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Research ArticleAdult Brain
Open Access

Surveillance of Unruptured Intracranial Saccular Aneurysms Using Noncontrast 3D-Black-Blood MRI: Comparison of 3D-TOF and Contrast-Enhanced MRA with 3D-DSA

C. Zhu, X. Wang, L. Eisenmenger, B. Tian, Q. Liu, A.J. Degnan, C. Hess, D. Saloner and J. Lu
American Journal of Neuroradiology June 2019, 40 (6) 960-966; DOI: https://doi.org/10.3174/ajnr.A6080
C. Zhu
aFrom the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
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  • ORCID record for C. Zhu
X. Wang
bDepartment of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
cDepartment of Radiology (X.W.), General Hospital of Northern Military Command, Liaoning, China
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L. Eisenmenger
aFrom the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
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B. Tian
bDepartment of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
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Q. Liu
bDepartment of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
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A.J. Degnan
dDepartment of Radiology (A.J.D.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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C. Hess
aFrom the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
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D. Saloner
aFrom the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
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J. Lu
bDepartment of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
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    Fig 1.

    A 61-year-old woman with a right posterior communicating artery aneurysm on DSA (A), TOF-MRA (B), CE-MRA (C), and 3D-BB MR imaging (D). Aneurysm height (red line), width (yellow line), and neck (white line) measurements are demonstrated in A.

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    Fig 2.

    Bland-Altman plots of aneurysm measurements of TOF-MRA (A), CE-MRA (B), and 3D-BB MR imaging (C) versus 3DRA as the reference standard. Solid horizontal lines define the reference standard, and upper and lower dashed lines define the LOA.

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    Fig 3.

    A 53-year-old man with multiple basilar artery aneurysms on DSA (A). The aneurysm shows isointensity on TOF-MRA (B) because of the slow flow (arrow). The aneurysm sac and neck were integrally visualized on CE-MRA (C) and 3D-BB MR imaging (D).

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    Fig 4.

    A 63-year-old woman with a right middle cerebral artery aneurysm on DSA (A). 3D-BB SPACE (D) can clearly visualize the sac and intraluminal thrombus of the aneurysm, which is superior to DSA (A), TOF-MRA (B), and CE-MRA (C).

Tables

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    Table 1:

    Comparison of aneurysm height, width, and neck measurements among MR and DSA imaging modalitiesa

    TOF-MRACE-MRA3D-BB MRI3DRAP Value
    Height (mm)7.7 (5.5–11.1)8.0 (6.0–12.8)7.8 (5.4–12.6)7.7 (5.5–12.6).918
    Width (mm)7.5 (5.8–11.5)8.4 (5.8–14.0)7.8 (5.5–13.9)8.1 (5.9–13.3).957
    Neck (mm)6.8 (5.3–10.4)6.7 (5.2–10.6)7.0 (4.8–10.2)6.9 (4.6–9.8).774
    • ↵a Data are median (interquartile range).

    • View popup
    Table 2:

    Comparison of MRI techniques with DSA for aneurysm measurements

    Mean (mm)SDCV (100%)BiasLOAICC
    Height
        TOF-MRA9.211.5015.43−0.55(−3.49–2.39)0.96 (0.93–0.98)
        CE-MRA9.900.626.320.14(−1.08–1.36)0.98 (0.97–0.99)
        3D-BB MRI9.730.596.04−0.03(−1.19–1.13)0.99 (0.99–0.99)
    Width
        TOF-MRA9.531.5615.78−0.33(−2.73–3.39)0.96 (0.94–0.97)
        CE-MRA10.120.616.180.26(−0.94–1.46)0.99 (0.98–0.99)
        3D-BB MRI9.960.585.870.10(−1.04–1.24)0.99 (0.99–0.99)
    Neck
        TOF-MRA8.000.9812.730.31(−1.61–2.23)0.96 (0.93–0.98)
        CE-MRA8.080.688.810.39(−0.94–1.72)0.97 (0.95–0.99)
        3D-BB MRI7.710.547.040.02(−1.04–1.08)0.98 (0.98–0.99)
    Overall
        TOF-MRA8.911.4115.54−0.19(−2.95–2.57)0.96 (0.95–0.97)
        CE-MRA9.370.647.030.26(−0.99–1.51)0.98 (0.98–0.99)
        3D-BB MRI9.140.576.260.03(−1.08–1.15)0.99 (0.99–0.99)
    • View popup
    Table 3:

    Sample size calculation using different MRI sequences to detect aneurysm growth

    Aneurysm GrowthTOF-MRA (CV = 15.54%)CE-MRA (CV = 7.03%)SPACE (CV = 6.26%)
    5%4068466
    10%1022117
    20%2665
    • View popup
    Table 4:

    Intra- and interreader agreement for aneurysm measurements

    CV (100%)BiasLOAICC
    Intrareader agreement
        Height
            TOF-MRA7.020.19(−0.87–1.25)0.99 (0.98–0.99)
            CE-MRA6.710.14(−1.09–1.37)0.99 (0.98–0.99)
            3D-BB MRI6.37−0.08(−1.18–1.02)0.99 (0.98–0.99)
            3DRA6.870.14(−1.04–1.32)0.99 (0.98–0.99)
        Width
            TOF-MRA6.940.06(−0.99–1.12)0.99 (0.98–0.99)
            CE-MRA6.450.10(−1.13–1.33)0.99 (0.98–0.99)
            3D-BB MRI6.310.18(−0.92–1.28)0.99 (0.98–0.99)
            3DRA6.250.11(−1.00–1.23)0.99 (0.98–0.99)
        Neck
            TOF-MRA7.290.18(−1.04–1.39)0.98 (0.98–0.99)
            CE-MRA7.050.13(−0.93–1.19)0.99 (0.98–0.99)
            3D-BB MRI6.720.14(−0.90–1.18)0.99 (0.98–0.99)
            3DRA6.98−0.08(−1.17–1.02)0.99 (0.98–0.99)
        Overall
            TOF-MRA7.080.14(−0.78–1.06)0.99 (0.98–0.99)
            CE-MRA6.780.12(−1.06–1.30)0.99 (0.98–0.99)
            3D-BB MRI6.510.08(−0.96–1.12)0.99 (0.98–0.99)
            3DRA6.750.06(−1.04–1.16)0.99 (0.98–0.99)
    Interreader agreement
        Height
            TOF-MRA8.120.02(−1.45–1.49)0.98 (0.98–0.99)
            CE-MRA8.190.23(−1.33–1.80)0.98 (0.98–0.99)
            3D-BB MRI8.030.03(−1.50–1.56)0.98 (0.98–0.99)
            3DRA7.87−0.07(−1.58–1.44)0.98 (0.98–0.99)
        Width
            TOF-MRA8.03−0.03(−1.50–1.44)0.98 (0.98–0.99)
            CE-MRA7.550.17(−1.30–1.64)0.99 (0.98–0.99)
            3D-BB MRI8.370.03(−1.61–1.67)0.98 (0.98–0.99)
            3DRA7.15−0.13(−1.54–1.28)0.99 (0.98–0.99)
        Neck
            TOF-MRA8.960.18(−0.74–1.10)0.97 (0.95–0.98)
            CE-MRA8.810.07−0.81–1.07)0.98 (0.97–0.99)
            3D-BB MRI8.950.14(−0.72–1.00)0.98 (0.97–0.99)
            3DRA8.820.10(−0.82–0.98)0.98 (0.97–0.99)
        Overall
            TOF-MRA8.440.06(−0.78–1.06)0.98 (0.98–0.99)
            CE-MRA8.160.16(−0.74–0.98)0.98 (0.98–0.99)
            3D-BB MRI8.430.07(−0.63–0.93)0.98 (0.98–0.99)
            3DRA8.15−0.03(−0.72–1.00)0.98 (0.98–0.99)
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C. Zhu, X. Wang, L. Eisenmenger, B. Tian, Q. Liu, A.J. Degnan, C. Hess, D. Saloner, J. Lu
Surveillance of Unruptured Intracranial Saccular Aneurysms Using Noncontrast 3D-Black-Blood MRI: Comparison of 3D-TOF and Contrast-Enhanced MRA with 3D-DSA
American Journal of Neuroradiology Jun 2019, 40 (6) 960-966; DOI: 10.3174/ajnr.A6080

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Surveillance of Unruptured Intracranial Saccular Aneurysms Using Noncontrast 3D-Black-Blood MRI: Comparison of 3D-TOF and Contrast-Enhanced MRA with 3D-DSA
C. Zhu, X. Wang, L. Eisenmenger, B. Tian, Q. Liu, A.J. Degnan, C. Hess, D. Saloner, J. Lu
American Journal of Neuroradiology Jun 2019, 40 (6) 960-966; DOI: 10.3174/ajnr.A6080
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