| Part one Comparative study of Silent magnetic resonance angiography and time-of-fight magnetic resonance angiography in the follow-up of endovascular-treated intracranial saccular aneurysmsObjectives: Digital subtraction angiography(DSA)is the gold standard for follow-up of endovascular-treated intracranial aneurysms,but it is invasive and should not be examined repeatedly.Silent magnetic resonance angiography(MRA)is a newly introduced cerebrovascular imaging technology in recent years.The aim of this study was to compare the usefulness of Silent MRA and time-of-flight(TOF)MRA in the follow-up of endovascular-treated intracranial saccular aneurysms.Methods: From January to October 2020,patients with endovascular-treated intracranial saccular aneurysms and followed up in our center were prospectively included.All included patients were examined with Silent MRA,TOF-MRA,and DSA.The image quality of the parent artery in the two MRA sequences was assessed using a 5-point scale,and the association between the image quality score and aneurysm diameter or neck width was analyzed.The aneurysm occlusion status was assessed using the Raymond scale and a simplified two-grade scale(complete or incomplete occlusion).Using DSA as the gold standard,the accuracy of Silent MRA and TOF-MRA in diagnosing aneurysm occlusion was calculated.Results: Forty-one patients with 46 saccular aneurysms were recruited.The mean aneurysm diameter was 4.9 ± 1.7 mm.The treatments performed were simple coiling(17/46,37.0%),stent-assisted coiling(19/46,41.3%),flow diversion(5/46,10.9%),and flow diversion with coiling(5/46,10.9%).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(r =-0.519,P = 0.033),while it showed no significant correlation in Silent MRA(r =-0.037,P = 0.887).According to the Raymond scale,the diagnostic accuracy of Silent MRA and TOF-MRA was 97.8% and 87.0%,respectively.According to the simplified two-grade scale,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of Silent MRA and TOF-MRA for diagnosing aneurysm remnants were 92.9%,100.0%,100.0%,97.0%,and 97.8%;and 64.3%,100.0%,100.0%,86.5%,and 89.1%,respectively.Conclusions: Silent MRA was superior to TOF-MRA in the follow-up of endovascular-treated intracranial saccular aneurysms and showed excellent diagnostic performance in the evaluation of aneurysm occlusion.Part two Diagnostic performance of Silent magnetic resonance angiography for endovascular-treated intracranial saccular aneurysm follow-upObjectives Multiple studies have reported the clinical usefulness of Silent magnetic resonance angiography(MRA)in the follow-up of endovascular-treated intracranial aneurysms.However,most previous studies were retrospective or with small sample sizes.With digital subtraction angiography(DSA)as the gold standard,we prospectively evaluated the diagnostic performance of Silent MRA in the follow-up of endovascularly-treated intracranial saccular aneurysms.Methods From January 2020 to December 2021,consecutive patients with endovascularly-treated intracranial saccular aneurysms and scheduled for a DSA follow-up in our center were recruited.A Silent MRA was performed on all patients before or after the DSA examination within 72 hours.The aneurysm occlusion status was evaluated using the Raymond Scale and a simplified 2-grade scale.The image quality of parent artery on Silent MRA was rated on a 5-point scale.On Silent MRA and DSA,the patency of the parent artery was rated on a 4-point scale and a simplified 2-grade scale.Results A total of 155 patients with 175 treated aneurysms were enrolled.The aneurysms were treated as follows: simple coiling(48/175,27.4%),stent-assisted coiling(94/175,53.7%),flow diversion(23/175,13.1%),and flow diversion with coiling(10,5.7%).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of Silent MRA for diagnosing aneurysm remnants were 98.5%,100.0%,100.0%,99.1%,and 99.4%,respectively.The average score for the image quality of parent artery was 3.92 ± 0.94.In the subgroup analysis,except the simple coiling group,which had an obviously higher score(4.95 ± 0.21),there was no significant difference(P = 0.621)among the stent-assisted coiling group(3.51± 0.77),flow diversion group(3.74 ± 0.80),and flow diversion with coiling group(3.40 ± 1.17).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of Silent MRA for diagnosing parent artery stenosis were 100.0%,50.3%,8.8%,100.0%,and 52.6%,respectively.In the subgroup analysis,the diagnostic accuracy of Silent MRA in the aneurysms treated with simple coiling,stent-assisted coiling,flow diversion,and flow diversion with coiling was97.9%,39.4%,17.4%,and 40.0%,respectively.Conclusions In the follow-up of endovascular-treated intracranial saccular aneurysms,Silent MRA showed an excellent diagnostic performance in the evaluation of aneurysm occlusion.Different interventional methods affected the image quality of parent artery on Silent MRA.In the assessment of the patency of the parent artery,Silent MRA showed excellent diagnostic performance in the aneurysms treated with simple coiling,but poor diagnostic performance in the aneurysms treated with stents or flow diverters.Part three Diagnostic performance of high-resolution vessel wall magnetic resonance imaging combined with time-of-flight magnetic resonance angiography in the follow-up of intracranial vertebrobasilar dissecting aneurysms after endovascular treatmentObjectives Few studies have reported the utility of high-resolution vessel wall magnetic resonance imaging(HR-VW-MRI)in the follow-up of endovascularly treated vertebrobasilar dissecting aneurysms(VBDAs).This study was aimed at evaluating the diagnostic performance of HR-VW-MRI combined with time-of-flight magnetic resonance angiography(TOF-MRA)in the follow-up of intracranial VBDAs after reconstructive endovascular treatment(EVT).Methods Between January 2016 and December 2021,patients with intracranial VBDAs treated with reconstructive EVT and followed up with TOF-MRA,HR-VW-MRI,and digital subtraction angiography(DSA)were retrospectively included.The image quality of parent artery on TOF-MRA and HR-VW-MRI was rated on a 5-point scale respectively.With DSA as the gold standard,the diagnostic performance of TOF-MRA,HR-VW-MRI,HR-VW-MRI combined with TOF-MRA in the evaluation of aneurysm occlusion status and parent artery patency was assessed.Results Twenty-seven patients with 29 aneurysms were included.Twelve(41.4%)aneurysms were ruptured and 17(58.6%)were unruptured.The average size of these aneurysms was 7.7 ± 2.2 mm ? 13.7 ± 5.3 mm.The aneurysms were treated as follows: 24(82.8%)with stent-assisted coiling,3(10.3%)with flow diversion,1(3.4%)with stents placement without coiling,and 1(3.4%)with flow diversion with coiling.The sensitivity,specificity,positive predictive value,and negative predictive value of TOF-MRA,HR-VW-MRI,and HR-VW-MRI combined with TOF-MRA for diagnosing aneurysm remnants were 80.0%,100.0%,100.0%,and 82.4%;53.3%,100.0%,100.0%,and 66.7%;and 93.3%,100.0%,100.0%,and 93.3%,respectively.The mean image quality score of HR-VW-MRI was significantly higher than that of TOF-MRA(4.88 ± 0.32 vs.2.53 ± 1.25,P < 0.001).In the evaluation of parent artery patency,the sensitivity,specificity,positive predictive value,and negative predictive value of TOF-MRA for diagnosing parent artery stenosis were 100.0%,8.0%,14.8%,and 100.0%,respectively,while the assessment results of HR-VW-MRI were completely consistent with DSA.Conclusions In the follow-up of intracranial VBDAs after reconstructive EVT,HR-VW-MRI combined with TOF-MRA at 3.0T showed good diagnostic performance in the evaluation of aneurysm occlusion and patency of the parent artery. |
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