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AJNR - American Journal of Neuroradiology

Published ahead of print on May 13, 2009
doi: 10.3174/ajnr.A1622

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American Journal of Neuroradiology 30:1524-1530, September 2009
© 2009 American Society of Neuroradiology

INTERVENTIONAL

MR Angiographic Follow-Up of Intracranial Aneurysms Treated with Detachable Coils: Evaluation of a Blood-Pool Contrast Medium

T. Kau^a, J. Gasser^a, S. Celedin^a, E. Rabitsch^a, W. Eicher^a, E. Uhl^b and K.A. Hausegger^a

^aFrom the Institute of Diagnostic and Interventional Radiology (T.K., J.G, S.C., E.R., W.E., K.A.H.)
^bDepartment of Neurosurgery (E.U.), General Hospital of Klagenfurt, Klagenfurt, Austria.

Please address correspondence to Thomas Kau, MD, General Hospital of Klagenfurt, Institute of Diagnostic and Interventional Radiology, St. Veiter Str 47, 9020 Klagenfurt, Austria; e-mail: t.kau{at}gmx.at

BACKGROUND AND PURPOSE: Blood-pool agents are promising in the imaging of small vessels with slow or complex flow. Our aim was to compare blood-pool contrast-enhanced MR angiography (BPCE-MRA) using gadofosveset trisodium (Vasovist) with 3D time-of-flight MRA (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular therapy.

MATERIALS AND METHODS: We included 32 patients with a total of 37 coiled aneurysms. MRAs in the early steady-state phase were performed on a 1.5T scanner within 8 days of digital subtraction angiography (DSA). Two radiologists independently analyzed TOF-MRA and BPCE-MRA images. Consensus was reached by review involving a third neuroradiologist. DSA images were interpreted separately by an interventional radiologist. Findings were assigned to 1 of 3 categories: 1) complete occlusion, 2) residual neck, and 3) residual aneurysm.

RESULTS: Follow-up DSA demonstrated 13 complete obliterations (class 1), 13 residual necks (class 2), and 11 residual aneurysms (class 3). Weighted statistics showed substantial concordance of TOF-MRA and DSA (0.664) as well as BPCE-MRA and DSA (0.724) ratings. Comparison between TOF-MRA and BPCE-MRA found excellent agreement (0.818) with only 6 (16.2%) discrepancies. For detecting residual flow, the difference in accuracy of both MRA techniques (83.8% versus 91.9%) was not significant (McNemar, P = 1.000). BPCE-MRA showed a tendency towards higher sensitivity and specificity (91.7% and 92.3%, respectively) compared with TOF-MRA (87.5% and 76.9%).

CONCLUSIONS: In classifying the completeness of endovascular cerebral aneurysm therapy, we found that BPCE-MRA and 3D TOF-MRA showed very good agreement. The use of Vasovist did not lead to a significantly increased accuracy of MRA follow-up.