Ultra-High-Resolution Time-of-Flight MR-Angiography for the Noninvasive Assessment of Intracranial Aneurysms, Alternative to Preinterventional DSA?

Tilman Schubert; Hakim Shakir Husain; Patrick Thurner; Jawid Madjidyar; Isabelle Barnaure; Marco Piccirelli; Markus Klarhöfer; Michaela Schmidt; Peter Speier; Christoph Forman; Zsolt Kulcsar

doi:10.1007/s00062-023-01320-z

Ultra-High-Resolution Time-of-Flight MR-Angiography for the Noninvasive Assessment of Intracranial Aneurysms, Alternative to Preinterventional DSA?

Clin Neuroradiol. 2023 Dec;33(4):1115-1122. doi: 10.1007/s00062-023-01320-z. Epub 2023 Jul 4.

Authors

Affiliations

¹ Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland. Tilman.schubert@usz.ch.
² Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
³ Baby Memorial Hospital, Calicut, Kerala, India.
⁴ Parco Institute of Medical Sciences, Vatakara, Kerala, India.
⁵ Neo Hospital, Noida, Uttar Pradesh, India.
⁶ Siemens Healthineers, Zurich, Switzerland.
⁷ Siemens Healthineers, Erlangen, Germany.

Abstract

Purpose: The 3D time-of-flight (TOF) magnetic resonance angiography (MRA) at 3T shows high sensitivity for intracranial aneurysms but is inferior to three-dimensional digital subtraction angiography (3D-DSA) regarding aneurysm characteristics. We applied an ultra-high-resolution (UHR) TOF-MRA using compressed sensing reconstruction to investigate the diagnostic performance in preinterventional evaluation of intracranial aneurysms compared to conventional TOF-MRA and 3D-DSA.

Methods: In this study 17 patients with unruptured intracranial aneurysms were included. Aneurysm dimensions, configuration, image quality and sizing of endovascular devices were compared between conventional TOF-MRA at 3T and UHR-TOF with 3D-DSA as gold standard. Quantitatively, contrast-to-noise ratios (CNR) were compared between TOF-MRAs.

Results: On 3D-DSA, 25 aneurysms in 17 patients were detected. On conventional TOF, 23 aneurysms were detected (sensitivity: 92.6%). On UHR-TOF, 25 aneurysms were detected (sensitivity: 100%). Image quality was not significantly different between TOF and UHR-TOF (p = 0.17). Aneurysm dimension measurements were significantly different between conventional TOF (3.89 mm) and 3D-DSA (4.2 mm, p = 0.08) but not between UHR-TOF (4.12 mm) and 3D-DSA (p = 0.19). Irregularities and small vessels at the aneurysm neck were more frequently correctly depicted on UHR-TOF compared to conventional TOF. Comparison of the planned framing coil diameter and flow-diverter (FD) diameter revealed neither a statistically significant difference between TOF and 3D-DSA (coil p = 0.19, FD p = 0.45) nor between UHR-TOF and 3D-DSA (coil: p = 0.53, FD 0.33). The CNR was significantly higher in conventional TOF (p = 0.009).

Conclusion: In this pilot study, ultra-high-resolution TOF-MRA visualized all aneurysms and accurately depicted aneurysm irregularities and vessels at the base of the aneurysm comparably to DSA, outperforming conventional TOF. UHR-TOF with compressed sensing reconstruction seems to represent a non-invasive alternative to pre-interventional DSA for intracranial aneurysms.

Keywords: Compressed sensing; Digital subtraction angiography; MR-angiography; Non-invasive assessment; Post-treatment; Pre-treatment.

MeSH terms

Angiography, Digital Subtraction / methods
Embolization, Therapeutic*
Follow-Up Studies
Humans
Intracranial Aneurysm* / pathology
Magnetic Resonance Angiography / methods
Pilot Projects
Sensitivity and Specificity