Follow-up imaging of clipped intracranial aneurysms with 3-T MRI: comparison between 3D time-of-flight MR angiography and pointwise encoding time reduction with radial acquisition subtraction-based MR angiography

Abstract

Objective: Metallic susceptibility artifact due to implanted clips is a major limitation of using 3D time-of-flight magnetic resonance angiography (TOF-MRA) for follow-up imaging of clipped aneurysms (CAs). The purpose of this study was to compare pointwise encoding time reduction with radial acquisition (PETRA) subtraction-based MRA with TOF-MRA in terms of imaging quality and visibility of clip-adjacent arteries for use in follow-up imaging of CAs.

Methods: Sixty-two patients with 73 CAs were included retrospectively in this comparative study. All patients underwent PETRA-MRA after TOF-MRA performed simultaneously with 3-T MRI between September 2019 and March 2020. Two neuroradiologists independently compared images obtained with both MRA modalities to evaluate overall image quality using a 4-point scale and visibility of the parent artery and branching vessels near the clips using a 3-point scale. Subgroup analysis was performed according to the number of clips (less-clipped [1-2 clips] vs more-clipped [≥ 3 clips] aneurysms). The ability to detect aneurysm recurrence was also assessed.

Results: Compared with TOF-MRA, PETRA-MRA showed acceptable image quality (score of 3.97 ± 0.18 for TOF-MRA vs 3.73 ± 0.53 for PETRA-MRA) and had greater visibility of the adjacent vessels near the CAs (score of 1.25 ± 0.59 for TOF-MRA vs 2.27 ± 0.75 for PETRA-MRA, p < 0.0001). PETRA-MRA had greater visibility of vessels adjacent to less-clipped aneurysms (score of 2.39 ± 0.75 for less-clipped aneurysms vs 2.09 ± 0.72 for more-clipped aneurysms, p = 0.014). Of 73 CAs, aneurysm recurrence in 4 cases was detected using PETRA-MRA.

Conclusions: This study demonstrated that PETRA-MRA is superior to TOF-MRA for visualizing adjacent vessels near clips and can be an advantageous alternative to TOF-MRA for follow-up imaging of CAs.