ABSTRACT
Objective To evaluate the application of 3.0 T magnetic resonance angiography (MRA) in follow-up after embolization of intracranial aneurysms with stent-assisted coils.Methods From June 2013 to June 2015,32 consecutive patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms underwent stent-assisted coil embolization at the Department of Neurosurgery,the Sixth People′s Hospital of Shenzhen were enrolled retrospectively,including 12 males and 20 female,their mean age was 56±10 years.All patients were confirmed to be solitary intracranial aneurysms by digital subtraction angiography (DSA) before embolization.They were followed up with 3.0 T time of flight MRA (TOF-MRA) and contrast enhanced MRA (CE-MRA) at 1 to 2 years after embolization.DSA findings were served as the golden standard.The effect of aneurysm embolization (stabilization,further embolization,recanalization/recurrence) and patency of the parent arteries (without stenosis/mild stenosis,moderate to severe stenosis and occlusion) were compared.Results (1) The comparisons of evaluating the aneurysmal effects and consistencies of DSA among TOF-MRA,CE-MRA and TOF-MRA+source images after stent-assisted coil embolization were poor (Kappa=0.039,P=0.002),medium (Kappa=0.582,P<0.01),and higher (Kappa=0.615,P<0.01),respectively.(2) The comparison of the consistencies in the patency of the parent artery after stent-assisted coil embolization between TOF-MRA,CE-MRA and DSA were poor (Kappa=0.171,P=0.211;Kappa=0.376,P=0.010).(3) With the DSA findings as reference,the accuracy rates of TOF-MRA,TOF-MRA+source images and CE-MRA for interpretation of aneurysm embolization were 37.5% (12/32),75.0% (24/32),and 71.9% (23/32),respectively.TOF-MRA compared with TOF-MRA+source images and CE-MRA respectively,there were significant differences in the accuracy rates (χ2=9.04,P=0.003;χ2=7.63,P=0.006);there were no significant differences in the accuracy rates between TOF-MRA+source images and CE-MRA (χ2=0.08,P=0.777).(4) With the DSA findings as reference,the accuracy rates of TOF-MRA and CE-MRA for interpretation of the patency of the parent artery were 37.5% (12/32) and 62.5% (20/32) respectively.There was no significant difference in the accuracy rate (χ2=4.67,P=0.097).Conclusions The accuracy rate of 3.0 T CE-MRA for evaluating the embolization effect of intracranial aneurysms after stent-assisted coil embolization was superior to that of TOF-MRA.It can be used as a preferred non-invasive examination during the follow-up.TOF-MRA+source images are equivalent to CE-MRA,however,TOF-MRA and CE-MRA for the evaluation of the accuracy of patency of the parent arteries are low.For positive or indeterminate results of MRA examinations,the individualized analysis should be performed,if necessary,perform DSA examination.
ABSTRACT
Objective To evaluate the clinical valence and resource consumption between precise stereotactic hematoma evacuation and expectant treatment in treating small hypertensive cerebral hemorrhage. Methods A total of 68 patients with small hypertensive cerebral hemorrhage (hemorrhage volume less than 30 mL), admitted to our hospital from January 2012 to August 2015, were divided into precise stereotactic hematoma evacuation group (n=32) and expectant treatment group (n=36) by clinical research methods of prospective randomized controlled and blind assessment. Preliminary treatment effects were evaluated by CT scan, Glasgow coma scale (GCS) and modified Rankin scale (mRS); hospital day and hospitalization costs were used for evaluating the consumption of social resources. Results Evacuation rate of hematoma was 88.38%±2.15%, hospital day was (7.2 ± 2.8) days, average hospitalization fee was (22257.6 ±2512.3) yuans, GCS scores were 14.5 ±0.5, mRS scores were 2.21 ±0.46 at 6 weeks after treatment in precise stereotactic hematoma evacuation group;evacuation rate of hematoma was 26.17%±1.99%%, hospital day was (18.6+3.2) days, average hospitalization fee was (25226.3 ±2212.8) yuans, GCS scores were 12.0 ±0.75, mRS scores were 3.18 ± 0.41 at 6 weeks after treatment in precise stereotactic hematoma evacuation group; the differences between the two groups were statistically significant (P<0.05). Conclusion For small hypertensive cerebral hemorrhage, precise stereotactic hematoma evacuation is prior to expectant treatment and can shorten rehabilitation period and improve the overall prognosis.