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Abstract - Original Article

J Cerebrovasc Endovasc Neurosurg. 2021 23(2): 108-116
The Journal of Cerebrovascular and Endovascular Neurosurgery
Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms
Victor Lopez-Rivera2, Christopher R Conner1, Aditya Sanzgiri1, Sunil A. Sheth2, Kadir Erkmen3, Dong H Kim1, Arthur L. Day1
Departments of 1Neurosurgery and 2Neurology, University of Texas McGovern Medical School, Houston, TX, USA, 3Department of Neurosurgery, Temple University, Philadelphia, PA, USA

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 low-cost, 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. Keywords‌Coil mass, Aneurysm recurrence, Skull x-ray, Digital subtraction angiography
Key words : Coil mass, Aneurysm recurrence, Skull x-ray, Digital subtraction angiography

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