A Comparability Study Between Intravenous Contrast-Enhanced Cone-Beam Computed Tomography (CBCT) and Magnetic Resonance Angiography (MRA) on the Post-Treatment Follow-Up of Intracranial Aneurysms: A Single-Center Prospective Cohort Study

<b>Background:</b> MRA is used in our center for monitoring post-treatment residual aneurysmal neck and stent patency. IV CBCT offers better spatial resolution and may provide significant advantages. <b>Objective:</b> This study investigates the image quality of IV CBCT compared to that of MRA for the follow-up of intracranial aneurysms. <b>Materials and Methods:</b> In this prospective cohort study, 97 patients (mean age: 63.1 ± 11.7; 75 women and 22 men) with 114 treated cerebral aneurysms were included from July 2023 to April 2024. All patients underwent IV CBCT and MRA on the same day. Two neurointerventional radiologists assessed image quality using a five-point Likert scale on two separate occasions six weeks apart. Diagnostic values were evaluated across six parameters. Intra-observer and inter-observer agreements were calculated. Subgroup analyses were performed. <b>Results:</b> Overall, IV CBCT and MRA are comparable in terms of their ability to assess parent vessel status and the degree of artifacts (<i>p</i> > 0.05) though MRA shows a slight advantage in evaluating residual aneurysmal neck (<i>p</i> = 0.05). For clipped aneurysms, IV CBCT is superior in assessing residual aneurysmal neck (OR = 16.0, <i>p</i> < 0.001) and parent vessel status (OR = 15.1, <i>p</i> < 0.001) with significantly fewer artifacts (OR > 100, <i>p</i> < 0.001). For aneurysms solely treated with stents, IV CBCT is superior in assessing residual aneurysmal neck (OR > 20, <i>p</i> = 0.002) and parent vessel status (OR > 20, <i>p</i> = 0.002) with significantly fewer artifacts (OR > 20, <i>p</i> = 0.002). IV CBCT outperforms MRA in evaluating stent struts and the vessel wall status of a stented segment when MRA is non-diagnostic. <b>Conclusions:</b> IV CBCT and MRA have their own strengths and roles in the follow-up of post-treatment intracranial aneurysms. Overall, IV CBCT is superior in terms of its assessment of intracranial aneurysms treated solely with stents or surgical clips.