J Korean Neurosurg Soc.  2021 Sep;64(5):726-731. 10.3340/jkns.2020.0332.

Source Image Based New 3D Rotational Angiography for Differential Diagnosis between the Infundibulum and an Internal Carotid Artery Aneurysm : Pilot Study

• Jang H
• Jung WS
• Myoung SU
• Kim JJ
• Jang CK
• Cho KC

• KMID: 2519699
• DOI: http://doi.org/10.3340/jkns.2020.0332

Abstract

Objective
: Distinguishing between an infundibulum and a true aneurysm is clinically important. This study aimed to evaluate whether using source image based new three-dimensional rotational angiography (S-n3DRA) can increase the rate of aneurysm detection and improve distinction between a true aneurysm and an infundibulum.
Methods
: Twenty-two consecutive patients with 23 lesions, were evaluated by time-of-flight (TOF) magnetic resonance angiography (MRA), S-n3DRA, and digital subtraction angiography (DSA). The data were retrospectively and independently reviewed by two neurointerventionists, and the diagnoses based on TOF MRA, S-n3DRA, and DSA were compared. The diagnostic efficacy (interobserver agreement and diagnostic performance) of S-n3DRA was compared with that of TOF MRA.
Results
: S-n3DRA showed higher interobserver agreement (κ=0.923) than TOF MRA (κ=0.465) and significantly higher accuracy than MRA in distinguishing an aneurysm from an infundibulum (p=0.0039).
Conclusion
: Compared to MRA, S-n3DRA could provide better screening accuracy and information for distinguishing an aneurysm from an infundibulum. Therefore, S-n3DRA has the potential to reduce the need for DSA.

Keyword

Source image based new three-dimensional rotational angiogram; Time-of-flight magnetic resonance angiography; Digital subtraction angiography; Intracranial aneurysm; Infundibulum

Figure

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  Fig. 1. A 74-year-old woman was admitted for the treatment of an unruptured aneurysm. A : On time-of-flight magnetic resonance angiography three-dimensional (3D) reconstruction images, a saccular dilatation, possibly an aneurysm (arrow), was suspected near the posterior communicating artery (PcomA). B : Source image based new 3D rotational angiography showed that the PcomA originated from the wedge-shaped infundibulum (arrow). C : This lesion was confirmed as an infundibulum (arrow) on 3D rotational angiogram.

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  Fig. 2. A 62-year-old man underwent magnetic resonance angiography (MRA) for a medical check-up. A : On time-of-flight MRA three-dimensional (3D) reconstruction images, a saccular dilatation (arrow) was identified in the anterior communicating artery (AcomA). B : Source image based new 3D rotational angiography showed that the median artery of the corpus callosum originated from the wedge-shaped infundibulum (arrow). C : This lesion was confirmed as an infundibulum (arrow) on 3D rotational angiogram.

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  Fig. 3. A 56-year-old woman underwent magnetic resonance angiography (MRA) for a headache. A : On time-of-flight MRA three-dimensional (3D) reconstruction images, a bulbous dilatation (arrow) was identified in the right middle cerebral artery (MCA). B : Source image based new 3D rotational angiography showed that the MCA branch originated from the infundibulum (arrow). C : This lesion was confirmed as an infundibulum (arrow) on 3D rotational angiogram.

Reference

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