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Original research
The sensitivity and specificity of TOF-MRA compared with DSA in the follow-up of treated intracranial aneurysms
  1. Sishi Xiang1,2,
  2. Fu Fan3,4,
  3. Peng Hu2,
  4. Kun Yang5,
  5. Xiaodong Zhai1,2,
  6. Jiewen Geng1,2,
  7. Zhe Ji1,2,
  8. Jie Lu1,3,4,
  9. Hongqi Zhang1,2
  1. 1Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  2. 2China International Neuroscience Institute, Beijing, China
  3. 3Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
  4. 4Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
  5. 5Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Hongqi Zhang, Capital Medical University, Department of Neurosurgery, Xuanwu Hospital, Beijing, China; xwzhanghq{at}


Background Time-of-flight magnetic resonance angiography (TOF-MRA) is widely used in detecting intracranial aneurysms (IA), but it is limited and controversial for use during follow-up to assess the outcome of interventional coiling or clipping surgery.

Methods To evaluate the specificity and sensitivity of using TOF-MRA as an imaging follow-up for IA with different treatments. A total of 280 patients with 326 treated IA underwent simultaneous TOF-MRA and digital subtraction angiography (DSA) as follow-up imaging on the same day. All images were independently reviewed by two neurosurgeons and two radiologists. The consensus evaluation of intra-arterial DSA as a reference test was used to evaluate the result of aneurysm occlusions. The aneurysmal embolization status was assessed with two ratings involving complete or incomplete occlusions. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value of three-dimensional-TOF-MRA to investigate the diagnostic performance.

Results Overall sensitivity and specificity of TOF-MRA for diagnosing the remnant were 83.3% and 95.2%, respectively. The sensitivity and specificity of interventional therapy was 90.0% and 94.2%, respectively, while the clipping group showed sensitivity and specificity of 50.0% and 100%, respectively. For additional groups, involving coil only, stent-assisted, and flow diverter, the analysis of interventional therapy showed sensitivities and specificities of 100.0% and 90.1%, 66.7% and 95.1%, and 91.7% and 100%, respectively.

Conclusions TOF-MRA can be used as a first-line noninvasive imaging modality during follow-up, especially for the patients treated with a pipeline embolization device and coils only. But it may not be enough for clipped aneurysms.

  • aneurysm
  • magnetic resonance angiography
  • angiography

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  • Contributors Sishi Xiang and Hongqi Zhang conceived and designed the research. Sishi Xiang and Peng Hu reviewed the DSA results. Fu Fan and Jie Lu interpreted the MRA results. Sishi Xiang and Kun Yang analyzed the data and performed the statistical analysis. Sishi Xiang drafted the manuscript. Sishi Xiang and Fan Fu contributed equally, as co-first authors. Jie Lu was the co-corresponding Author. Others contributed equally to this work.

  • Funding This study received grants from the National Key R&D program of China (2016YFC1300800) and a project on the research and application of effective intervention techniques for high risk populations of stroke from the National Health and Family Planning Commission in China (GN-2016R0004).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This study was approved by our institutional ethics committee (Xuanwu hospital, N0.2017024 and No.2017082).

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data comes from the China Intracranial Aneurysm Project (CIAP) dataset.