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Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?

  • Diagnostic Neuroradiology
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Abstract

Introduction

Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation. The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography (DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up.

Materials and methods

From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers 1 and 2) and two other reviewed DSA images.

Results

Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity of CE-MRA to detect aneurysm recanalisation was 95.5%.

Conclusion

CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up.

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neuroradiology, Erasme University Hospital, 808 route de Lennik, 1070, Brussels, Belgium

    Boris Lubicz, Carine Neugroschl, Laurent Collignon, Olivier François & Danielle Balériaux

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  1. Boris Lubicz
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  2. Carine Neugroschl
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Correspondence to Boris Lubicz.

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Lubicz, B., Neugroschl, C., Collignon, L. et al. Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?. Neuroradiology 50, 841–848 (2008). https://doi.org/10.1007/s00234-008-0450-2

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