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Neuroimaging
Review
MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis
  1. Syed Uzair Ahmed1,
  2. J Mocco2,
  3. Xiangnan Zhang3,
  4. Michael Kelly4,
  5. Amish Doshi5,
  6. Kambiz Nael3,
  7. Reade De Leacy3
  1. 1 Division of Neurosurgery, Saskatoon, Saskatchewan, Canada
  2. 2 The Mount Sinai Health System, New York, New York, USA
  3. 3 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4 Royal University Hospital, University of Saskatchewan, Neurosurgery, Saskatoon, Saskatchewan, Canada
  5. 5 Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Reade De Leacy, Neurosurgery, Icahn School of Medicine at Mount Sinai, New York 10029, USA; reade.deleacy{at}mountsinai.org

Abstract

Background Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed.

Methods Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond–Roy occlusion grading scale.

Results The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%.

Conclusion MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.

  • Aneurysm
  • Angiography
  • Magnetic Resonance Angiography
  • Coil
  • Flow Diverter

https://doi.org/10.1136/neurintsurg-2019-014936

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    Footnotes

    • Contributors SUA and RDL: study design, data acquisition and analysis, manuscript preparation, and editing. JM: study design, manuscript preparation, and editing. XZ: data analysis, manuscript preparation, and editing. MK, AD, and KN: study design, and manuscript editing. All authors were involved with manuscript final approval and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Data sharing statement Study characteristics and the search strategy are available as supplementary materials. Original 2 x 2 data for the meta-analysis are available from the corresponding author upon request.

    • Patient consent for publication Not required.