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Original research
Voxel based analysis of recurrence dynamics in intracranial aneurysms after coiling
  1. Marielle Ernst1,
  2. Anika Buchholz2,
  3. Romain Bourcier3,
  4. Hubert Desal3,
  5. Pierre-Yves Le Floch3,
  6. Markus Möhlenbruch4,
  7. Martin Bendszus4,
  8. Jens Fiehler1
  1. 1Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
  2. 2Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
  3. 3Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nantes, Nantes, France
  4. 4Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
  1. Correspondence to Dr Marielle Ernst, University Medical Centre, Hamburg-Eppendorf Haus Ost 22 (O 22), Martinistr 5220246, Hamburg, Germany; m.ernst{at}uke.de

Abstract

Background Understanding aneurysm growth is critical for the appropriate follow-up of patients after coil embolization and the need for retreatment. The purpose of the study was to stratify the growth dynamics of aneurysm recurrences after coiling by volumetric analysis and to determine predictive factors for aneurysm recurrences.

Methods Source images of follow-up three-dimensional time of flight MR angiography (ToF-MRA) scans were compared with the first post-interventional ToF-MRA scan and analyzed for residual flow after co-registration using ANALYZE-software. In the event of incomplete occlusion, the residual volume was segmented and calculated. Growth dynamic was determined for each aneurysm after embolization.

Results We analyzed 326 patients with 345 aneurysms from two centers. Each case had at least two ToF-MRA examinations after endovascular therapy. The mean observation interval was 59 months. Volumetric analysis of 1139 follow-up MRAs revealed that 218/345 aneurysms (63.2%) showed complete occlusion on initial follow-up imaging, and of these 95.0% remained stable. A steady increase in intra-aneurysmal flow was observed in 83/345 (24.1%). Less frequent observations were a steep increase (21/345; 6.1%) and a decrease (27/345; 7.8%). Independent predictors of increasing residual flow were greatest aneurysm diameter, total coil length, and incomplete occlusion.

Conclusions Volumetric analysis of registered three-dimensional ToF-MRA follow-up datasets allows the detection of different growth patterns with high precision, avoids the low inter-rater reliability, and represents a promising approach for future studies that include analysis of more complex predictors of residual flow. In cases of aneurysm recurrence after coiling, the major pattern seems to be a steady increase in intra-aneurysmal flow over several months.

  • aneurysm
  • coil
  • magnetic resonance angiography

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Footnotes

  • Contributors ME designed the data collection tools, monitored the data collection for the whole trial, wrote the statistical analysis plan, cleaned and analyzed the data, and drafted and revised the paper. She is the guarantor. AB wrote the statistical analysis plan, and revised the draft paper. RB, P-YL, and MB revised the draft paper. JF initiated the collaborative project, designed the data collection tools, monitored the data collection for the whole trial, analyzed the data, and drafted and revised the paper. HD and MM designed the data collection tools, monitored the data collection for the whole trial, analyzed the data, and drafted and revised the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study was approved by Ethik-Kommission Ärztekammer Hamburg WF-040/13.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no unpublished data to share.

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