Meta-Analysis on Diagnostic Accuracy of MR Angiography in the Follow-up of Residual Intracranial Aneurysms Treated with Guglielmi Detachable Coils

Abstract

Patients with intracranial aneurysm after coiling with Guglielmi detachable coils (GDC) require imaging follow-up. The accuracy of noninvasive magnetic resonance angiography (MRA) techniques including time-of-flight (TOF) and contrast-enhancement (CE) have been compared with the gold standard digital subtraction angiography (DSA). We systematically reviewed the diagnostic accuracy of these imaging methods in follow-up study of patients with residual intracranial aneurysms after GDC treatment. The authors used MEDLINE, bibliographies, review articles, textbooks, and expert opinion to retrieve English- and non-English-language articles published from 1966 to December 2007. Sixteen suitable MRA original articles (14 TOF-MRA and six CE-MRA) with comparison to DSA have met the inclusion criteria. TOF-MRA had a pooled sensitivity of 90% (95% CI, 79% to 95%), a specificity of 95% (95% CI, 88% to 98%), and a diagnostic odds ratio (DOR) of 168.4 (95% CI, 60.3 to 470.3). CE-MRA had an overall sensitivity of 92% (95% CI, 79% to 97%), a specificity of 96% (95% CI, 91% to 98%), and a DOR of 280.4 (95% CI, 64.8 to 1212.6). The areas under two summary ROC curves of TOF-MRA and CE-MRA were 0.97 (95% CI, 0.96 to 0.99) and 0.98 (95% CI, 0.96 to 0.99), respectively. Compared with DS angiography, both TOF-MRA and CE-MRA can accurately depict the residual aneurysm. The diagnostic accuracy of TOF-MRA and CE-MRA tests offer comparable and equal results and may obviate the invasive DS angiography