Clinicopathological Insights From Vessel Wall Imaging of Unruptured Intracranial Aneurysms

Shimonaga, Koji; Matsushige, Toshinori; Ishii, Daizo; Sakamoto, Shigeyuki; Hosogai, Masahiro; Kawasumi, Tomohiro; Kaneko, Mayumi; Ono, Chiaki; Kurisu, Kaoru

doi:10.1161/strokeaha.118.021819

Cited by 105 publications

(77 citation statements)

References 12 publications

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“…Recent advance in magnetic resonance vessel wall imaging (MR-VWI) has shown association between wall enhancement and aneurysm rupture (20). Further histopathological analyses revealed that wall enhancement was associated with wall thickening with atherosclerotic change (21,22). Our study suggested that increased lipid infiltration was associated with rupture, which was in line with these new findings from vessel wall imaging.…”

Section: Discussionsupporting

confidence: 86%

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Qian

Zhang

et al. 2020

Front. Neurol.

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Background: Intracranial aneurysm wall degradation can be associated with lipid infiltration. However, the relationship between lipid infiltration and aneurysm rupture has not been explored quantitatively. To investigate the correlation between lipid infiltration and aneurysm rupture, we utilized patient-specific simulation of low-density lipoprotein (LDL) transport to analyze lipid infiltration in the cerebral aneurysm wall. Methods: Sixty-two aneurysms were analyzed. Patient blood pressure, plasma LDL concentration, and three-dimensional angiographic images were obtained to simulate LDL transport in aneurysms. Morphological, hemodynamic, and lipid accumulation parameters were compared between ruptures and unruptured groups. Multivariate logistic regression was also performed to determine parameters that are independently associated with rupture. Results: Size ratio, wall shear stress, low shear area, relative residence time, area-averaged LDL infiltration rate, and maximum LDL infiltration rate were significant parameters in univariate analysis (P < 0.05). Multivariate analysis revealed that only average LDL infiltration remained as a significant variable (P < 0.05). The prediction model derived showed good performance for rupture prediction (AUC, 0.885; 95% CI, 0.794-0.976). Conclusions: Ruptured aneurysms showed significantly higher LDL infiltration compared to unruptured ones. Our results suggested that lipid infiltration may promote aneurysm rupture. Lipid infiltration characteristics should be considered when assessing aneurysm rupture risk.

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Section: Discussionsupporting

confidence: 86%

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Qian

Zhang

et al. 2020

Front. Neurol.

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“…Additionally, the pattern of AWE is significantly associated with the morphological changes observed in IAs, such as aneurysmal sac expansion or daughter sac formation [31]. It remains controversial if AWE could serve as potential imaging modality capable of identifying unstable IAs [32,33], as 20-40% of stable unruptured IAs may also demonstrate the AWE [19,31,34]. In our study, AWE did not have a high PPV for MBs associated with SH, but lack of AWE had a high NPV.…”

Section: Discussioncontrasting

confidence: 47%

Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tools to Detect Microbleed in Sentinel Headache

Ishii

Nakagawa

Zanaty

et al. 2020

JCM

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Background: MR-quantitative susceptibility mapping (QSM) can identify microbleeds (MBs) in intracranial aneurysm (IA) wall associated with sentinel headache (SH) preceding subarachnoid hemorrhage. However, its use is limited, due to associated skull base bonny and air artifact. MR-vessel wall imaging (VWI) is not limited by such artifact and therefore could be an alternative to QSM. The purpose of this study was to investigate the correlation between QSM and VWI in detecting MBs and to help develop a diagnostic strategy for SH. Methods: We performed a prospective study of subjects with one or more unruptured IAs in our hospital. All subjects underwent evaluation using 3T-MRI for MR angiography (MRA), QSM, and pre-and post-contrast VWI of the IAs. Presence/absence of MBs detected by QSM was correlated with aneurysm wall enhancement (AWE) on VWI. Results: A total of 40 subjects harboring 51 unruptured IAs were enrolled in the study. MBs evident on the QSM sequence was detected in 12 (23.5%) IAs of 11 subjects. All these subjects had a history of severe headache suggestive of SH. AWE was detected in 22 (43.1%) IAs. Using positive QSM as a surrogate for MBs, the sensitivity, specificity, positive predictive value, and negative predictive value of AWE on VWI for detecting MBs were 91.7%, 71.8%, 50%, and 96.6%, respectively. Conclusions: Positive QSM findings strongly suggested the presence of MBs with SH, whereas, the lack of AWE on VWI can rule it out with a probability of 96.6%. If proven in a larger cohort, combining QSM and VWI could be an adjunctive tool to help diagnose SH, especially in cases with negative or non-diagnostic CT and lumbar puncture.

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“…27 Vessel wall imaging in humans has shown that aneurysm wall enhancement corresponds histopathologically to wall thickening, wall atherosclerosis, neovascularization, and macrophage infiltration. 36 domes were resected for histological analysis. 20 Increased wall thickness and macrophage infiltration were correlated to both vessel wall enhancement and rupture.…”

Section: Discussionmentioning

confidence: 99%

Aspirin associated with decreased rate of intracranial aneurysm growth

Zanaty¹,

Roa²,

Nakagawa

et al. 2020

Journal of Neurosurgery

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OBJECTIVEAspirin has emerged as a potential agent in the prevention of rupture of intracranial aneurysms (IAs). In this study, the authors’ goal was to test if aspirin is protective against aneurysm growth in patients harboring multiple IAs ≤ 5 mm.METHODSThe authors performed a retrospective review of a prospectively maintained database covering the period July 2009 through January 2019. Patients’ data were included if the following criteria were met: 1) the patient harbored multiple IAs; 2) designated primary aneurysms were treated by surgical/endovascular means; 3) the remaining aneurysms were observed for growth; and 4) a follow-up period of at least 5 years after the initial treatment was available. Demographics, earlier medical history, the rupture status of designated primary aneurysms, aneurysms’ angiographic features, and treatment modalities were gathered.RESULTSThe authors identified 146 patients harboring a total of 375 IAs. At the initial encounter, 146 aneurysms were treated and the remaining 229 aneurysms (2–5 mm) were observed. During the follow-up period, 24 (10.48%) of 229 aneurysms grew. All aneurysms observed to grow later underwent treatment. None of the observed aneurysms ruptured. Multivariate analysis showed that aspirin was significantly associated with a decreased rate of growth (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05–0.63). Variables associated with an increased rate of growth included hypertension (OR 14.38, 95% CI 3.83–53.94), drug abuse (OR 11.26, 95% CI 1.21–104.65), history of polycystic kidney disease (OR 9.48, 95% CI 1.51–59.35), and subarachnoid hemorrhage at presentation (OR 5.91, 95% CI 1.83–19.09).CONCLUSIONSIn patients with multiple IAs, aspirin significantly decreased the rate of aneurysm growth over time. Additional prospective interventional studies are needed to validate these findings.

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Clinicopathological Insights From Vessel Wall Imaging of Unruptured Intracranial Aneurysms

Cited by 105 publications

References 12 publications

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tools to Detect Microbleed in Sentinel Headache

Aspirin associated with decreased rate of intracranial aneurysm growth

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