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Purpose <p>Magnetic resonance imaging follow-up of cerebral aneurysms treated with flow diverters (FD) has a crucial role in assessing changes of the aneurysm size, intra-aneurysmal thrombosis and of the peri-aneurysmal environment. The value of Time-of-Flight (TOF) Magnetic Resonance Angiography (MRA) and TOF-Contrast-Enhanced (TOF-CE) MRA in assessing residual aneurysms and in-stent stenosis remains debated. This study evaluates the diagnostic performance of these modalities compared with Digital Subtraction Angiography (DSA).</p> Methods <p>A retrospective analysis of 73 patients treated with FD between 2018 and 2022 was conducted. Patients underwent TOF MRA, TOF-CE MRA and DSA imaging post-treatment and at one-year follow-up. Diagnostic accuracy, sensitivity and specificity of the two MRA modalities were calculated relative to DSA.</p> Results <p>Compared to DSA, TOF MRA demonstrated an accuracy of 90% in detecting residual aneurysm filling, with a sensitivity of 96% and specificity of 66%, while TOF-CE MRA showed an accuracy of 88% in detecting residual aneurysms, with a sensitivity of 91% and specificity of 73%. Misclassification rates increased for larger aneurysms. Both modalities were limited in detecting in-stentstenosis and aneurysm occlusion.</p> Conclusions <p>TOF MRA and TOF-CE MRA showed high sensitivity and moderate specificity in detecting residual aneurysm filling, but contrast material provided no significant added benefit. MRI cannot fully replace DSA for evaluating residual aneurysms and in-stent stenosis. The combination of DSA and MRA remains the most effective follow-up strategy at 12 months, with further MR-only follow-up feasible in most patients.</p>

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The value of non-contrast and contrast-enhanced time-of-flight magnetic resonance angiography in the follow-up assessment of cerebral aneurysms treated with flow diverter stents

  • 期刊论文

  • 发表日期：

    2026年4月14日

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  • Amir Reza Rezaeiserej,
  • Patrick Thurner,
  • Gergely Bertalan,
  • Maté Czencz,
  • Miklós Krepuska,
  • Anna A. Kyselyova,
  • Ramona Alexandra Todea,
  • Jawid Madjidyar,
  • Tilman Schubert,
  • Nicolin Hainc,
  • Zsolt Kulcsar

摘要

Purpose

Magnetic resonance imaging follow-up of cerebral aneurysms treated with flow diverters (FD) has a crucial role in assessing changes of the aneurysm size, intra-aneurysmal thrombosis and of the peri-aneurysmal environment. The value of Time-of-Flight (TOF) Magnetic Resonance Angiography (MRA) and TOF-Contrast-Enhanced (TOF-CE) MRA in assessing residual aneurysms and in-stent stenosis remains debated. This study evaluates the diagnostic performance of these modalities compared with Digital Subtraction Angiography (DSA).

Methods

A retrospective analysis of 73 patients treated with FD between 2018 and 2022 was conducted. Patients underwent TOF MRA, TOF-CE MRA and DSA imaging post-treatment and at one-year follow-up. Diagnostic accuracy, sensitivity and specificity of the two MRA modalities were calculated relative to DSA.

Results

Compared to DSA, TOF MRA demonstrated an accuracy of 90% in detecting residual aneurysm filling, with a sensitivity of 96% and specificity of 66%, while TOF-CE MRA showed an accuracy of 88% in detecting residual aneurysms, with a sensitivity of 91% and specificity of 73%. Misclassification rates increased for larger aneurysms. Both modalities were limited in detecting in-stentstenosis and aneurysm occlusion.

Conclusions

TOF MRA and TOF-CE MRA showed high sensitivity and moderate specificity in detecting residual aneurysm filling, but contrast material provided no significant added benefit. MRI cannot fully replace DSA for evaluating residual aneurysms and in-stent stenosis. The combination of DSA and MRA remains the most effective follow-up strategy at 12 months, with further MR-only follow-up feasible in most patients.