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Bologna XIX Symposium Neuroradiologicum

Bologna XIX Symposium Neuroradiologicum. Follow Up of Coiled Intracranial Aneurysms: MRA vs. DSA. XIX Symposium Neuroradiologicum Bologna Dr. Stefan Celedin Klagenfurt / Austria. Bologna XIX Symposium Neuroradiologicum. How to Check if the Mine is Still Defused.

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Bologna XIX Symposium Neuroradiologicum

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  1. Bologna XIX Symposium Neuroradiologicum

  2. Follow Up of Coiled Intracranial Aneurysms:MRA vs. DSA XIX Symposium Neuroradiologicum Bologna Dr. Stefan Celedin Klagenfurt / Austria Bologna XIX Symposium Neuroradiologicum

  3. How to Check if the Mine is Still Defused Bologna XIX Symposium Neuroradiologicum

  4. Follow Up in Austria F/U in Austria Bologna XIX Symposium Neuroradiologicum

  5. DSA vs. MRA F/U in Austria Gold Standard Bologna XIX Symposium Neuroradiologicum

  6. DSA vs. MRA F/U in Austria Gold Standard Literature 1,5 Tesla 3 Tesla 2D Time of Flight +/- contrast 3D Time of Flight +/- contrast 2 Standard Projections MOTSA Multiple Overlapping Thin Slab Acquisition 5 Standard Projections 3D – Rotational - Angio Ce-MRA First Pass Steady State with Blood Pool Flat – Panel – Detector Matrix Matrix / TE Coil-Type / Stent K-Space Bologna XIX Symposium Neuroradiologicum

  7. F/U in Austria Gold Standard Literature Bologna XIX Symposium Neuroradiologicum

  8. Smaller Methodologically HeterogeneousSingle-Center-Studies Buhk et al: No Advantage of time-of-flight magnetic resonance angiography at 3 Tesla coompared to 1,5 Tesla in follow-up after endovascular treatment of cerebral aneurysms:Neuroradiology 2008;50(10):855-861 Deutschmann et al: Diagnostic accuracy of 3D time-of-flight MR angiography compared with digital subtraction angiography for follow-up of coiled intracranial aneurysms: influence of aneurysm size. AJNR 2007;28(4):628-634 Ferré et al: Time-of-Flight MR angiography at 3T versus digital subraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils. EurJRadiol 2009;72(3):365-369 Gauvrit et al: Intracranial Aneurysms treated with Guglielmi detachable coils: long-term imaging follow up with contrast enhanced magnetic resonsnce angiography.J Neurosurg 2008;108(3):443-449 Kwee et al: MR angiography in the follow up of intracraniel aneurysms treated with gulielmi detachable coils: systematic review and meta-analysis.Neuroradiology 2007;49(9):703-713 Urbach et al: Three-dimensional time-of-flight MR angiography at 3T compared to digital substraction angiography in the follow-up of ruptured and coiled intracraniel aneurysms: a prospective study.Neuroradiology 2008;50(5)383-389 Wong et al: Assessment of brain aneurysms by using high-resolution magnetic resonsnce angiography after endovascular coil delivery.J Neurosurg 2007;107(2):283-289 F/U in Austria Gold Standard Literature Bologna XIX Symposium Neuroradiologicum

  9. Meta – Analysis I Kwee T: MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis.Neuroradiology. 2007;49(9):703-13 Included 16 Studies Detection of Residual Flow TOF: Sensitivity: 83,3%(95% CI 70.3 – 91,3%) Specificity: 90,6%(95% CI 80.4 – 95.8%) Detection of Residual Flow ceMRA: Sensitivity: 86,8% (95% CI 71,4 – 94,5%) Specificity: 91,9% (95% CI 79.8 - 97.0%) F/U in Austria Gold Standard Literatur Meta-Analysis Bologna XIX Symposium Neuroradiologicum

  10. Conclusion Kwee: Both TOF-MRA and ce-MRA achieve a moderate to high diagnostic performance. Studies of moderate methodological quality Pooled estimates subject to heterogeneity. F/U in Austria Gold Standard Literature Meta-Analysis Bologna XIX Symposium Neuroradiologicum

  11. Meta – Analysis II Weng HH: Meta-analysis on diagnostic accuracy of MR Angiography in follow-up of residual intracranial aneurysms treated with Gulielmi detachable coils.Interv Neuroradiol. 2008;14 Suppl2:53-63 Included 16 Studies Detection of Residual Flow TOF: Sensitivity: 90%(95% CI 79 – 95%) Specificity: 95%(95% CI 88 – 98%) Detection of Residual Flow ceMRA: Sensitivity: 92% (95% CI 79 – 97%) Specificity: 96 (95% CI 91 - 98%) F/U in Austria Gold Standard Literature Meta-Analysis Bologna XIX Symposium Neuroradiologicum

  12. Conclusion Weng: The diagnostic accuracy of TOF-MRA and ce-MRA tests offer comparable and equal results and may obviate the invasive DS angiography F/U in Austria Gold Standard Literature Meta-Analysis Bologna XIX Symposium Neuroradiologicum

  13. Intracranial Aneurysms Treated with Coil Placement: Test Characteristics of Follow-up MR Angiography-Multicenter Study Schaafsma Joanna et al Radiology July 2010 F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma Bologna XIX Symposium Neuroradiologicum

  14. M & M 4 University Hospitals 311 pat, 343 aneurysms DSA: 3 Projections(AP, LV, OPT) MRA: 3D-TOF, ceMRA (1st pass) 2 Neuroradiologists (1 Intervent.) Occlusion Class I-III (Roy) Occlusion Class: I&II vs. III F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM Complete Subtotal Incomplete Bologna XIX Symposium Neuroradiologicum

  15. Image Evaluation: MRA: 1 Aneur. (platinum-iridium coils) excluded 2 Aneur. not interpretable in TOF (thombus/orientation) → ceMRA only 6 Aneur. not interpretable in ceMRA (orientation/timing/contras t)→ TOF only DSA: 3 Aneur. not interpretable → excluded F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Bologna XIX Symposium Neuroradiologicum

  16. Image Evaluation: Incomplete Occlusion: DSA: 25% patients (76; 95%CI 20-29%) 23% examinations (88; 95%CI 19-27%) Interobserver Agreement: DSA: κ 0,62 (95%CI 0,56-0,69) MRA: κ 0,64 (95%CI 0,57-0,70) INR: κ 0,61 (95%CI 0,54-0,68) INR/NINR: κ 0,65 (95%CI 0,60-0,71) F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Bologna XIX Symposium Neuroradiologicum

  17. Discrepancies 16 (88) incomplete Occlusion (III°) in DSA: 1 total Occlusion in MRA (coil artifacts) 15 subtotal (II°) Occlusions in MR 32 incomplete Occlusions in MRA: 20 subtotal in DSA 12 totally occluded in DSA F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image discrep. Bologna XIX Symposium Neuroradiologicum

  18. Discrepancies F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image discrep. Accuracy: 0,89 Accuracy for 1,5T and 3T were comparable. Bologna XIX Symposium Neuroradiologicum

  19. ceMRA Change of Classification in 6% (n=21) 9 Change = DSA 1 overstimated Degree of Occlusion 11 underestimated Degree of Occlusion Accuracy: TOF (0,86) and ceMRA (0,85) similar F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Discrep. ceMRA Bologna XIX Symposium Neuroradiologicum

  20. Coil Artifacts Platinum-Iridium coils with nitinol Core Excluded. Artifacts impeded interpretation in 29 Aneurysms (8%) 22 @ TOF 1 @ ceMRA 6 @ both 1 MRA I°, DSA III° 8 MRA II°, DSA I° 20 MRA = DSA F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Discrep. CeMRA coils Bologna XIX Symposium Neuroradiologicum

  21. Associated with Discrepancy Small Residual Lumen Suboptimal projection in DSA F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Discrep. CeMRA coils Bologna XIX Symposium Neuroradiologicum

  22. Discussion TOF & ceMRA @ 1,5 and 3,0T high NPV for Aneurysm Recurrence. MRA showed all III° Occlusions that required treatment. No additional value of ceMRA over TOF Is Incomplete Occlusion in MRA but not in DSA false poitive? Imperfect reference test? F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Discrep. CeMRA Coild discuss Bologna XIX Symposium Neuroradiologicum

  23. Discussion Results favor the use of MRA at 1,5T or 3,0T instead of DSA. When MRA shows I or II° occlusion, DSA is likely not required. F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Discrep. CeMRA Coild discuss Bologna XIX Symposium Neuroradiologicum

  24. Conclusion Schaafsma et al The diagnostic performance of MR angiography in patients treated with coil placement is likely to be sufficient for it to replace routine follow-up intraarterial digital subtraction angiography, even though evaluation of costs and health benefits for both modalities is still needed. F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Discrep. CeMRA Coild Discuss conclude Bologna XIX Symposium Neuroradiologicum

  25. The End F/U in Austria Gold Standard Literature Meta-Analysis Schaafsma MM image Discrep. CeMRA Coild Discuss Conclude END Bologna XIX Symposium Neuroradiologicum

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