Follow-up after embolization of ruptured intracranial aneurysms: a prospective comparison of two-dimensional digital subtraction angiography, three-dimensional digital subtraction angiography, and time-of-flight magnetic resonance angiography

Neuroradiology. 2012 Nov;54(11):1253-60. doi: 10.1007/s00234-012-1030-z. Epub 2012 Apr 10.


Introduction: To prospectively compare of the diagnostic value of digital subtraction angiography (DSA) and time-of-flight magnetic resonance angiography (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular treatment.

Methods: Seventy-two consecutive patients were examined 3 months after the embolization. The index tests included: two-dimensional DSA (2D-DSA), three-dimensional DSA (3D-DSA), and TOF-MRA. The reference test was a retrospective consensus between 2D-DSA images, 3D-DSA images, and source rotational DSA images. The evaluation included: detection of the residual flow, quantification of the flow, and validity of the decision regarding retreatment. Intraobserver agreement and interobserver agreement were determined.

Results: The sensitivity and specificity of residual flow detection ranged from 84.6 % (2D-DSA and TOF-MRA) to 92.3 % (3D-DSA) and from 91.3 % (TOF-MRA) to 97.8 % (3D-DSA), respectively. The accuracy of occlusion degree evaluation ranged from 0.78 (2D-DSA) to 0.92 (3D-DSA, Cohen's kappa). The 2D-DSA method presented lower performance in the decision on retreatment than 3D-DSA (P < 0.05, ROC analysis). The intraobserver agreement was very good for all techniques (κ = 0.80-0.97). The interobserver agreement was moderate for TOF-MRA and very good for 2D-DSA and 3D-DSA (κ = 0.72-0.94).

Conclusion: Considering the invasiveness of DSA and the minor difference in the diagnostic performance between 3D-DSA and TOF-MRA, the latter method should be the first-line modality for follow-up after aneurysm embolization.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / therapy*
  • Angiography, Digital Subtraction / methods*
  • Embolization, Therapeutic*
  • Female
  • Follow-Up Studies
  • Humans
  • Imaging, Three-Dimensional*
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / therapy*
  • Magnetic Resonance Angiography / methods*
  • Male
  • Middle Aged
  • Prospective Studies