Abstract / Summary
Abstract This study evaluated the practicality of three-dimensional (3D)-digital subtraction angiography using intravenous contrast injection (IV-3D-DSA) as a minimally invasive follow-up imaging after flow diverter (FD) placement for intracranial aneurysms. This study included 40 patients with 42 aneurysms treated with FDs. Forty-nine IV-3D-DSA images were acquired and compared with ultra-short echo time magnetic resonance angiography (MRA) images and conventional 3D computed tomography angiography (3D-CTA) images to evaluate the resolution and accuracy. In five cases, conventional angiography was performed concurrently for comparison with IV-3D-DSA. Two C-arm rotation speeds, 5 and 10 seconds, were tested for image acquisition. Five interventional neuroradiologists evaluated and scored the image quality based on four criteria: sharpness of vessel contour (VC), visualization of stent struts (SS), visualization of in-stent lumen (SL), and visualization of jailed branches and remnant aneurysmal space with minimal metal artifacts (MA). IV-3D-DSA scored significantly higher than MRA and 3D-CTA for all four criteria. No significant differences were found between the FD-only and FD overlap groups. However, the FD with coil group scored significantly lower for VC, SS, and SL. The 10-second acquisition mode achieved significantly higher scores than the 5-second mode across all criteria. The image quality of IV-3D-DSA may be minimally affected by MAs compared with 3D-CTA and MRA, accurately reflecting posttreatment vessel and aneurysm conditions, making it one of the reliable follow-up imaging methods.