Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms
10.7461/jcen.2021.E2020.10.002
- Author:
Peng Roc CHEN
1
;
Victor LOPEZ-RIVERA
;
Christopher R CONNER
;
Aditya SANZGIRI
;
Sunil A. SHETH
;
Kadir ERKMEN
;
Dong H KIM
;
Arthur L. DAY
Author Information
1. Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
- Publication Type:Original Article
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2021;23(2):108-116
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized.
Methods:Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence.
Results:A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence.
Conclusions:The findings of our study suggest that skull x-rays may represent a lowcost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.
