MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: A meta-analysis

Syed Uzair Ahmed, J. Mocco, Xiangnan Zhang, Michael Kelly, Amish Doshi, Kambiz Nael, Reade De Leacy

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. Methods: Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. Results: The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. Conclusion: MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.

Original languageEnglish (US)
JournalJournal of neurointerventional surgery
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Endovascular Procedures
Digital Subtraction Angiography
Magnetic Resonance Angiography
Intracranial Aneurysm
Meta-Analysis
Aneurysm
Sensitivity and Specificity
Stents
PubMed
Databases

Keywords

  • Aneurysm
  • Angiography
  • Coil
  • Flow Diverter
  • Magnetic Resonance Angiography

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques : A meta-analysis. / Ahmed, Syed Uzair; Mocco, J.; Zhang, Xiangnan; Kelly, Michael; Doshi, Amish; Nael, Kambiz; De Leacy, Reade.

In: Journal of neurointerventional surgery, 01.01.2019.

Research output: Contribution to journalReview article

@article{45fc14fcf6ff4614839685d78fa87d73,
title = "MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: A meta-analysis",
abstract = "Background: Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20{\%} of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. Methods: Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. Results: The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88{\%} and 94{\%}, respectively. For CE-MRA, the sensitivity and specificity were 88{\%} and 96{\%}, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86{\%} and 95{\%}, respectively. CE-MRA had sensitivity and specificity of 90{\%} and 92{\%}. Conclusion: MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.",
keywords = "Aneurysm, Angiography, Coil, Flow Diverter, Magnetic Resonance Angiography",
author = "Ahmed, {Syed Uzair} and J. Mocco and Xiangnan Zhang and Michael Kelly and Amish Doshi and Kambiz Nael and {De Leacy}, Reade",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/neurintsurg-2019-014936",
language = "English (US)",
journal = "Journal of NeuroInterventional Surgery",
issn = "1759-8478",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques

T2 - A meta-analysis

AU - Ahmed, Syed Uzair

AU - Mocco, J.

AU - Zhang, Xiangnan

AU - Kelly, Michael

AU - Doshi, Amish

AU - Nael, Kambiz

AU - De Leacy, Reade

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. Methods: Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. Results: The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. Conclusion: MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.

AB - Background: Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. Methods: Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. Results: The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. Conclusion: MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.

KW - Aneurysm

KW - Angiography

KW - Coil

KW - Flow Diverter

KW - Magnetic Resonance Angiography

UR - http://www.scopus.com/inward/record.url?scp=85065229805&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065229805&partnerID=8YFLogxK

U2 - 10.1136/neurintsurg-2019-014936

DO - 10.1136/neurintsurg-2019-014936

M3 - Review article

AN - SCOPUS:85065229805

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

ER -