Usefulness of Silent MR Angiography for Intracranial Aneurysms Treated with a Flow-Diverter Device

• Published in: American journal of neuroradiology : AJNR Vol. 40; no. 5; pp. 808 - 814
• Main Authors: Oishi, H., Fujii, T., Suzuki, M., Takano, N., Teranishi, K., Yatomi, K., Kitamura, T., Yamamoto, M., Aoki, S., Arai, H.
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.05.2019
• Subjects: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction - methods; Cerebral Angiography - methods; Editor's Choice; Embolization, Therapeutic - instrumentation; Endovascular Procedures - instrumentation; Female; Follow-Up Studies; Humans; Interventional; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Magnetic Resonance Angiography - methods; Male; Middle Aged; Neuroimaging - methods
• ISSN: 0195-6108; 1936-959X; 1936-959X
• DOI: 10.3174/ajnr.A6047

The flow-diverter device has been established as a treatment procedure for large unruptured intracranial aneurysms. The purpose of this study was to compare the usefulness of Silent MR angiography and time-of-flight MRA to assess the parent artery and the embolization state of the aneurysm after a flow-diverter placement. Seventy-eight large, unruptured internal carotid aneurysms in 78 patients were the subjects of this study. After 6 months of treatment, they underwent follow-up digital subtraction angiography, Silent MRA, and TOF-MRA, performed simultaneously. All images were independently reviewed by 2 neurosurgeons and 1 radiologist and rated on a 4-point scale from 1 (not visible) to 4 (excellent) to evaluate the parent artery. The aneurysmal embolization status was assessed with 2 ratings: complete or incomplete occlusion. The mean scores of Silent MRA and TOF-MRA regarding the parent artery were 3.18 ± 0.72 and 2.31 ± 0.86, respectively, showing a significantly better score with Silent MRA ( < .01). In the assessment of the embolization of aneurysms on Silent MRA and TOF-MRA compared with DSA, the percentages of agreement were 91.0% and 80.8%, respectively. Silent MRA is superior for visualizing blood flow images inside flow-diverter devices compared with TOF-MRA. Furthermore, Silent MRA enables the assessment of aneurysmal embolization status. Silent MRA is useful for assessing the status of large and giant unruptured internal carotid aneurysms after flow-diverter placement.