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Usefulness of high-resolution three-dimensional proton density-weighted turbo spin-echo MRI in distinguishing a junctional dilatation from an intracranial aneurysm of the posterior communicating artery: a pilot study
  1. Sunghan Kim1,2,
  2. Joonho Chung2,
  3. Jihoon Cha3,
  4. Byung Moon Kim3,
  5. Dong Joon Kim3,
  6. Yong Bae Kim4,
  7. Jae Whan Lee2,
  8. Seung Kon Huh2,
  9. Keun Young Park2,3
  1. 1 Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
  2. 2 Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  3. 3 Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  4. 4 Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  1. Correspondence to Dr Keun Young Park, Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea; kypark78.md{at}gmail.com

Abstract

Background Discriminating a junctional dilatation from a true saccular aneurysm is clinically important.

Purpose To evaluate the usefulness of high-resolution three-dimensional proton density-weighted turbo spin-echo magnetic resonance imaging (PD MRI) in distinguishing a junctional dilatation from an aneurysm of the posterior communicating artery (PcomA).

Methods Eighty-two consecutive patients with 83 PcomA lesions, which were evaluated by time-of-flight (TOF) MR angiography (MRA), PD MRI, and digital subtraction angiography (DSA), were enrolled. These radiologic data were retrospectively and independently reviewed by two neurosurgeons, and each diagnosis based on TOF MRA, PD MRI, and DSA was compared. The diagnostic efficacy (interobserver agreement, intermodality agreement, and diagnostic performance) of PD MRI was compared with that of TOF MRA.

Results PD MRI showed higher AC1 (Gwet’s agreement coefficient, PD MRI: 0.8942, 95% CI 0.8204 to 0.968; TOF MRA: 0.7185, 95% CI 0.5753 to 0.8617) and prevalence-adjusted bias-adjusted kappa coefficient (PABAK) (PD MRI: 0.8554, TOF MRA: 0.5904) than TOF MRA for interobserver agreement. For intermodality agreement, PD MRI also showed higher AC1 (PD MRI: 0.9069, 95% CI 0.8374 to 0.9764; TOF MRA: 0.7983, 95% CI 0.6969 to 0.8996) and PABAK (PD MRI: 0.8735, TOF MRA: 0.7289) than TOF MRA. The diagnostic performance of PD MRI was statistically superior to that of TOF MRA in sensitivity, specificity, positive predictive value, and negative predictive value.

Conclusions PD MRI could provide excellent diagnostic accuracy and better information in distinguishing a junctional dilatation from a true saccular aneurysm of the PcomA compared with TOF MRA.

  • aneurysm
  • angiography
  • magnetic resonance angiography
  • magnetic resonance imaging

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Footnotes

  • Contributors Substantial contribution to the conception or design of the work: KYP. Acquisition, analysis, or interpretation of the data for the work: SK, BMK, DJK, and KYP. Drafting the work or revising it critically for important intellectual content: SK, JoC, JiC, BMK, DJK, YBK, JWL, SKH, and KYP. Final approval of the version to be published: SK, JoC, JiC, BMK, DJK, YBK, JWL, SKH, and KYP. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SK, JoC, JiC, BMK, DJK, YBK, JWL, SKH, and KYP.

  • 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.

  • Ethics approval This study was approved by Severance Hospital institutional review board.

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

  • Data sharing statement The relevant anonymised patient level data are available on reasonable request from the authors.

  • Patient consent for publication Not required.

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