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Follow-up of Intracranial Aneurysms Treated with Detachable Coils: Comparison of Gadolinium-enhanced 3D Time-of-Flight MR Angiography and Digital Subtraction Angiography¹

¹ From the Department of Diagnostic and Therapeutic Neuroradiology, Foch Hospital, 40 rue Worth, BP 36, 92151 Suresnes, France. Received March 17, 2000; revision requested April 26; revision received June 29; accepted August 29. Address correspondence to L.P. (e-mail: l.pierot@hopital-foch.org).

View larger version (157K): [in a new window]   Figure 1a. Ruptured 8-mm anterior communicating artery aneurysm in a 43-year-old woman treated with GDC placement. The initial anatomic result was total occlusion, and 3 months after treatment, DSA was normal. One year later, MR angiography and DSA were performed. (a) Maximum intensity projection (MIP) reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4 msec) shows at the right A1 segment to A2 segment junction a vascular abnormality (arrow), which was interpreted as an arterial loop, but (b) frontal and (c) oblique DSA views of the right internal carotid artery show the corresponding region to be an aneurysm remnant (arrow).

View larger version (155K): [in a new window]   Figure 1b. Ruptured 8-mm anterior communicating artery aneurysm in a 43-year-old woman treated with GDC placement. The initial anatomic result was total occlusion, and 3 months after treatment, DSA was normal. One year later, MR angiography and DSA were performed. (a) Maximum intensity projection (MIP) reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4 msec) shows at the right A1 segment to A2 segment junction a vascular abnormality (arrow), which was interpreted as an arterial loop, but (b) frontal and (c) oblique DSA views of the right internal carotid artery show the corresponding region to be an aneurysm remnant (arrow).

View larger version (177K): [in a new window]   Figure 1c. Ruptured 8-mm anterior communicating artery aneurysm in a 43-year-old woman treated with GDC placement. The initial anatomic result was total occlusion, and 3 months after treatment, DSA was normal. One year later, MR angiography and DSA were performed. (a) Maximum intensity projection (MIP) reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4 msec) shows at the right A1 segment to A2 segment junction a vascular abnormality (arrow), which was interpreted as an arterial loop, but (b) frontal and (c) oblique DSA views of the right internal carotid artery show the corresponding region to be an aneurysm remnant (arrow).

View larger version (176K): [in a new window]   Figure 2a. Ruptured 4-mm anterior communicating aneurysm in a 64-year-old woman treated with endovascular GDC placement. Initially, this patient had total occlusion, but 3 months later, DSA depicted a small remnant in the aneurysmal neck. (a) Transverse source MR image and (b) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 15 months after treatment show no remnant. (c) Lateral DSA view of the left internal carotid artery obtained 15 months after treatment shows a small remnant (arrow) at the base of the aneurysm.

View larger version (145K): [in a new window]   Figure 2b. Ruptured 4-mm anterior communicating aneurysm in a 64-year-old woman treated with endovascular GDC placement. Initially, this patient had total occlusion, but 3 months later, DSA depicted a small remnant in the aneurysmal neck. (a) Transverse source MR image and (b) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 15 months after treatment show no remnant. (c) Lateral DSA view of the left internal carotid artery obtained 15 months after treatment shows a small remnant (arrow) at the base of the aneurysm.

View larger version (161K): [in a new window]   Figure 2c. Ruptured 4-mm anterior communicating aneurysm in a 64-year-old woman treated with endovascular GDC placement. Initially, this patient had total occlusion, but 3 months later, DSA depicted a small remnant in the aneurysmal neck. (a) Transverse source MR image and (b) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 15 months after treatment show no remnant. (c) Lateral DSA view of the left internal carotid artery obtained 15 months after treatment shows a small remnant (arrow) at the base of the aneurysm.

View larger version (140K): [in a new window]   Figure 3a. Ruptured left posterior communicating artery aneurysm in a 53-year-old woman treated with GDC placement during the acute phase. The initial anatomic result was total occlusion. (a) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 3 months after treatment shows no remnant. (b) Lateral DSA image of the left internal carotid artery obtained 3 months after treatment shows a 2-mm remnant (arrow) in the aneurysmal neck.

View larger version (140K): [in a new window]   Figure 3b. Ruptured left posterior communicating artery aneurysm in a 53-year-old woman treated with GDC placement during the acute phase. The initial anatomic result was total occlusion. (a) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 3 months after treatment shows no remnant. (b) Lateral DSA image of the left internal carotid artery obtained 3 months after treatment shows a 2-mm remnant (arrow) in the aneurysmal neck.

View larger version (200K): [in a new window]   Figure 4a. Ruptured anterior communicating artery aneurysm in a 54-year-old man treated with endovascular GDC placement during the acute phase. This treatment resulted in subtotal occlusion. (a) Transverse source MR image and (b) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 3 months after treatment show no remnant. (c) Lateral and (d) oblique DSA views of the right internal carotid artery obtained 3 months after treatment show residual flow (arrows) in the coil mesh close to the neck.

View larger version (152K): [in a new window]   Figure 4b. Ruptured anterior communicating artery aneurysm in a 54-year-old man treated with endovascular GDC placement during the acute phase. This treatment resulted in subtotal occlusion. (a) Transverse source MR image and (b) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 3 months after treatment show no remnant. (c) Lateral and (d) oblique DSA views of the right internal carotid artery obtained 3 months after treatment show residual flow (arrows) in the coil mesh close to the neck.

View larger version (119K): [in a new window]   Figure 4c. Ruptured anterior communicating artery aneurysm in a 54-year-old man treated with endovascular GDC placement during the acute phase. This treatment resulted in subtotal occlusion. (a) Transverse source MR image and (b) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 3 months after treatment show no remnant. (c) Lateral and (d) oblique DSA views of the right internal carotid artery obtained 3 months after treatment show residual flow (arrows) in the coil mesh close to the neck.

View larger version (103K): [in a new window]   Figure 4d. Ruptured anterior communicating artery aneurysm in a 54-year-old man treated with endovascular GDC placement during the acute phase. This treatment resulted in subtotal occlusion. (a) Transverse source MR image and (b) MIP reconstruction of MR angiogram (three-dimensional time-of-flight spoiled gradient-echo sequence, 26.0/2.4) obtained 3 months after treatment show no remnant. (c) Lateral and (d) oblique DSA views of the right internal carotid artery obtained 3 months after treatment show residual flow (arrows) in the coil mesh close to the neck.