Details

Autor(en) / Beteiligte

• Suh, Pae Sun
• Jung, Seung Chai
• Moon, Hye Hyeon
• Roh, Yun Hwa
• Song, Yunsun
• Kim, Minjae
• Lee, Jungbok
• Choi, Keum Mi

Titel

Diagnosis of Unruptured Intracranial Aneurysms Using Proton-Density Magnetic Resonance Angiography: A Comparison With High-Resolution Time-of-Flight Magnetic Resonance Angiography

Ist Teil von

• Korean Journal of Radiology, 2024, 25(6), , pp.575-588

Ort / Verlag

Korea (South): 대한영상의학회

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• Differentiating intracranial aneurysms from normal variants using CT angiography (CTA) or MR angiography (MRA) poses significant challenges. This study aimed to evaluate the efficacy of proton-density MRA (PD-MRA) compared to high-resolution time-of-flight MRA (HR-MRA) in diagnosing aneurysms among patients with indeterminate findings on conventional CTA or MRA. In this retrospective analysis, we included patients who underwent both PD-MRA and HR-MRA from August 2020 to July 2022 to assess lesions deemed indeterminate on prior conventional CTA or MRA examinations. Three experienced neuroradiologists independently reviewed the lesions using HR-MRA and PD-MRA with reconstructed voxel sizes of 0.25 mm or 0.2 mm , respectively. A neurointerventionist established the gold standard with digital subtraction angiography. We compared the performance of HR-MRA, PD-MRA (0.25 -mm voxel), and PD-MRA (0.2 -mm voxel) in diagnosing aneurysms, both per lesion and per patient. The Fleiss kappa statistic was used to calculate inter-reader agreement. The study involved 109 patients (average age 57.4 ± 11.0 years; male:female ratio, 11:98) with 141 indeterminate lesions. Of these, 78 lesions (55.3%) in 69 patients were confirmed as aneurysms by the reference standard. PD-MRA (0.25 -mm voxel) exhibited significantly higher per-lesion diagnostic performance compared to HR-MRA across all three readers: sensitivity ranged from 87.2%-91.0% versus 66.7%-70.5%; specificity from 93.7%-96.8% versus 58.7%-68.3%; and accuracy from 90.8%-92.9% versus 63.8%-69.5% ( ≤ 0.003). Furthermore, PD-MRA (0.25 -mm voxel) demonstrated significantly superior per-patient specificity and accuracy compared to HR-MRA across all evaluators ( ≤ 0.013). The diagnostic accuracy of PD-MRA (0.2 -mm voxel) surpassed that of HR-MRA and was comparable to PD-MRA (0.25 -mm voxel). The kappa values for inter-reader agreements were significantly higher in PD-MRA (0.820-0.938) than in HR-MRA (0.447-0.510). PD-MRA outperformed HR-MRA in diagnostic accuracy and demonstrated almost perfect inter-reader consistency in identifying intracranial aneurysms among patients with lesions initially indeterminate on CTA or MRA.