AJNR. American journal of neuroradiology · 2026
Comparison of Pointwise Encoding Time Reduction with Radial Acquisition (PETRA) MR-Angiography with conventional MR-Angiography-Sequences for Follow-Up of intracranial Aneurysms in a real-world cohort.
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Sondermann Stefan, Schramm Peter, Keric Naureen, Höltje Jan, Boppel Tobias
Аннотация
BACKGROUND AND PURPOSE: MRI follow-up of treated cerebral aneurysms is essential to detect remnants or reperfusion but contrast-enhanced MR-angiography (ceMRA) and TOF-MRA can be impaired by implant-related artifacts. Pointwise Encoding Time Reduction with Radial Acquisition MRA (PETRA) is a novel, non-contrast MRA technique with promising results for aneurysms treated with clipping or coiling. However, its performance in patients treated with other devices, including flow diverters and intrasaccular devices, remains unclear. This study aimed to compare PETRA with other MRA sequences with a particular focus on vessel visibility.
MATERIALS AND METHODS: Ninety-seven patients with 124 aneurysms treated with various endovascular devices or surgical clips were included. All patients underwent MRI including PETRA, TOF-MRA and ceMRA between September 2024 and February 2026. Three neuroradiologists independently rated aneurysm reperfusion, as well as image quality and the visibility of the parent artery and branching vessels, using 3-point scales. Artifact-related signal loss and signal reduction due to artifacts were measured in millimeters. Interrater reliability was determined using Fleiss Kappa.
RESULTS: Vessel visibility was rated superior with PETRA compared to TOF-MRA, and comparable to ceMRA. Artifact-induced signal loss and impairment were highest with TOF-MRA, differing significantly from ceMRA and PETRA. Overall image quality was lowest with PETRA. Reperfusion detection did not differ among the MRA sequences.
CONCLUSIONS: PETRA shows potential as a non-contrast MRA technique for follow-up of cerebral aneurysms, providing better vessel visibility than TOF and diagnostic performance comparable to ceMRA. However, its prolonged acquisition time and associated lower image quality currently limits clinical feasibility and real-world applicability. Further studies focusing on scan time reduction and cross-device performance are required.
MATERIALS AND METHODS: Ninety-seven patients with 124 aneurysms treated with various endovascular devices or surgical clips were included. All patients underwent MRI including PETRA, TOF-MRA and ceMRA between September 2024 and February 2026. Three neuroradiologists independently rated aneurysm reperfusion, as well as image quality and the visibility of the parent artery and branching vessels, using 3-point scales. Artifact-related signal loss and signal reduction due to artifacts were measured in millimeters. Interrater reliability was determined using Fleiss Kappa.
RESULTS: Vessel visibility was rated superior with PETRA compared to TOF-MRA, and comparable to ceMRA. Artifact-induced signal loss and impairment were highest with TOF-MRA, differing significantly from ceMRA and PETRA. Overall image quality was lowest with PETRA. Reperfusion detection did not differ among the MRA sequences.
CONCLUSIONS: PETRA shows potential as a non-contrast MRA technique for follow-up of cerebral aneurysms, providing better vessel visibility than TOF and diagnostic performance comparable to ceMRA. However, its prolonged acquisition time and associated lower image quality currently limits clinical feasibility and real-world applicability. Further studies focusing on scan time reduction and cross-device performance are required.