial luminal narrowing (ALN) was obtained using pixel by pixel analysis.ResultThe Enterprise stent, performed in both 1.5 T and 3 T MR systems, showed mean RIS values much less than those for the Helistent for all different doses of gadolinium solution. Increased gadolinium concentration resulted in a gradual reduction in RIS values in the Enterprise group. Also, ALN in the Enterprise group showed no or little change with various gadolinium doses.ConclusionsThe Enterprise stent demonstrated good luminal visibility regardless of gadolinium concentration. The relative in-stent signals were more predictable in the Enterprise stent with various doses of gadolinium. Therefore, the Enterprise stent has been shown to provide better in-stent visibility compared with the Helistent using various gadolinium doses.
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Timsit C, Soize S, Benaissa A, Portefaix C, Gauvrit JY, Pierot L. Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated with the WEB Device. AJNR Am J Neuroradiol 2016; 37:1684-9. [PMID: 27102311 DOI: 10.3174/ajnr.a4791] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/28/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging follow-up at 3T of intracranial aneurysms treated with the WEB Device has not been evaluated yet. Our aim was to assess the diagnostic accuracy of 3D-time-of-flight MRA and contrast-enhanced MRA at 3T against DSA, as the criterion standard, for the follow-up of aneurysms treated with the Woven EndoBridge (WEB) system. MATERIALS AND METHODS From June 2011 to December 2014, patients treated with the WEB in our institution, then followed for ≥6 months after treatment by MRA at 3T (3D-TOF-MRA and contrast-enhanced MRA) and DSA within 48 hours were included. Aneurysm occlusion was assessed with a simplified 2-grade scale (adequate occlusion [total occlusion + neck remnant] versus aneurysm remnant). Interobserver and intermodality agreement was evaluated by calculating the linear weighted κ. MRA test characteristics and predictive values were calculated from a 2 × 2 contingency table, by using DSA data as the standard of reference. RESULTS Twenty-six patients with 26 WEB-treated aneurysms were included. The interobserver reproducibility was good with DSA (κ = 0.71) and contrast-enhanced-MRA (κ = 0.65) compared with moderate with 3D-TOF-MRA (κ = 0.47). Intermodality agreement with DSA was fair with both contrast-enhanced MRA (κ = 0.36) and 3D-TOF-MRA (κ = 0.36) for the evaluation of total occlusion. For aneurysm remnant detection, the prevalence was low (15%), on the basis of DSA, and both MRA techniques showed low sensitivity (25%), high specificity (100%), very good positive predictive value (100%), and very good negative predictive value (88%). CONCLUSIONS Despite acceptable interobserver reproducibility and predictive values, the low sensitivity of contrast-enhanced MRA and 3D-TOF-MRA for aneurysm remnant detection suggests that MRA is a useful screening procedure for WEB-treated aneurysms, but similar to stents and flow diverters, DSA remains the criterion standard for follow-up.
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Affiliation(s)
- C Timsit
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - S Soize
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - A Benaissa
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - C Portefaix
- CReSTIC SIC EA3804 (C.P.), Université de Champagne-Ardenne, Reims, France
| | - J-Y Gauvrit
- Department of Neuroradiology (J.-Y.G.), Hôpital Pontchaillou, Rennes, France Unité VISAGES U746 INSERM-INRIA (J.-Y.G.), IRISA UMR CNRS 6074, University of Rennes, Rennes, France
| | - L Pierot
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
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Jeon JP, Cho YD, Rhim JK, Yoo DH, Cho WS, Kang HS, Kim JE, Han MH. Fate of Coiled Aneurysms with Minor Recanalization at 6 Months: Rate of Progression to Further Recanalization and Related Risk Factors. AJNR Am J Neuroradiol 2016; 37:1490-5. [PMID: 26965468 DOI: 10.3174/ajnr.a4763] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/28/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Minor recanalization in coiled aneurysms may remain stable with time or may progress to major recanalization. Our aim was to monitor the aneurysms displaying minor recanalization in imaging studies at 6 months, gauging major recanalization rates and related risk factors through extended follow-up. MATERIALS AND METHODS Sixty-five aneurysms (in 65 patients) showing minor recanalization in follow-up imaging at 6 months were reviewed retrospectively. Medical records and radiologic data accruing during extended monitoring (mean, 24.8 ± 8.2 months) were assessed. Univariate and multivariate analyses were conducted to identify risk factors for progression from minor-to-major recanalization. RESULTS Progression to major recanalization was observed in 24 (36.9%) of the initially qualifying aneurysms during a follow-up of 112.5 aneurysm-years, for an annual rate of 17.84% per aneurysm-year. Progression was determined chronologically as follows: 14 (58.3%) at 6 months, 8 (33.3%) at 18 months, and 2 (8.4%) at 30 months. Stent deployment significantly decreased the occurrence of major recanalization (OR = 0.22, P = .03), whereas antiplatelet therapy (OR = 0.82, P = .75), posterior location (OR = 0.24, P = .20), and second coiling for recanalized aneurysms (OR = 0.96, P = .96) were unrelated. CONCLUSIONS Our analysis determined a 36.9% rate of major recanalization during a follow-up of 112.5 aneurysm-years in coiled aneurysms showing minor recanalization at 6 months. Stent deployment alone conferred a protective effect, preventing further recanalization without additional treatment. Given the fair probability of late major recanalization, aneurysms showing minor recanalization at 6 months should be monitored diligently, particularly in the absence of stent placement.
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Affiliation(s)
- J P Jeon
- From the Department of Neurosurgery (J.P.J.), Hallym University College of Medicine, Chuncheon, Korea
| | - Y D Cho
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
| | - J K Rhim
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
| | - D H Yoo
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
| | - W-S Cho
- Neurosurgery (W.s.C., H.-S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea
| | - H-S Kang
- Neurosurgery (W.s.C., H.-S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea
| | - J E Kim
- Neurosurgery (W.s.C., H.-S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea
| | - M H Han
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
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Gory B, Spiotta AM, Mangiafico S, Consoli A, Biondi A, Pomero E, Killer-Oberpfalzer M, Weber W, Riva R, Labeyrie PE, Turjman F. PulseRider Stent-Assisted Coiling of Wide-Neck Bifurcation Aneurysms: Periprocedural Results in an International Series. AJNR Am J Neuroradiol 2016; 37:130-5. [PMID: 26338920 DOI: 10.3174/ajnr.a4506] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/08/2015] [Indexed: 11/07/2022]
Abstract
The PulseRider is a novel endovascular device specifically designed to treat bifurcation intracranial aneurysms with wide necks. In an international series, we report the results of PulseRider stent-assisted coiling of 15 patients (9 women and 6 men; mean age, 62.6 years) with 15 unruptured wide-neck (median dome size, 8 mm; median neck size, 5 mm) bifurcation aneurysms. Failure of PulseRider treatment occurred in 1 case, and 1 intraprocedural thromboembolic complication was observed. There was no mortality or neurologic permanent morbidity at discharge and at 1 month. Immediate angiographic outcome showed 12 complete occlusions and 2 neck remnants. Follow-up at 6 months was available for 3 aneurysms and demonstrated 2 complete aneurysm occlusions and 1 growing neck remnant. In this small series of selected patients, PulseRider stent-assisted coiling of wide-neck bifurcation aneurysms was feasible with low procedural complication rates. Angiographic follow-up will be required to evaluate the efficacy of the PulseRider device.
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Affiliation(s)
- B Gory
- From the DHU IRIS, Department of Interventional Neuroradiology (B.G., R.R., P.E.L., F.T.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - A M Spiotta
- Department of Neurosciences (A.M.S.), Division of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - S Mangiafico
- Department of Neuroradiology (S.M., A.C.), Careggi University Hospital, Florence, Italy
| | - A Consoli
- Department of Neuroradiology (S.M., A.C.), Careggi University Hospital, Florence, Italy
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A.B., E.P.), Jean-Minjoz Hospital, Franche-Comté University, Besançon, France
| | - E Pomero
- Department of Neuroradiology and Endovascular Therapy (A.B., E.P.), Jean-Minjoz Hospital, Franche-Comté University, Besançon, France
| | - M Killer-Oberpfalzer
- Neuroscience Institute/Department of Neurology (M.K.-O.), Paracelsus Medical University, Christian Doppler Clinic, Salzburg, Austria
| | - W Weber
- Department of Neuroradiology (W.W.), Knappschaftskrankenhaus, Recklinghausen, Germany
| | - R Riva
- From the DHU IRIS, Department of Interventional Neuroradiology (B.G., R.R., P.E.L., F.T.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - P E Labeyrie
- From the DHU IRIS, Department of Interventional Neuroradiology (B.G., R.R., P.E.L., F.T.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - F Turjman
- From the DHU IRIS, Department of Interventional Neuroradiology (B.G., R.R., P.E.L., F.T.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Desai AA, Strother MK, Faraco CC, Morgan VL, Ladner TR, Dethrage LM, Jordan LC, Donahue MJ. The Contribution of Common Surgically Implanted Hardware to Functional MR Imaging Artifacts. AJNR Am J Neuroradiol 2015; 36:2068-73. [PMID: 26272973 DOI: 10.3174/ajnr.a4419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/26/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Blood oxygenation level-dependent MR imaging is increasingly used clinically to noninvasively assess cerebrovascular reactivity and/or language and motor function. However, many patients have metallic implants, which will induce susceptibility artifacts, rendering the functional information uninformative. Here, we calculate and interpret blood oxygenation level-dependent MR imaging artifact impact arising from surgically implanted hardware. MATERIALS AND METHODS A retrospective analysis of all blood oxygenation level-dependent MRIs (n = 343; B0 = 3T; TE = 35 ms; gradient echo EPI) acquired clinically (year range = 2006-2014) at our hospital was performed. Blood oxygenation level-dependent MRIs were most commonly prescribed for patients with cerebrovascular disease (n = 80) or patients undergoing language or motor localization (n = 263). Artifact volume (cubic centimeters) and its impact on clinical interpretation were determined by a board-certified neuroradiologist. RESULTS Mean artifact volume associated with intracranial hardware was 4.3 ± 3.2 cm(3) (range = 1.1-9.4 cm(3)). The mean artifact volume from extracranial hardware in patients with cerebrovascular disease was 28.4 ± 14.0 cm(3) (range = 6.1-61.7 cm(3)), and in patients with noncerebrovascular disease undergoing visual or motor functional mapping, it was 39.9 (3)± 27.0 cm(3) (range = 6.9-77.1 cm(3)). The mean artifact volume for ventriculoperitoneal shunts was 95.7 ± 39.3 cm(3) (range = 64.0-139.6 cm(3)). Artifacts had no-to-mild effects on clinical interpretability in all patients with intracranial implants. Extracranial hardware artifacts had no-to-moderate impact on clinical interpretability, with the exception of 1 patient with 12 KLS-Martin maxDrive screws with severe artifacts precluding clinical interpretation. All examined ventriculoperitoneal shunts resulted in moderate-to-severe artifacts, limiting clinical interpretation. CONCLUSIONS Blood oxygenation level-dependent MR imaging yields interpretable functional maps in most patients beyond a small (30-40 cm(3)) artifact surrounding the hardware. Exceptions were ventriculoperitoneal shunts, particularly those with programmable valves and siphon gauges, and large numbers of KLS-Martin maxDrive screws.
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Affiliation(s)
- A A Desai
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - M K Strother
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - C C Faraco
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - V L Morgan
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - T R Ladner
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - L M Dethrage
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | | | - M J Donahue
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.) Division of Pediatric Neurology, Psychiatry (M.J.D.) Neurology (M.J.D.), Vanderbilt University School of Medicine, Nashville, Tennessee Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, Tennessee
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Arauz-Garofalo G, Camacho-Puerma LM, García-Santiago A, Tejada J. Microwave spectrometry for the evaluation of in-stent neoatherosclerosis. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/3/035202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gory B, Klisch J, Bonafé A, Mounayer C, Beaujeux R, Moret J, Lubicz B, Riva R, Turjman F. Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms: mid-term results from the SOLARE Study. Neurosurgery 2015; 75:215-9; discussion 219. [PMID: 24818784 DOI: 10.1227/neu.0000000000000415] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endovascular treatment of intracranial aneurysms can be technically difficult when the neck is wide. The Solitaire AB stent (Covidien, Irvine, California), the only fully retrieved stent, assists in the coiling of wide-neck intracranial aneurysms. OBJECTIVE To evaluate the mid-term angiographic follow-up of wide-necked aneurysms treated with the Solitaire AB stent. METHODS SOLARE (SOLitaire Aneurysm Remodeling) is a consecutive, prospective study conducted in 7 European centers. A core laboratory evaluated the postoperative and mid-term (6 month ± 15 days) angiographic results by using the Raymond classification Scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement in the Raymond scale score. RESULTS The mean width of the aneurysm sac was 7.5 mm, and the mean diameter of the aneurysm neck was 4.7 mm. Angiographic mid-term follow-up was obtained in 55 of 65 aneurysms (85.9%). Complete occlusion was achieved in 33 aneurysms (60%); a neck remnant was seen in 16 aneurysms (29.1%) and an aneurysm remnant in 6 aneurysms (10.9%). Of 55 aneurysms, recanalization was observed in 8 aneurysms (14.5%), and progressive thrombosis was observed in 17 aneurysms (30.9%). No bleeding or rebleeding was observed during the follow-up period. CONCLUSION Stent-assisted coiling of wide-necked intracranial aneurysms was found to be safe and effective with the Solitaire AB stent at 6-month follow-up. Angiographic results improve with time due to progressive thrombosis of the aneurysm.
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Affiliation(s)
- Benjamin Gory
- *Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; ‡Department of Neuroradiology, Helios Klinikum, Erfurt, Germany; §Department of Neuroradiology, Montpellier University Hospital, Montpellier, France; ¶Department of Interventional Neuroradiology, Dupuytren University Hospital, Limoges, France; ‖Department of Neuroradiology, Strasbourg University Hospital, Strasbourg, France; #Department of Neuroradiology, Beaujon Hospital, Paris, France; **Department of Neuroradiology, Erasme Hospital, Brussels, Belgium
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Irie R, Suzuki M, Yamamoto M, Takano N, Suga Y, Hori M, Kamagata K, Takayama M, Yoshida M, Sato S, Hamasaki N, Oishi H, Aoki S. Assessing Blood Flow in an Intracranial Stent: A Feasibility Study of MR Angiography Using a Silent Scan after Stent-Assisted Coil Embolization for Anterior Circulation Aneurysms. AJNR Am J Neuroradiol 2014; 36:967-70. [PMID: 25523588 DOI: 10.3174/ajnr.a4199] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/29/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Blood flow in an intracranial stent cannot be visualized with 3D time-of-flight MR angiography owing to magnetic susceptibility and radiofrequency shielding. As a novel follow-up tool after stent-assisted coil embolization, we applied MRA by using a Silent Scan algorithm that contains an ultrashort TE combined with an arterial spin-labeling technique (Silent MRA). The purpose of this study was to determine whether Silent MRA could visualize flow in an intracranial stent placed in the anterior circulation. MATERIALS AND METHODS Nine patients treated with stent-assisted coil embolization for anterior circulation aneurysms underwent MRAs (Silent MRA and TOF MRA) and x-ray digital subtraction angiography. MRAs were performed in the same session on a 3T unit. Two neuroradiologists independently reviewed the MRA images and subjectively scored flow in a stent as 1 (not visible) to 4 (excellent) by referring to the latest x-ray digital subtraction angiography image as a criterion standard. RESULTS Both observers gave MRA higher scores than TOF MRA for flow in a stent in all cases. The mean score for Silent MRA was 3.44 ± 0.53, and for TOF MRA, it was 1.44 ± 0.46 (P < .001). CONCLUSIONS Silent MRA was able to visualize flow in an intracranial stent more effectively than TOF MRA. Silent MRA might be useful for follow-up imaging after stent-assisted coil embolization, though these study results may be only preliminary due to some limitations.
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Affiliation(s)
- R Irie
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - M Suzuki
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - M Yamamoto
- Neurosurgery (M. Yamamoto, Y.S., H.O.), Juntendo University Hospital, Tokyo, Japan
| | - N Takano
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - Y Suga
- Neurosurgery (M. Yamamoto, Y.S., H.O.), Juntendo University Hospital, Tokyo, Japan
| | - M Hori
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - K Kamagata
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - M Takayama
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - M Yoshida
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - S Sato
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - N Hamasaki
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
| | - H Oishi
- Neurosurgery (M. Yamamoto, Y.S., H.O.), Juntendo University Hospital, Tokyo, Japan Department of Neuroendovascular Therapy (H.O.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Aoki
- From the Departments of Radiology (R.I., M.S., N.T., M.H., K.K., M.T., M. Yoshida, S.S., N.H., S.A.)
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Oh HH, Jung C, Lee TH, Kwon BJ, Kim Y, Lee KC. Will Fluoroscopic Follow-up after Stent-Assisted Coiling of Cerebral Aneurysms Provide Information on Recanalization? Interv Neuroradiol 2014; 20:693-703. [PMID: 25496679 DOI: 10.15274/inr-2014-10062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/10/2014] [Indexed: 11/12/2022] Open
Abstract
Fluoroscopic images for comparison (FICs) can be easily obtained for follow-up on an outpatient basis. This study retrospectively assessed the diagnostic performance of a set of FICs for evaluation of recanalization after stent-assisted coiling, with digital subtraction angiography (DSA) as the reference standard. A total of 124 patients harboring 144 stent-assisted coiled aneurysms were included. At least one month postembolization they underwent follow-up angiograms comprising a routine frontal and lateral DSA and a working-angle DSA. For analysis, FICs should be compared with the mask images of postprocedural DSAs to find recanalization. Instead of FIC acquisition, the mask images of follow-up DSAs were taken as a substitute because of the same view-making processes as FICs, full availability, and perfect coincidence with follow-up DSAs. Two independent readers evaluated a set of 169 FICs and DSA images for the presence of recanalization one month apart. Sensitivity, specificity, and interreader agreement were determined. Recanalization occurred in 24 (14.2%) cases. Of these, nine (5.3%) cases were found to have significant recanalization in need of retreatment. Sensitivity and specificity rates were 79.2% (19 of 24) and 95.9% (139 of 145) respectively for reader 1, and 66.7% (16 of 24) and 97.9% (142 of 145) for reader 2. Minimal recanalization was identified in seven out of all eight false negative cases. Excluding minimally recanalized cases in no need for retreatment from the recanalization group, calculation resulted in high sensitivity and specificity of over 94% for both readers. Interreader agreement between the two readers was excellent (96.4%; κ = 0.84). FICs may be a good imaging modality to detect significant recanalization of stent-assisted coiled aneurysms.
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Affiliation(s)
- Hyun Ho Oh
- Department of Neurosurgery, Myongji Hospital; Goyang, South Korea -
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital; Seongnam, South Korea
| | - Tae Hong Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital; Pusan, South Korea
| | - Bae Ju Kwon
- Department of Radiology, Myongji Hospital; Goyang, South Korea
| | - Young Kim
- Department of Neurosurgery, Myongji Hospital; Goyang, South Korea
| | - Kyu Chang Lee
- Department of Neurosurgery, Myongji Hospital; Goyang, South Korea
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Cho YD, Kim KM, Lee WJ, Sohn CH, Kang HS, Kim JE, Han MH. Time-of-flight magnetic resonance angiography for follow-up of coil embolization with enterprise stent for intracranial aneurysm: usefulness of source images. Korean J Radiol 2014; 15:161-8. [PMID: 24497808 PMCID: PMC3909851 DOI: 10.3348/kjr.2014.15.1.161] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/23/2013] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to determine the interobserver and intermodality agreement in the interpretation of time-of-flight (TOF) MR angiography (MRA) for the follow-up of coiled intracranial aneurysms with the Enterprise stent. Materials and Methods Two experienced neurointerventionists independently reviewed the follow-up MRA studies of 40 consecutive patients with 44 coiled aneurysms. All aneurysms were treated with assistance from the Enterprise stent and the radiologic follow-up intervals were greater than 6 months after the endovascular therapy. Digital subtraction angiography (DSA) served as the reference standard. The degree of aneurysm occlusion was determined by an evaluation of the maximal intensity projection (MIP) and source images (SI) of the TOF MRA. The capability of the TOF MRA to depict the residual flow within the coiled aneurysms and the stented parent arteries was compared with that of the DSA. Results DSA showed stable occlusions in 25 aneurysms, minor recanalization in 8, and major recanalization in 11. Comparisons between the TOF MRA and conventional angiography showed that the MIP plus SI had almost perfect agreement (κ = 0.892, range 0.767 to 1.000) and had better agreement than with the MIP images only (κ = 0.598, range 0.370 to 0.826). In-stent stenosis of more than 33% was observed in 5 cases. Both MIP and SI of the MRA showed poor depiction of in-stent stenosis compared with the DSA. Conclusion TOF MRA seemed to be reliable in screening for aneurysm recurrence after coil embolization with Enterprise stent assistance, especially in the evaluation of the SI, in addition to MIP images in the TOF MRA.
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Affiliation(s)
- Young Dae Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Kang Min Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Woong Jae Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
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Seok JH, Choi HS, Jung SL, Ahn KJ, Kim MJ, Shin YS, Kim BS. Artificial luminal narrowing on contrast-enhanced magnetic resonance angiograms on an occasion of stent-assisted coiling of intracranial aneurysm: in vitro comparison using two different stents with variable imaging parameters. Korean J Radiol 2012; 13:550-6. [PMID: 22977321 PMCID: PMC3435851 DOI: 10.3348/kjr.2012.13.5.550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 03/15/2012] [Indexed: 11/15/2022] Open
Abstract
Objective Intracranial stenting for stent-assisted coiling of aneurysms requires adequate follow-up imaging. The aim of this in vitro study was to compare in-stent artificial luminal narrowing on contrast-enhanced MR angiograms (CE-MRA) when applying Neuroform® and Enterprise® stents for stent-assisted coiling. Materials and Methods Two intracranial nitinol stents (Enterprise® and Neuroform®) were placed in silicon tubes and then imaged at 3 T and 1.5 T by the use of a T1-weighted three-dimensional spoiled gradient-echo sequence with minimal TR and TE. CE-MRAs were obtained by using different imaging planes, voxel sizes, and bandwidths, and with or without parallel imaging. Artificial lumen narrowing (ALN) was calculated and the results were compared. Results Lower magnetic field strength, axial plane perpendicular to axis of stent, and wider bandwidth resulted in a lower ALN on CE-MRA for both stents. Larger voxel size resulted in lower ALN for Neuroform® stent. The parallel imaging acceleration factor did not affect ALN. The mean ALN was lower for Neuroform®, but it was not significant by a paired t test. Conclusion CE-MRA of the stented lumen of vascular phantom was partially impaired with ALN. Consequently, image plane orientation, magnetic field strength, bandwidth, and voxel size should be adjusted appropriately to reduce ALN.
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Affiliation(s)
- Jee Hyun Seok
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul 137-701, Korea
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