Angiorresonancia versus angiografía por sustracción digital en el seguimiento de aneurismas intracraneales embolizados. Comparación del desempeño diagnóstico
González Gaita, Juan Manuel
Amado Castro, Danys
Puentes Vargas, Juan Carlos
Introduction: DSA is the method of choice to follow patients with embolized intracranial aneurysms; it may be associated with disabling or fatal complications. The MRA has been proposed as an alternative because has less cost and less morbidity and mortality, although its diagnostic performance remains under discussion due to the development of new protocols, more powerful magnets and new applications for DSA. Methodology: We explored literature up to present and compared the diagnostic performance of the MRA with the DSA to detect residual flow after therapeutic embolization of intracranial aneurysms. We performed a systematic review of the literature and meta-analysis based on 34 articles detected in the search which included PubMed, Scopus, ScIELO and BVS databases. Results: TOF-MRA showed sensitivity of 86.8% (84.3%-89.1%) and specificity of 91.2% (89%-93.1%); the SROC for TOF-MRA showed an AUC of 0.95. The performance of CE-MRA showed sensitivity of 88.1% (84.6%-91.1%) and specificity of 89.1% (85.7%-91.9%); the SROC demonstrated an AUC of 0.93. Stratified analysis according to resonator strength found that TOF-MRA has better performance under 3T magnets, although it is not statistically significant. Interobserver concordance was moderate to very good for TOF-MRA and CE-MRA. Discussion: The diagnostic performance of the MRA in the monitoring of embolized intracranial aneurysms proved to be good, with sensitivity higher than 84%, slightly better with TOF-MRA, without being able to replace the DSA. However, the results should be evaluated with caution because of the heterogeneity of the results from the included studies. (Abbreviations: DSA: Digital Subtraction Angiography; MRA: Magnetic Resonance Angiography; TOF-MRA: Resonance Angiography by Time of Flight; CE-MRA: Resonance Angiography with Contrast).