Dataset Information

Features of "false positive" unruptured intracranial aneurysms on screening magnetic resonance angiography.

ABSTRACT: BACKGROUND:Physicians can find it challenging to decide whether confirmative digital subtraction angiography (DSA) should be performed in patients who present with "suspicious small aneurysm-like structures" on magnetic resonance angiography (MRA). Factors associated with "false positive aneurysms on MRA" (FPAMs)," which are finally confirmed as negative on DSA, have rarely been reported. This study aimed to identify the clinical or radiologic clues indicative of FPAM on DSA. METHODS:Patients who had undergone DSA between 2016 and 2019 for suspicious aneurysm-like structures < 5 mm in size on MRA were enrolled. Patient demographics and the details regarding the geometry of the structures were retrospectively reviewed. Univariate and multivariate logistic regression analyses were conducted to identify the associated factors. Receiver operating characteristic curve analysis was performed to assess the clinical implications. RESULTS:Of the 107 suspicious structures, 46 were indicated as being false positive on DSA (42.96%). Location (positive on C7 and negative on C5-6 ICA) and lower dome to neck ratio were found to be significant parameters in the multivariate analysis. The dome to neck ratio threshold value was 0.99. CONCLUSION:Suspicious aneurysm-like structures located not on C5-6 but on C7 ICA and having wide neck morphologies (dome to neck ratio < 0.99) are highly likely to be negative on DSA.

SUBMITTER: Jang M

PROVIDER: S-EPMC7470380 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Features of "false positive" unruptured intracranial aneurysms on screening magnetic resonance angiography.

Jang Minsu M Kim Jang Hun JH Park Jin Woo JW Roh Haewon H Lee Han-Joo HJ Seo Junghan J Hwang Sung Hwan SH Yoon Joon Ho JH Yoon Sang Hoon SH Cho Byung-Kyu BK

PloS one 20200903 9

<h4>Background</h4>Physicians can find it challenging to decide whether confirmative digital subtraction angiography (DSA) should be performed in patients who present with "suspicious small aneurysm-like structures" on magnetic resonance angiography (MRA). Factors associated with "false positive aneurysms on MRA" (FPAMs)," which are finally confirmed as negative on DSA, have rarely been reported. This study aimed to identify the clinical or radiologic clues indicative of FPAM on DSA.<h4>Methods< ...[more]

PMID: 32881975

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Project description:BackgroundAdvanced imaging methods can enhance the identification of aneurysms of the infundibula, which can reduce unnecessary follow-ups or further work-up, fear, and anxiety in patients.PurposeThis study aimed to evaluate the added diagnostic value of three-dimensional proton density-weighted vessel wall magnetic resonance imaging (3D-PD MRI) in identifying aneurysms from index lesions refer to vascular bulging lesions without vessels arising from the apex, observed using volume-rendered TOF-MRA in the circle-of-Willis compared with time-of-flight magnetic resonance angiography (TOF-MRA).Study typeRetrospective.PopulationA total of 299 patients who underwent 3D-PD MRI, digital subtraction angiography (DSA), and TOF-MRA between January 2012 and December 2016 were retrospectively enrolled in this study.Field strength/sequence3 Tesla, 3D-PD MRI.AssessmentThree neuroradiologists independently evaluated TOF-MRA and 3D-PD MRI combined with TOF-MRA for the determination of intracranial aneurysms in patients with index lesions within the circle of Willis. Final diagnoses were made by another neuroradiologist and neurointerventionist in consensus using DSA as the reference standard. The diagnostic performance and proportions of undetermined lesions on TOF-MRA and 3D-PD MRI with TOF-MRA were assessed based on the final diagnoses.Statistical testsThe sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of unruptured intracranial aneurysms were calculated for each imaging modality.ResultsOf 452 lesions identified on volume-rendered TOF-MRA images, 173 (38%) aneurysms and 276 (61%) infundibula were finally diagnosed on DSA. 3D-PD MRI with TOF-MRA showed superior diagnostic performance (p = .001; accuracy, 85.5% versus 95.4%), superior area under the receiver operating characteristic curve over TOF-MRA (p = .001; 0.837 versus 0.947), and a lower proportion of undetermined lesions than TOF-MRA (p = .001; 25.1% versus 2.3%).Data conclusionFor unruptured intracranial aneurysms in the circle of Willis, 3D-PD MRI can complement TOF-MRA to improve diagnostic performance and lower the proportion of undetermined lesions.

Project description:Background and purposeAneurysmal wall enhancement (AWE) on vessel wall magnetic resonance imaging (VW-MRI) has been described as a new imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). Previous studies of symptomatic UIAs are limited due to small sample sizes and lack of AWE quantification. Our study aims to investigate whether qualitative and quantitative assessment of AWE can differentiate symptomatic and asymptomatic UIAs.MethodsConsecutive patients with UIAs were prospectively recruited for vessel wall magnetic resonance imaging at 3T from October 2014 to October 2019. UIAs were categorized as symptomatic if presenting with sentinel headache or oculomotor nerve palsy directly related to the aneurysm. Evaluation of wall enhancement included enhancement pattern (0=none, 1=focal, and 2=circumferential) and quantitative wall enhancement index (WEI). Univariate and multivariate analyses were used to identify the parameters associated with symptoms.ResultsTwo hundred sixty-seven patients with 341 UIAs (93 symptomatic and 248 asymptomatic) were included in this study. Symptomatic UIAs more frequently showed circumferential AWE than asymptomatic UIAs (66.7% versus 17.3%, P<0.001), as well as higher WEI (median [interquartile range], 1.3 [1.0-1.9] versus 0.3 [0.1-0.9], P<0.001). In multivariate analysis, both AWE pattern and WEI were independent factors associated with symptoms (odds ratio=2.03 across AWE patterns [95% CI, 1.21-3.39], P=0.01; odds ratio=3.32 for WEI [95% CI, 1.51-7.26], P=0.003). The combination of AWE pattern and WEI had an area under the curve of 0.91 to identify symptomatic UIAs, with a sensitivity of 95.7% and a specificity of 73.4%.ConclusionsIn a large cohort of UIAs with vessel wall magnetic resonance imaging, both AWE pattern and WEI were independently associated with aneurysm-related symptoms. The qualitative and quantitative features of AWE can potentially be used to identify unstable intracranial aneurysms.

Project description:BackgroundThis study was to prospectively investigate the feasibility of four-dimensional computed tomography angiography (4D-CTA) with electrocardiogram-gated (ECG) reconstruction for preoperative evaluation of morphological parameters, and compared with digital subtraction angiography (DSA). We also aimed to detect pulsation in unruptured intracranial aneurysms (UIAs) by using 4D-CTA, as a potential predicting factor of growth or rupture.Materials64 patients with 64 UIAs underwent ECG-gated dynamic 4D-CTA imaging before treatment, of which 46 patients additionally underwent DSA. Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5%-time intervals. The extent of agreement on UIAs morphological features assessed with 4D-CTA and DSA was estimated using the k coefficient of the Kappa test. The radiation doses were also calculated and compared between 4D-CTA and DSA. In the aneurysmal surgically treated in our institution, we were able to compare the surgical findings of the aneurysm wall with 4D-CTA images. We performed long-term follow-up on untreated patients.ResultsThe morphological characteristics detected by 4D-CTA and DSA were consistent in aneurysm location (k = 1.0), shape (k = 0.76), maximum diameter (k = 0.94), aneurysm neck (k = 0.79) and proximity to parent and branch vessels (k = 0.85). 4D-CTA required lower radiation doses (0.32 ± 0.11 mSv) than DSA (0.84 ± 0.37 mSv, P < 0.001). Pulsation was detected in 26 of the 64 unruptured aneurysms, and all underwent neurosurgical clipping or interventional embolization. In aneurysms surgically treated in our hospital, we observed a significant correlation between 4D-CTA findings and surgical evaluation of the aneurysmal wall, in particular the irregular pulsations detected on 4D-CTA have demonstrated to correspond to dark-reddish thinner wall at surgery.ConclusionsIn this proof-of-concept study, 4D-CTA provided real-time, non-invasive preoperative assessments of UIAs comparable to DSA. Moreover, optimal correlation between the irregular pulsation detected by 4D-CTA and the surgical findings support a possible role of this technique to identify aneurysms with a higher risk of rupture.

Project description:BackgroundDespite a high prevalence of intracranial aneurysm (ICA) in autosomal dominant polycystic kidney disease (ADPKD), rupture events are rare. The current recommendations for ICA screening are based on expert opinions and studies with low levels of evidence.ObjectivesThe aim of our study was to describe the attitudes of practicing nephrologists in Europe towards screening for ICA using magnetic resonance angiography (MRA).MethodsWe conducted a web-based survey among 1315 European French-speaking nephrologists and nephrology residents. An anonymous, electronic questionnaire including 24 independent questions related to ICA screening modalities, indications and participant profiles was sent by email between September and December 2014. Four hundred and twenty nephrologists (mostly from France) participated, including 31 nephrology residents; the response rate was 32%.ResultsSystematic screening for ICA was advocated by 28% of the nephrologists. A family history of ICA rupture, sudden death, stroke and migraine were consensual indications for screening (> 90% of the panel). In other clinical situations largely not covered by the recommendations (pregnancy, nephrectomy, kidney transplantation, cardiac or hepatic surgery, uncontrolled hypertension, lack of familial ADPKD history, at-risk activity, tobacco use), the attitudes towards screening were highly divergent. ICA screening was influenced by nephrologists experience with ADPKD and by their practice setting. The majority of participants (57%) would not repeat a normal ICA screening. Only a few participants (22%) knew that non-contrast MRA was the reference diagnostic tool for ICA screening, whereas most participants thought that contrast enhancement was necessary to screen for ICA. The results from the nephrology residents were analyzed separately and yielded similar results.ConclusionThis practice survey revealed that most nephrologists follow the current recommendations for the initial screening of ICAs. However, more than a quarter of the panel was in favor of systematic ICA screening, most nephrologists did not know that contrast medium was not necessary to screen for ICA using MRA, and many areas of uncertainty remain.

Dataset Information

Features of "false positive" unruptured intracranial aneurysms on screening magnetic resonance angiography.

Publications

Features of "false positive" unruptured intracranial aneurysms on screening magnetic resonance angiography.

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