Murat DÖKDÖK, Kutlay KARAMAN, Selcuk GOCMEN

İntrakraniyal anevrizmaların tedavisi için uygulanan endovasküler koil embolizasyonunun manyetik rezonans anjiyografi ile takibi

Amaç: Manyetik rezonans anjiyografinin (MRA) endovasküler koil ile tedavi edilen intrakraniyal anevrizmaların takiplerinde kullanışlılığını ve tekrarlanabilirliğini değerlendirmek.Gereç ve Yöntem: Platin koil ile tedavi edilen 51 hasta (18 erkek, 33 kadın; yaş 21-86 yıl, ort. yaş 50.2 yıl) bu çalışmaya alındı. Hastalara, endovasküler tedaviden 3-6 ay sonra takip MRA planlandı. İki girişimsel nöroradyolog, TOF-MRA görüntülerini körleme değerlendirdi. Bu amaçla, maksimum yoğunluk projeksiyonu (MIP) ve multiplanar reformasyon (MPR) gibi 3D TOF görüntülerinin kaynak MR görüntüleri ve hacimsel işleme teknikleri kullanılmıştır. Altı ay ile birinci yılda hastanın özelliklerine bağlı olarak biplanar anjiografi ünitesinde bir referans testi olarak takip dijital subtraksiyon anjiyografi (DSA) yapılmıştır. Bulgular: Tedavi edilen 54 serebral anevrizmalı hastadan, 5’inde rezidü veya rekürren anevrizma olduğu DSA ile doğrulandı; ikisi baziler tepe , biri sol MCA bifurkasyosu, biri anterior komünikan arter ve biri sağ supraklinoid internal karotid arterdi. Daha sonra DSA, MRA verileriyle karşılaştırıldı. MRA için toplam uzlaşma 0,94 idi. MRA için, okuyucuların iyi uyumunu göstermek için Kappa katsayısı 0.74 idi (%95 CI 0.44 ile 1.04 idi). Sonuç: MRA, endovasküler koil embolizasyonundan sonra anevrizmaların takibi için tekrarlanabilir bir tekniktir. Altın standart bir test olarak konvansiyonel kateter anjiyografi şüpheli olguları göstermek için kullanılabilir.

Anahtar Kelimeler:

Serebral anevrizma, Endovasküler tedavi, Koil embolizasyon, manyetik rezonans anjiyografi, Dijital subtraksiyon anjiyografi, rezonans anjiyografi

Follow-Up of endovascular coil embolization applied for the treatment of intracranial aneurysms by magnetic resonance angiography

Purpose: To assess the usefulness and reproducibility of magnetic resonance angiography (MRA) for the evaluation of intracranial aneurysms treated by endovascular coiling. Materials and Methods: 51 patients (18 men, 33 women; 21-86 year-old, mean age 50.2) with 54 aneurysms treated by detachable platinum coils were included in this study. The patients were scheduled for follow-up MRA imaging at three to six months after endovascular treatment. Two interventional neuroradiologists, evaluated the TOF-MRA images blindly. Source MR images and volume rendering techniques of 3D TOF images such as maximum intensity projection (MIP) and multiplanar reformation (MPR) were utilized for this purpose. Follow-up digital subtraction angiography (DSA) was performed as a reference test on a biplane angiographic unit on the sixth month and the first year depending on the patient's characteristics. Results: DSA confirmed residual or recurrent aneurysmal flow in 5 patients out of 54 treated cerebral aneurysms; two with tip of basilary artery, one with left MCA bifurcation, one with anterior communicating artery and one with right supraclinoid internal carotid artery. Then the DSA images were compared with the MRA data. Total agreement was 0.94 for MRA. Kappa coefficient was 0.74 for indicating good concordance of the readers for MRA (95 % CI was 0.44 to 1.04). Conclusion: MRA is a reproducible technique for the follow-up of aneurysms after endovascular coil embolization. Conventional catheter angiography as a gold standard test could be used to solve uncertain cases.

Keywords:

Cerebral aneurysm, endovascular treatment, coil embolization, magnetic resonance angiography, digital subtraction angiography,

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