Diagnosing flow residuals in coiled cerebral aneurysms by MR angiography: meta-analysis

Jan Menke, Peter Schramm, Jan Martin Sohns, Kai Kallenberg, Wieland Staab


This meta-analysis summarizes the accuracy of magnetic resonance angiography (MRA) for diagnosing residuals in coiled cerebral aneurysms by using the threefold Roy classification (residuals: none, neck, or sac). Four databases were searched from 2000 to June 2013 for eligible studies that compared MRA to digital subtraction angiography (DSA) and reported 3 × 3 count data of threefold Roy classification, or a reduced scheme of 2 × 2 count data. Bivariate and trivariate Bayesian random-effects models were used for meta-analysis. Among 27 included studies (2,119 coiled aneurysms in 1,809 patients) the average prevalence of DSA-confirmed sac residuals was 18.2 % (range 0-43 %). The pooled sensitivity was 88.0 % (95 % CI 81.4-94.0) and specificity was 97.2 % (94.6-99.0 %) for assessing sac residuals by MRA. In the trivariate meta-analysis, a "sac residual" finding at MRA had a high positive likelihood ratio of 28.2 (14.0-79.0). A "neck residual" finding had a moderate negative likelihood ratio of 0.246 (0.111-0.426), and the MRA finding of "no residual" had a good negative likelihood ratio of 0.044 (0.013-0.096). Subgroup analyses identified no significant influence of covariates on diagnostic accuracy (P > 0.05). In conclusion, in coiled cerebral aneurysms MRA with application of the threefold Roy classification is well suited for detecting or excluding sac residuals that might require retreatment.

Original languageEnglish
JournalJournal of Neurology
Issue number4
Pages (from-to)655-62
Number of pages8
Publication statusPublished - 04.2014


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