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Utility of CT Angiography and MR Angiography for the Follow-up of Experimental Aneurysms Treated with Stents or Guglielmi Detachable Coils

Anthony M. Masaryka, Richard Fraynea, Orhan Unala, Alan H. Rappea and Charles M. Strothera

a From the Department of Radiology, University of Arizona Health Sciences Center, Tucson (A.M.M.); the Departments of Radiology (O.U., A.H.R., C.M.S.) and Medical Physics (O.U.), University of Wisconsin, Madison; and the Departments of Clinical Neurosciences and Radiology, University of Calgary, Alberta, Canada (R.F.).



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  		FIG 1. Untreated experimentally induced canine aneurysms.

A, Cut-film subtraction angiogram.

B, Conventional 3D-TOF MR angiogram (33/3.3/1).

C, Contrast-enhanced 3D-TOF MR angiogram (33/3.3/1).

D, 3D MR DSA image (9.3/1.8/1) produced by subtraction of a peak arterial phase 3D image from a baseline 3D mask acquired before the arrival of the intravenous contrast bolus.

E, CT angiogram.



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  		FIG 2. Aneurysm partially treated with a stainless steel stent.

A, Conventional angiogram of stent partially overlying the ostium of a patent aneurysm.

B, CT angiogram.

C, Contrast-enhanced 3D-TOF MR angiographic reformatted planar image (33/3.3/1) parallel to the carotid artery.

D, 3D MR DSA image (11.6/2.4/1). Ferromagnetic artifacts completely suppressed luminal signal intensity on all MR sequences.



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  		FIG 3. Aneurysm partially treated with a nitinol stent.

A, Conventional angiogram of a nitinol stent overlying the ostium of a patent aneurysm.

B, CT angiogram.

C, Contrast-enhanced 3D-TOF MR angiographic reformatted planar image (33/3.3/1) parallel to the carotid artery.

D, 3D MR DSA image (11.4/2.2/1). Luminal signal intensity in the parent artery and in the region of the aneurysmal neck are visible but some artifacts are present owing to the nitinol stent. Despite dynamic contrast enhancement, some enhancement is seen within the adjacent jugular vein (arrow).



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  		FIG 4. Aneurysm completely treated by placement of a PTFE-nitinol stent-graft.

A, Conventional angiogram.

B, CT angiogram. A small focal luminal protrusion is seen where the stent-graft overlies the ostium of the aneurysm (arrow).

C, Contrast-enhanced reformatted planar image (33/3.3/1) parallel to the carotid artery.

D, 3D MR DSA image (11.6/2.4/1). Luminal signal intensity on MR angiographic sequences is clearly defined despite the presence of the stent-graft.



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  		FIG 5. CT angiographic source images of aneurysm treated with stents and stent-grafts show differences in artifacts produced by different device compositions.

A, Animal 1. Right (lower aneurysm), stainless steel stent partially herniating into an experimental aneurysm (arrowhead). Left, PTFE/nitinol stent-graft (arrow). The apparent wall thickness of the stainless steel stent on CT is greater than that of the stent-graft because of the high attenuation of the former.

B, Animal 2. Right (lower aneurysm), stainless steel stent (arrowhead). Left, nitinol stent (arrow). The apparent wall thickness of the nitinol stent on CT is less than the stainless steel stent and the PTFE/nitinol stent-graft.



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  		FIG 6. Aneurysms partially and completely treated with GDC embolization.

A and B, Conventional angiograms of left- (A) and right-sided (B) aneurysms before and after GDC embolization. The left-sided aneurysm (arrowhead) was completely treated. The two right-sided aneurysms were partially treated, such that there was persistent flow within the aneurysm (arrows).

C and D, 3D MR DSA images of the left- (C) and right-sided (D) aneurysms before (9.6/2.1/1) and after (11.5/2.3/1) GDC embolization. The left-sided aneurysm is obliterated after treatment (arrowhead). Note the absence of high signal artifacts from thrombosis, soft tissue enhancement, or susceptibility artifacts. Residual flow is accurately depicted in the two right-sided aneurysms, which were partially treated with GDCs (arrows).

E, CT angiographic source image of GDCs. Severe beam-hardening artifact renders these images diagnostically useless.

F, Contrast-enhanced 3D-TOF source image (33/3.3/1) of the left-sided aneurysm completely treated by GDCs. The GDC mass is surrounded by high signal intensity (arrow), which may be the result of flowing blood, thrombus, enhancing granulation tissue, mild susceptibility artifacts, or a combination thereof.

G and H, Contrast-enhanced 3D-TOF source images (33/3.3/1) of incompletely treated carotid aneurysms on lower right (G) and upper right (H) sides. The signal intensity around the coil mass (arrows) is lower than that of the parent artery, although it is similar to that found in the completely treated aneurysm (F). Conventional angiography and 3D MR DSA documented that the two right-sided aneurysms contained flowing blood (C, D).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X