MR Angiography at 3T versus Digital Subtraction Angiography in the Follow-up of Intracranial Aneurysms Treated with Detachable Coils
Charles B. L. M. Majoiea,
Marieke E. Sprengersa,
Willem Jan J. van Rooijc,
Cristina Lavinia,
Menno Sluzewskic,
Jeroen C. van Rijnb and
Gerard J. den Heetena
a Department of Radiology, Academic Medical Center, University of Amsterdam, the Netherlands
b Department of Biostatistics, Academic Medical Center, University of Amsterdam, the Netherlands
c Department of Radiology St. Elisabeth Ziekenhuis, Hilvarenbeekseweg, the Netherlands
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FIG 1. Interobserver disagreement on MRA and disagreement between MRA and DSA on the occlusion of a basilar tip aneurysm after treatment with coils.
A, DSA image obtained immediately after treatment with coils shows complete aneurysm occlusion.
B, Nonenhanced MOTSA 3D TOF MRA image obtained 5 months after treatment shows filling of the aneurysm neck (arrow), which was interpreted by one observer as a 2-mm remnant and by the other observer as a 2-mm recurrence. During the consensus reading, it was scored as a remnant. Note minor signal intensity loss in the proximal P1 segment of the left posterior cerebral artery.
C, DSA image obtained 5 months after treatment with coils. This image was interpreted as occlusion.
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FIG 2. Posterior communicating artery aneurysm with small neck remnant 7 months after treatment with coils.
A, Axial nonenhanced MOTSA 3D TOF MRA source image demonstrates a 2-mm neck remnant (arrow).
B, Nonenhanced MOTSA 3D TOF MR target maximum intensity projection image also shows a small neck remnant (arrow).
C, DSA image confirms the presence of a small neck remnant (arrow).
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FIG 3. Middle cerebral artery aneurysm with high-signal-intensity rim artifact and recurrence 6 months after treatment with detachable coils.
A, Axial fast spin-echo T2-weighted MR image (3394/80) shows a 2-mm rim of increased signal intensity around the coils (arrow).
B, Axial nonenhanced MOTSA 3D TOF MRA source image demonstrates recurrence of the aneurysm (arrow).
C, Nonenhanced MOTSA 3D TOF MRA image shows recurrence (arrow).
D, Contrast-enhanced MOTSA 3D TOF MRA image shows the same recurrence (arrow).
E, DSA image obtained 6 months after treatment confirms the presence of recurrence (arrow).
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FIG 4. Anterior communicating artery aneurysm with recurrence 8 months after treatment with coils.
A, DSA image shows large anterior communicating artery aneurysm.
B, DSA image shows complete occlusion after coiling.
C, Axial nonenhanced MOTSA 3D TOF MRA source image obtained 8 months after treatment demonstrates recurrence (arrow).
D, Nonenhanced MOTSA 3D TOF MRA image demonstrates recurrence (arrow).
E, DSA image obtained 8 months after treatment confirms the presence of recurrence due to coil compaction (arrow).
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FIG 5. Disagreement between MRA and DSA on the occlusion status of a posterior inferior cerebellar artery aneurysm 14 months after treatment with coils.
A, DSA image obtained immediately after coiling shows a small area of residual filling (arrow).
B, Nonenhanced MOTSA 3D TOF MRA image obtained 14 months after treatment shows flow in the aneurysm neck (arrow), which was interpreted as a 2-mm remnant by both observers.
C, DSA image shows filling of the aneurysm neck (arrow), which was interpreted as a 2-mm recurrence (including a 1-mm remnant) due to coil compaction. Both observers thought that additional treatment for this small recurrence was not indicated.
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FIG 6. Anterior communicating artery aneurysm with coil-related signal intensity loss in parent and branch vessels.
A, Axial nonenhanced MOTSA 3D TOF MRA source image obtained 8 months after treatment shows narrowing of the anterior communicating artery (arrow). No neck remnant or aneurysm recurrence was found.
B, Nonenhanced MOTSA 3D TOF MRA image shows narrowing of the anterior communicating artery (arrow) and the proximal part of both A2 segments of the anterior cerebral arteries (arrowheads).
C, Enhanced MOTSA 3D TOF MRA image shows similar narrowings as described in B.
D, DSA image shows complete occlusion of the aneurysm without narrowing of parent and branch vessels.
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