• Krishnamoorthy Thamburaj, Samer Zammar, Annie Tsay, Kyaw Tun, Scott Simon, Paul Kalapos, Marco Fiorelli, and Kevin Cockroft.
• Department of Radiology, Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine, Penn State University, Hershey, Pennsylvania, USA. Electronic address: kthamburaj@pennstatehealth.psu.edu.
• World Neurosurg. 2022 Jun 1; 162: e147-e155.

BackgroundFew studies have evaluated flow diversion with magnetic resonance angiography (MRA). Studies have shown better success of MRA in assessing the aneurysm response, but limited success in assessing stent patency. The patency of arterial branches on MRA remains to be explored.MethodsRetrospective evaluation of 31 consecutive cases of carotid aneurysms treated with flow diversion was performed with noncontrast time-of-flight (TOF), contrast-enhanced TOF, and cine MRA (time-resolved angiography with interleaved stochastic trajectories) independently by 2 investigators for aneurysm occlusion, stent patency, and arterial branch patency. Digital subtraction angiography served as the gold standard technique.ResultsPatients were 6 men and 25 women with a mean ± SD age of 57.8 ± 12.27 years (range, 32-79 years). Stent patency, aneurysm occlusion, and branch patency mostly revealed substantial to perfect interobserver agreement (κ >0.60). Sensitivity, specificity, positive predictive value, and negative predictive value for stent patency on raw data images of TOF were 0.50, 0.86, 0.20, and 0.96 and on contrast-enhanced TOF were 1.0, 0.93, 0.50, and 1.0. Ranges for aneurysm response on the 3 MRA scans were 0.78-0.89 for sensitivity, 0.54-0.92 for specificity, 0.73-0.93 for positive predictive value, and 0.78-0.86 for negative predictive value. Ranges for arterial branch patency among the 3 MRA scans were 0.87-0.96 for sensitivity, 0.50-1.0 for specificity, 0.90-1.0 for positive predictive value, and 0.33-0.80 for negative predictive value.ConclusionsAneurysm occlusion, stent patency, and arterial branch patency in flow diversion can be successfully evaluated with the combination of 3 MRA techniques.Copyright © 2022 Elsevier Inc. All rights reserved.

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