Aneurysm Wall Enhancement in Unruptured Intracranial Aneurysms: A Histopathological Evaluation

Abstract

Background Unruptured intracerebral aneurysm wall enhancement (AWE) on vessel wall magnetic resonance imaging scans may be a promising predictor for rupture‐prone intracerebral aneurysms. However, the pathophysiology of AWE remains unclear. To this end, the association between AWE and histopathological changes was assessed in this study. Methods and Results A total of 35 patients with 41 unruptured intracerebral aneurysms who underwent surgical clipping were prospectively enrolled. A total of 27 aneurysms were available for histological evaluation. The macroscopic and microscopic features of unruptured intracerebral aneurysms with and without enhancement were assessed. The microscopic features studied included inflammatory cell invasion and vasa vasorum, which were assessed using immunohistochemical staining with CD68, CD3, CD20, and myeloperoxidase for the former and CD34 for the latter. A total of 21 (51.2%) aneurysms showed AWE (partial AWE, n=7; circumferential AWE, n=14). Atherosclerotic and translucent aneurysms were identified in 17 and 14 aneurysms, respectively. Aneurysm size, irregularity, and atherosclerotic and translucent aneurysms were associated with AWE on univariate analysis ( P <0.05). Multivariate logistic regression analysis showed that atherosclerosis was the only factor significantly and independently associated with AWE ( P =0.027). Histological assessment revealed that inflammatory cell infiltration, intraluminal thrombus, and vasa vasorum were significantly associated with AWE ( P <0.05). Conclusions Though AWE on vessel wall magnetic resonance imaging scans may be associated with the presence of atherosclerotic lesions in unruptured intracerebral aneurysms, inflammatory cell infiltration within atherosclerosis, intraluminal thrombus, and vasa vasorum may be the main pathological features associated with AWE. However, the underlying pathological mechanism for AWE still needs to be further studied.

Serum IL-1, Pyroptosis and Intracranial Aneurysm Wall Enhancement: Analysis Integrating Radiology, Serum Cytokines and Histology

“…The strong AWE is considered the sign of severe inflammation in the aneurysm wall. Existing studies revealed the correlation of AWE and atherosclerosis, and inflammatory cell invasion (7,8,21,22). In this study, our findings from histological analysis complied with existing studies.…”

“…Inflammation infiltration and aneurysm wall remodeling are recognized as two vital pathological characteristics of the wall of ruptured intracranial aneurysm (6). As revealed from existing studies, the inflammation is severer in the aneurysm wall of UIAs with AWE as compared with UIAs without AWE (7,8). As revealed by the fact above, the pathological features of UIAs with AWE may be close to those of the ruptured intracranial aneurysms.…”

Intracranial aneurysm is predicted by abdominal aortic calcification index: A retrospective case-control study

“…Connection between these two clinical entities is under investigation. A recent study found out that atherosclerotic lesions and immunohistochemical signs of inflammation in intracranial aneurysms were associated with aneurysm wall enhancement in imaging [26].…”

Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye

“…Moreover, FAWE is observed in areas of morphological changes in the IA vessel wall, supporting the hypothesis that FAWE could be a marker of instability ( 80 ). On the other hand, circumferential AWE (CAWE) is thought to be due to wall thickening with abundant inflammatory cell infiltration and neovascularization ( 78 , 81 , 82 ).…”