Endovasküler tedavi yapılmış intrakranial anevrizmaların farklı manyetik rezonans anjiografi teknikleriyle retrospektif olarak karşılaştırılması
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Date
2019
Authors
Mırçık, Emre
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
İntrakraniyal anevrizmalar travmatik olmayan subaraknoid kanamanın en sık nedenidir. İntrakraniyal anevrizmaların tedavisinde cerrahi ya da endovasküler tedaviden biri tercih edilmektedir. Endovasküler tedavide koil ya da stent uygulaması temel iki tedavi yöntemidir. Tedavisi yapılan anevrizmaların olası nüks-rezidüleri takip edebilmek amacıyla çoğunlukla DSA ya da MRA inceleme yapılmaktadır. DSA altın standart yöntem iken daha az invaziv olan MRA da sıklıkla tercih edilmektedir. Çalışmamızda endovasküler olarak tedavisi yapılan 90 hastadaki 113 anevrizma değerlendirildi. 3 Tesla (T) MR’de 66 ve 1,5 T MR’de 47 olgu incelendi. 3 T ve 1,5 T MR’de Raymond sınıflamasına göre anevrizma oklüzyon oranları birbiri ile karşılaştırıldı. 3 T MR’de THRIVE (T1 weighted high resolution isotropic volume examination) TOF-MRA (Time of flight manyetik rezonans anjiografi), K-MRA (Kontrastlı manyetik rezonans anjiografi) inceleme yapıldı. 1,5 T MR’de TOF-MRA ve K-MRA inceleme yapıldı. THRIVE ve K-MRA arasında kappa analizine göre toplam 61 olguda uyum izlenmektedir ve %92,42 uyum saptanmış olup kappa değerlerine göre (0,800) mükemmel uyum gözlendi (p<0,001). 3 T MR’de K-MRA’da 48 tam oklüzyon (sınıf 1), 18 rezidü akım (sınıf 2,3), TOF-MRA’da 57 tam oklüzyon, 9 rezidü akım olarak değerlendirildi. 3 T MR’da TOF ve K-MRA arasında istatistiksel olarak anlamlı farklılık saptanmış olup (p<0,05) K-MRA’nın rezidü akımı gösterme durumu TOF-MRA sekansına göre daha fazladır. 1,5 T MR’de K-MRA’da 36 olgu tam oklüzyon, 11 olgu rezidü akım olarak değerlendirildi. TOF-MRA’da 40 olgu tam oklüzyon, 7 olgu rezidü akım olarak değerlendirilmiş olup sekanslar arasında istatistiksel olarak anlamlı fark saptanmadı (p=0,125).
Intracranial aneurysms are the most common cause of non-traumatic subarachnoid hemorrhage. Surgical or endovascular treatment is one of the preferred methods for the treatment of intracranial aneurysms. Coil or stent treatment is the main treatment modality for endovascular treatment. In order to follow the possible recurrence-residues of treated aneurysms, DSA or MRA examination is usually performed. While DSA is the gold standard method, MRA, which is less invasive, is frequently preferred. In our study, 113 aneurysms were evaluated in 90 patients treated endovascularly. 66 cases is assessed with 3 T MR and 47 cases is assessed with 1,5 T MR. According to Raymond classification in 3 T and 1,5 T MR, the occlusion rates are compared with each other. THRIVE, TOF-MRA, CE-MRA were performed on 3 T MR. 1,5 T MR was performed with TOF-MRA and K-MRA. According to kappa analysis between THRIVE and CE-MRA, compliance was observed in a total of 61 cases and 92,42% was found to be compatible and a perfect fit was observed according to the kappa values (0,800) (p <0,001). In 3 T MR, 48 complete occlusion (class 1), 18 residual flow (class 2,3) in K-MRA, 57 complete occlusion 9 in TOF-MRA were evaluated as residual flow. 3 T MR showed a statistically significant difference between TOF and CE-MRA (p <0,05). In 1,5 T MRI, 36 cases were evaluated as complete occlusion and 11 as residual flow in K-MRA. In TOF-MRA, 40 cases were evaluated as complete occlusion and 7 cases as residual flow and no statistically significant difference was found between the sequences (p = 0,125).
Intracranial aneurysms are the most common cause of non-traumatic subarachnoid hemorrhage. Surgical or endovascular treatment is one of the preferred methods for the treatment of intracranial aneurysms. Coil or stent treatment is the main treatment modality for endovascular treatment. In order to follow the possible recurrence-residues of treated aneurysms, DSA or MRA examination is usually performed. While DSA is the gold standard method, MRA, which is less invasive, is frequently preferred. In our study, 113 aneurysms were evaluated in 90 patients treated endovascularly. 66 cases is assessed with 3 T MR and 47 cases is assessed with 1,5 T MR. According to Raymond classification in 3 T and 1,5 T MR, the occlusion rates are compared with each other. THRIVE, TOF-MRA, CE-MRA were performed on 3 T MR. 1,5 T MR was performed with TOF-MRA and K-MRA. According to kappa analysis between THRIVE and CE-MRA, compliance was observed in a total of 61 cases and 92,42% was found to be compatible and a perfect fit was observed according to the kappa values (0,800) (p <0,001). In 3 T MR, 48 complete occlusion (class 1), 18 residual flow (class 2,3) in K-MRA, 57 complete occlusion 9 in TOF-MRA were evaluated as residual flow. 3 T MR showed a statistically significant difference between TOF and CE-MRA (p <0,05). In 1,5 T MRI, 36 cases were evaluated as complete occlusion and 11 as residual flow in K-MRA. In TOF-MRA, 40 cases were evaluated as complete occlusion and 7 cases as residual flow and no statistically significant difference was found between the sequences (p = 0,125).
Description
Keywords
İntrakraniyal anevrizma, MR anjiografi, Endovasküler tedavi, THRIVE, TOF, Intracranial aneurysm, Endovascular treatment, MR angiography
Citation
Mırçık, E. (2019). Endovasküler tedavi yapılmış intrakranial anevrizmaların farklı manyetik rezonans anjiografi teknikleriyle retrospektif olarak karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.