Nicoletta Anzalone MD, Presenter: Nothing to Disclose

Costantino De Filippis MD, Abstract Co-Author: Nothing to Disclose

Francesco Scomazzoni MD, Abstract Co-Author: Nothing to Disclose

Claudio Righi, Abstract Co-Author: Nothing to Disclose

Franco Simionato, Abstract Co-Author: Nothing to Disclose

Giuseppe Scotti MD, Abstract Co-Author: Nothing to Disclose

Magnetic Resonance Angiography (MRA) allows follow up imaging (FUI) of coils-treated aneurysms (CtA) its accuracy having been well established as compared to digital subtraction angiography (DSA) particularly if contrast enhanced sequences are added to MRA protocol. Due to non invasiveness, MRA is nowadays accepted as a first line technique in CtA FUI, DSA being performed only in cases of MRA disclosed recurrence. We sought to investigate stability of end procedural DSA (EP-DSA) occlusion on long term longitudinal MRA FUI in a single centre CtA population.

From June 2004 to march 2008, 65 over 110 CtA were rated as completely occluded at EP-DSA in our Institution. We focused on 42 cases among these, in which MRA FUI protocol was applied internally. Internal FUI protocol included MRA studies at 6 months and then each year for at least 3 years. In most cases (33/42) imaging was performed on 3Tesla equipment and in most cases (all except 7) imaging included both 3D TOF and 3D GE contrast enhanced techniques. Six months MRA findings were compared with EP-DSA results. Treatment results were rated according to Raymond classification. FUI protocol included DSA only in cases of "residual aneurysms" on MRA.  

The selected population included 34 small, 7 large and 1 giant aneurysms. Six months MRA FUI session confirmed EP-DSA occlusion in 25 over 42 cases and disclosed recurrences in the remaining 17. Six month MRA FUI session occlusion invariably remained stable thereafter. Among the 17 recurrences on 6 months MRA FUI session 12 were rated as “residual neck” (RN), 5 as “residual aneurysm” (RA). On later MRA FUI sessions, 3 over 12 cases of RN enlarged to RA, respectively at 2, 3 and 5 years from treatment. DSA confirmed results in all (8) MRA RA recurrences  

Our data confirm instability of EP-DSA occlusion in CtA and stress the necessity of at least a 6 month FUI session. Moreover , our data confirm previous angiographic data of  stability of occluded aneurysms at  6 month  FUI . On the opposite, 6 month MRA recurrences may show further evolution on later sessions suggesting persisting instability of treatment results.  

The study shows MRA appropriatness in the FUI of CtA and shows the relevance of recurrencies even when complete occlusion was achieved at EP-DSA

Anzalone, N, De Filippis, C, Scomazzoni, F, Righi, C, Simionato, F, Scotti, G, Contrast-enhanced MRA Evaluation of Stability of Coils-occluded Aneurysms at Longitudinal Long-term Follow-up.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034399.html