Aneurysm wall enhancement on magnetic resonance imaging as a risk factor for progression of unruptured vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment

Abstract

ABBREVIATIONS 3D-TOF = 3D time of flight; CI = confidence interval; DSA = digital subtraction angiography; EVT = endovascular treatment; FSE = fast spin-echo; HRMRI = high-resolution MRI; IMH = intramural hematoma; MRA = MR angiography; OR = odds ratio; TSE = turbo spin-echo; VBDA = vertebrobasilar dissecting aneurysm. SUBMITTED September 20, 2016 Department of Neurosurgery, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China OBJECTIVE The recurrence rate of vertebrobasilar dissecting aneurysms (VBDAs) after reconstructive endovascular treatment (EVT) is relatively high. The aneurysm wall enhancement on high-resolution MRI (HRMRI) reportedly predicts an unsteady state of an intracranial aneurysm. The authors used HRMRI to investigate the relationship between wall enhancement on HRMRI and progression of VBDAs after reconstructive EVT. METHODS From January 2012 to December 2015, patients with an unruptured VBDA who underwent reconstructive EVT were enrolled in this study. Preoperative enhanced HRMRI was performed to evaluate radiological characteristics. The relationships between aneurysm wall enhancement and various potential risk factors were statistically analyzed. Follow-up angiographic examination was performed with digital subtraction angiography and conventional HRMRI. Cox regression analysis was performed to identify predictors of VBDA progression after reconstructive EVT. RESULTS Eighty-two patients (12 women and 70 men, mean age 53.48 ± 9.23 years) with 83 VBDAs were evaluated in the current study. The average maximum diameter of the VBDAs was 11.30 ± 7.90 mm. Wall enhancement occurred in 43 VBDAs (51.81%). Among all 83 VBDAs, 62 (74.70%) were treated by stent-assisted coil embolization and 21 (25.30%) by stenting alone. The mean duration of imaging follow-up among all 82 patients was 10.55 months (range 6-45 months), and 15 aneurysms (18.07%) exhibited progression. The statistical analysis indicated no significant differences in age, sex, risk factors (high blood pressure, smoking, diabetes mellitus, and a high cholesterol level), VBDA stage, or VBDA size between enhanced and unenhanced VBDAs. Univariate Cox regression analysis showed that both the maximum diameter of the VBDAs and wall enhancement were associated with recurrence (p < 0.05). Multivariate Cox proportional hazard regression analysis showed that the maximum diameter of the VBDAs and wall enhancement on HRMRI were independent risk factors for aneurysm progression (p < 0.05). CONCLUSIONS Aneurysm size and wall enhancement on HRMRI can predict the progression of VBDAs after reconstructive EVT.https://thejns.org/doi/abs/10.3171/2016.11.JNS162433 KEY WORDS wall enhancement; high-resolution magnetic resonance imaging; intracranial dissecting aneurysm; endovascular treatment; progression; stent; vascular disorders S pontaneouS intracranial dissecting aneurysms are rare.2 However, East Asian populations demonstrate a higher incidence of these types of aneurysms.14 The incidence rate may have increased due to the d...

Unfavorable Outcomes Related to Endovascular Treatment of Giant Vertebrobasilar Aneurysms

“…Regular physical examination including MRI and MRA for the patients with high risk factor (such as family history of GVBAs), might be an optional method for discovery of these lesions early. Moreover, the assessment of HRMRI in GVBAs patients might be identified the high-risk patients with evidence of progression on imaging (8). However, future studies are necessary to clarify these points and provide optimal treatment for patients with GVBAs and further advancements are necessary to provide optimal treatment for patients with GVBAs.…”

“…All patients were recommended to undergo a 6-month angiographic follow-up, and a magnetic resonance (MR) angiogram or computed tomography angiogram performed annually thereafter. Any aneurysm that displayed an increasing percentage of contrast filling of the aneurysmal sac on follow-up angiography or presented with more than 1-mm enlargement on MR imaging was considered an unfavorable angiographic outcome ( 8 ). The occlusion rate (<90%) for the aneurysms with flow diverter and re-patency of parent artery for the aneurysms with internal trapping were defined as unfavorable angiographic outcomes ( 9 ).…”

Circumferential Thick Enhancement at Vessel Wall MRI Has High Specificity for Intracranial Aneurysm Instability

“…First, wall enhancement has not yet been validated by using histopathologic data; therefore, its inflammatory nature remains speculative (17,18). One may consider the possibility that, although many studies (7,8,10,15,19,20) have reported that vessel wall enhancement of aneurysms may be a marker for instability, CAWE may be the mere consequence of slow flow artifact near the wall. Furthermore, we acquired images a short time after contrast agent injection, meaning that slow flowing, T1-shortened blood near the wall could cause wall enhancement-like flow artifacts.…”

China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms

“… In our experience, follow-up angiography alone does not adequately predict the outcome whereas HRMRI is a more useful means of following these lesions [ 38 ]. We have also found and reported that aneurysm wall enhancement on HRMRI predicts instability of an intracranial aneurysm [ 39 ]. HRMRI will be performed on patients enrolled in the UIA follow-up cohort at the 20 participating centers and HRMRI-identified aneurysm wall enhancement assessed as a possible predictor of UIA rupture.…”