Surveillance of Unruptured Intracranial Saccular Aneurysms Using Noncontrast 3D-Black-Blood MRI: Comparison of 3D-TOF and Contrast-Enhanced MRA with 3D-DSA

C. Zhu; X. Wang; L. Eisenmenger; B. Tian; Q. Liu; A.J. Degnan; C. Hess; D. Saloner; J. Lu

doi:10.3174/ajnr.A6080

Abstract

BACKGROUND AND PURPOSE: Patients with unruptured intracranial aneurysms routinely undergo surveillance imaging to monitor growth. Angiography is the criterion standard for aneurysm diagnosis, but it is invasive. This study aimed to evaluate the accuracy and reproducibility of a 3D noncontrast black-blood MR imaging technique for unruptured intracranial aneurysm measurement in comparison with 3D-TOF and contrast-enhanced MRA, using 3D rotational angiography as a reference standard.

MATERIALS AND METHODS: Sixty-four patients (57.3 ± 10.9 years of age, 41 women) with 68 saccular unruptured intracranial aneurysms were recruited. Patients underwent 3T MR imaging with 3D-TOF-MRA, 3D black-blood MR imaging, and contrast-enhanced MRA, and they underwent 3D rotational angiography within 2 weeks. The neck, width, and height of the unruptured intracranial aneurysms were measured by 2 radiologists independently on 3D rotational angiography and 3 MR imaging sequences. The accuracy and reproducibility were evaluated by Bland-Altman plots, the coefficient of variance, and the intraclass correlation coefficient.

RESULTS: 3D black-blood MR imaging demonstrates the best agreement with DSA, with the smallest limits of agreement and measurement error (coefficients of variance range, 5.87%–7.04%). 3D-TOF-MRA had the largest limits of agreement and measurement error (coefficients of variance range, 12.73%–15.78%). The average coefficient of variance was 6.26% for 3D black-blood MR imaging, 7.03% for contrast-enhanced MRA, and 15.54% for TOF-MRA. No bias was found among 3 MR imaging sequences compared with 3D rotational angiography. All 3 MR imaging sequences had excellent interreader agreement (intraclass correlation coefficient, >0.95). 3D black-blood MR imaging performed the best for patients with intraluminal thrombus (n = 10).

CONCLUSIONS: 3D black-blood MR imaging achieves better accuracy for aneurysm size measurements compared with 3D-TOF, using 3D rotational angiography as a criterion standard. This noncontrast technique is promising for surveillance of unruptured intracranial aneurysms.

ABBREVIATIONS:

BB: black-blood
CE: contrast-enhanced
CV: coefficient of variance
3DRA: 3D rotational angiography
IA: intracranial aneurysm
ICC: intraclass correlation coefficient
LOA: limit of agreement
SPACE: spatial and chemical-shift encoded excitation
UIA: unruptured intracranial aneurysm

Footnotes

Chengcheng Zhu and Xinrui Wang contributed equally to this work.
Disclosures: Christopher Hess—UNRELATED: Expert Testimony: various medicolegal firms; Grants/Grants Pending: National Institutes of Health*; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Korean Society of Radiology, MRI Garmisch Symposium, Comments: Korean Society of Radiology; travel costs to lecture and participate in Korean Congress of Radiology 2018 and 18th MRI International MRI Symposium Garmisch-Partenkirchen. *Money paid to individual.
This work was supported by the National Natural Science Foundation of China (No. 81670396, No. 31470910), and the National Institutes of Health, grant K99HL136883.
The sponsoring organizations had no involvement in the study design, data collection, data analysis, data interpretation, writing of the article, or the decision to submit for publication.

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