ABSTRACT
BACKGROUND AND PURPOSE: Blood-pool agents are promising in the imaging of small vessels with slow or complex flow. Our aim was to compare blood-pool contrast-enhanced MR angiography (BPCE-MRA) using gadofosveset trisodium (Vasovist) with 3D time-of-flight MRA (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular therapy. MATERIALS AND METHODS: We included 32 patients with a total of 37 coiled aneurysms. MRAs in the early steady-state phase were performed on a 1.5T scanner within 8 days of digital subtraction angiography (DSA). Two radiologists independently analyzed TOF-MRA and BPCE-MRA images. Consensus was reached by review involving a third neuroradiologist. DSA images were interpreted separately by an interventional radiologist. Findings were assigned to 1 of 3 categories: 1) complete occlusion, 2) residual neck, and 3) residual aneurysm. RESULTS: Follow-up DSA demonstrated 13 complete obliterations (class 1), 13 residual necks (class 2), and 11 residual aneurysms (class 3). Weighted kappa statistics showed substantial concordance of TOF-MRA and DSA (0.664) as well as BPCE-MRA and DSA (0.724) ratings. Comparison between TOF-MRA and BPCE-MRA found excellent agreement (0.818) with only 6 (16.2%) discrepancies. For detecting residual flow, the difference in accuracy of both MRA techniques (83.8% versus 91.9%) was not significant (McNemar, P = 1.000). BPCE-MRA showed a tendency towards higher sensitivity and specificity (91.7% and 92.3%, respectively) compared with TOF-MRA (87.5% and 76.9%). CONCLUSIONS: In classifying the completeness of endovascular cerebral aneurysm therapy, we found that BPCE-MRA and 3D TOF-MRA showed very good agreement. The use of Vasovist did not lead to a significantly increased accuracy of MRA follow-up.
Subject(s)
Embolization, Therapeutic/instrumentation , Gadolinium , Image Enhancement/methods , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/surgery , Magnetic Resonance Angiography/methods , Organometallic Compounds , Contrast Media , Device Removal , Female , Follow-Up Studies , Gated Blood-Pool Imaging/methods , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
SUMMARY: We report a case of transtumoral diapedesis of microparticles during preoperative embolization of a large symptomatic temporofrontal meningioma, resulting in severe neurological deficit. In retrospective analysis of angiographic images, the pattern of supply to the tumour was found to be predictive for wide anastomotic channels connecting the dural and pial supply, thereby increasing the risk of the procedure. Recognising this pattern can prevent this rare cause of complication in a still controversial procedure.
ABSTRACT
PURPOSE: To evaluate the value of flat-panel CT (FP-CT) as a new perinterventional imaging modality in aortic stentgraft procedures. MATERIALS AND METHODS: FP-CT was performed in 21 patients (19 males, mean age 77, range 54 to 90) from June 2005 to February 2007 immediately after endovascular treatment of thoracic and abdominal aortic aneurysms on the angiographic table. Nine thoracic aortic aneurysms were treated with Zenith-endoprosthesis. Nine of twelve abdominal aortic aneurysms were treated with Zenith-endoprosthesis and three with an Excluder-endoprosthesis. Images were acquired with a rotating C-arm and the following parameters: during an acquisition time of 20 seconds and at a rotation of 217 degrees, 538 projections were acquired. Contrast agent was administered in 14 patients. Images were displayed in MIP, MPR and VRT mode. RESULTS: In all patients the stentgraft was shown exactly and the alignment of the prosthesis along the landing zones was well displayed. The aneurismal sack was well shown in all patients. 1 x an endoleak II was detected, 1 x an angiographically verified endoleak I was not detected. In one patient distal extension was considered due to suspected short stentgraft at the distal neck. Flat-panel CT showed sufficient neck coverage and no extension was inserted. Due to artifacts of the prosthesis, the platinum markers and the guide wire as well as due to pulsation of the aorta, the resolution of detail decreased and reduced the visualization of the alignment. CONCLUSION: FP-CT is a promising tool and may provide additional information, but further studies are necessary to define the value of flat-panel CT in thoracic and abdominal aortic stentgraft procedures.
Subject(s)
Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/surgery , Coronary Angiography/instrumentation , Radiography, Interventional/instrumentation , Stents , Tomography, X-Ray Computed/instrumentation , X-Ray Intensifying Screens , Aged , Aged, 80 and over , Blood Vessel Prosthesis , Female , Humans , Image Enhancement/instrumentation , Male , Middle Aged , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
SUMMARY: In a child undergoing combined transarterial and direct percutaneous puncture embolization of an extensive and complex facial arteriovenous malformation, severe arterial spasm fixed a flow-directed microcatheter in an ethmoidal branch of the left ophthalmic artery. Multiple traction attempts failed to remove the microcatheter. After catheterization of the distal, post central retinal artery part of the same ophthalmic artery, with a second flow-directed microcatheter and following intraarterial papaverine injection through this second microcatheter, the fixed microcatheter could be removed without complication. This case demonstrates a technique that can be attempted before deciding to leave the microcatheter in the patient or to remove it surgically.
