Is MRA at 3.0 Tesla sufficient for preoperative planning for aneurysmal clipping in patients with contraindicated condition of contrast media?

Abstract

Background: We evaluated the possibility that 3.0 T MRA was sufficient for unique imaging modality before aneurysmal clipping in patients with contraindication to contrast media. Method: 13 cases (16 aneurysms) were retrospectively evaluated. Ruptured aneurysms were 3 cases (3 aneurysms). 10 cases (12 aneurysms) were operated on after preoperative evaluation using only 3.0 T MRA because of contraindication to contrast media, whereas both 3D-DSA/CTA and 3.0 T MRA were performed in 3 cases (4 aneurysms) before the operation because of each clinical reasons. In these 13 cases, we compared aneurysmal findings between intraoperative views and images of 3D-time of flight MRA with volume rendering at 3.0 T. Results: Compared to operative views, the shape of aneurysm including bleb in MRA tended not to be slightly sharp, but the size of neck and dome of aneurysms did not show significant differences. These discrepancies did not affect the intraoperative procedures. Regarding perforators, posterior communicating artery and anterior choroidal artery were confirmed in the operation as same view with MRA findings. It was difficult to distinguish double anterior communicating artery aneurysm by 3.0 T MRA. In thrombosed case, it was necessary to examine raw data of MRA as pretreatment planning tool in order to evaluate the extent of thrombus in aneurysmal neck. Reviewing the cases operated using only 3.0 T MRA retrospectively, there was no case that showed treatment planning by 3.0 T MRA was insufficient. Conclusions: This paper may suggest that treatment planning of aneurysmal clipping on the basis of 3.0 T MRA is feasible and an effective option for patients with contraindication to contrast media. Keywords: Aneurysm, Clipping, MRA, CTA, DSA, Contrast media