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Original research
Vessel wall imaging with advanced flow suppression in the characterization of intracranial aneurysms following flow diversion with Pipeline embolization device
  1. Eytan Raz1,
  2. Adam Goldman-Yassen2,
  3. Anna Derman1,
  4. Ahrya Derakhshani1,
  5. John Grinstead3,
  6. Seena Dehkharghani1
  1. 1Department of Radiology, New York University Langone Medical Center, New York, New York, USA
  2. 2Department of Radiology, Emory University, Atlanta, Georgia, USA
  3. 3Ohio State University Foundation, Columbus, Ohio, USA
  1. Correspondence to Dr Seena Dehkharghani, Department of Radiology Neuroradiology Section, New York University, New York, NY, USA; Seena.Dehkharghani{at}NYUMC.org

Abstract

Background High-resolution vessel wall MRI (VWI) is increasingly used to characterize intramural disorders of the intracranial vasculature unseen by conventional arteriography.

Objective To evaluate the use of VWI for surveillance of flow diverter (FD) treated aneurysms.

Materials and methods Retrospective study of 28 aneurysms (in 21 patients) treated with a FD (mean 57 years; 14 female). All examinations included VWI and a contemporaneously obtained digital subtraction angiogram. Multiplanar pre- and post-gadolinium 3D, variable flip-angle T1 black-blood VWI was obtained using delay alternating nutation for tailored excitation (DANTE) at 3T. 3D time-of-flight MR angiography (MRA) was also carried out. Images were assessed for in-stent stenosis, aneurysm occlusion, presence and pattern/distribution of aneurysmal or parent vessel gadolinium enhancement.

Results The VWI-MRI was performed on average at 361±259 days after the intervention. Follow-up DSA was performed at 338±254 days postintervention. Good or excellent black-blood angiographic quality was recorded in 22/28 (79%) pre-contrast and 21/28 (75%) post-contrast VWI, with no cases excluded for image quality. Aneurysm enhancement was noted in 24/28 (85.7%) aneurysms, including in 79% of angiographically occluded aneurysms and 100% of angiographically non-occluded aneurysms. Enhancement of the stented parent-vessel wall occurred significantly more often when aneurysm enhancement was present (92% vs 33%, p=0.049).

Conclusion Advanced VWI produces excellent depiction of FD-treated aneurysms, with robust evaluation of the parent vessel and aneurysm wall to an extent not achievable with conventional MRI/MRA. Gadolinium enhancement may, however, continue even after enduring catheter angiographic occlusion, confounding interpretation, and requiring cognizance of this potentially prolonged effect in such patients.

  • aneurysm
  • flow diverter
  • vessel wall
  • MRI

Data availability statement

Data are available upon reasonable request. as above.

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Data availability statement

Data are available upon reasonable request. as above.

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Footnotes

  • Twitter @eytanraz

  • Contributors ER and SD designed the study. SD and JG created and tuned the imaging protocol. AG-Y, AnD, AhD contributed to data collection. ER and AG-Y drafted the manuscript. All authors contributed to editing the manuscript and approved the final manuscript. SD is the guarantor.

  • 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 ER: stock holder for Siemens.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.