Semiautomated 3D mapping of aneurysmal wall enhancement with 7T-MRI

Raghuram, Ashrita; Varón, Alberto Rodríguez; Roa, Jorge A; Ishii, Daizo; Lu, Yongjun; Raghavan, Madhavan L.; Wu, Chaorong; Magnotta, Vincent A.; Hasan, David; Koscik, Timothy R.; Samaniego, Edgar A

doi:10.1038/s41598-021-97727-0

Cited by 20 publications

(10 citation statements)

References 52 publications

(59 reference statements)

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“…org). Then, to quantify the AWE spatial distribution in consideration of eliminating the pseudo-enhancement induced by near-wall slow flow, a method similar to that described by Khan et al, (19) and Raghuram et al, (26) was used. Explicitly, the 3D vessel model was generated from the registered 3D TOF-MRA based on algorithms, including threshold segmentation, region growth, connected domain selection, and surface smoothing in our custom-built software programmed in Python.…”

Section: Awe Analysismentioning

confidence: 99%

Aneurysmal wall enhancement and hemodynamics: pixel-level correlation between spatial distribution

Fu¹,

Peng²,

Zhang³

et al. 2022

Quant Imaging Med Surg

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Background: Inflammation and hemodynamics are interrelated risk factors for intracranial aneurysm rupture. This study aimed to identify the relationship between these risk factors from an individual-patient perspective using biomarkers of aneurysm wall enhancement (AWE) derived from high-resolution magnetic resonance imaging (HR-MRI) and hemodynamic parameters by four-dimensional flow MRI (4D-flow MRI).Methods: A total of 29 patients with 29 unruptured intracranial aneurysms larger than 4 mm were included in this prospective cross-sectional study. A total of 24 aneurysms had AWE and 5 did not have AWE. A three-dimensional (3D) vessel model of each individual aneurysm was generated with 3D time-of-flight magnetic resonance angiography (3D TOF-MRA). Quantification of AWE was sampled with HR-MRI.Time-averaged wall shear stress (WSS) and oscillatory shear index (OSI) were calculated from the 4D-flow MRI. The correlation between spatial distribution of AWE and hemodynamic parameters measured at pixellevel was evaluated for each aneurysm.Results: In aneurysms with AWE, the spatial distribution of WSS was negatively correlated with AWE in 100% (24/24) of aneurysms, though 2 had an absolute value of the correlation coefficient <0.1. The OSI was positively correlated with AWE in 91.7% (22/24) of aneurysms; the other 2 aneurysms showed a negative correlation with AWE. In aneurysms with no AWE, there was no correlation between WSS (100%, 5/5), OSI (80%, 4/5), and wall inflammation. Conclusions:The spatial distribution of WSS was negatively correlated with AWE in aneurysms with AWE, and OSI was positively correlated with AWE in most aneurysms with AWE. While aneurysms that did not contain AWE showed no correlation between hemodynamics and wall inflammation.

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Section: Awe Analysismentioning

confidence: 99%

Aneurysmal wall enhancement and hemodynamics: pixel-level correlation between spatial distribution

Fu¹,

Peng²,

Zhang³

et al. 2022

Quant Imaging Med Surg

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“…Fourth, the authors concentrated on two different sections which maybe not sufficiently manifest the overall AWE conditions of FIAs. More accurate methods like 3D space technology should be carried out in the future ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Comparisons between cross-section and long-axis-section in the quantification of aneurysmal wall enhancement of fusiform intracranial aneurysms in identifying aneurysmal symptoms

et al. 2022

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BackgroundTo investigate the quantification of aneurysmal wall enhancement (AWE) in fusiform intracranial aneurysms (FIAs) and to compare AWE parameters based on different sections of FIAs in identifying aneurysm symptoms.MethodsConsecutive patients were prospectively recruited from February 2017 to November 2019. Aneurysm-related symptoms were defined as sentinel headache and oculomotor nerve palsy. All patients underwent high resolution magnetic resonance imaging (HR-MRI) protocol, including both pre and post-contrast imaging. CRstalk (signal intensity of FIAs' wall divided by pituitary infundibulum) was evaluated both in the cross-section (CRstalk−cross) and the long-axis section (CRstalk−long) of FIAs. Aneurysm characteristics include the maximal diameter of the cross-section (Dmax), the maximal length of the long-axis section (Lmax), location, type, and mural thrombus. The performance of parameters for differentiating symptomatic and asymptomatic FIAs was obtained and compared by a receiver operating characteristic (ROC) curve.ResultsForty-three FIAs were found in 43 patients. Eighteen (41.9%) patients who presented with aneurysmal symptoms were classified in the symptomatic group. In univariate analysis, male sex (P = 0.133), age (P = 0.013), FIAs type (P = 0.167), mural thrombus (P = 0.130), Lmax (P = 0.066), CRstalk−cross (P = 0.027), and CRstalk−long (P = 0.055) tended to be associated with aneurysmal symptoms. In the cross-section model of multivariate analysis, male (P = 0.038), age (P = 0.018), and CRstalk−cross (P = 0.048) were independently associated with aneurysmal symptoms. In the long-axis section model of multivariate analysis, male (P = 0.040), age (P = 0.010), CRstalk−long (P = 0.046), and Lmax (P = 0.019) were independently associated with aneurysmal symptoms. In the combination model of multivariate analysis, male (P = 0.027), age (P = 0.011), CRstalk−cross (P = 0.030), and Lmax (P = 0.020) were independently associated with aneurysmal symptoms. CRstalk−cross has the highest accuracy in predicting aneurysmal symptoms (AUC = 0.701). The combination of CRstalk−cross and Lmax exhibited the highest performance in discriminating symptomatic from asymptomatic FIAs (AUC = 0.780).ConclusionAneurysmal wall enhancement is associated with symptomatic FIAs. CRstalk−cross and Lmax were independent risk factors for aneurysmal symptoms. The combination of these two factors may improve the predictive performance of aneurysmal symptoms and may also help to stratify the instability of FIAs in future studies.

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“…Specific imaging parameters are described in online supplemental table S1. T1 and T1+Gd images were isotropically resampled, denoised, and registered 12. The range of raw signal intensity (SI) values did not change after processing.…”

Section: Methodsmentioning

confidence: 99%

“…A post-acquisition pipeline developed for 7T-MRI was adapted to 3T-MRI. The goal of this semi-automated method was to generate 3D-AWE maps of the entire aneurysm 12. Manual segmentations of the aneurysm sac and parent vessel were created using T1 images.…”

Section: Methodsmentioning

confidence: 99%

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3D aneurysm wall enhancement is associated with symptomatic presentation

Raghuram

Sanchez

Wendt

et al. 2022

J NeuroIntervent Surg

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BackgroundAneurysm wall enhancement (AWE) is a potential surrogate biomarker for aneurysm instability. Previous studies have assessed AWE using 2D multiplanar methods, most of which were conducted qualitatively.ObjectiveTo use a new quantitative tool to analyze a large cohort of saccular aneurysms with 3D-AWE mapsMethodsSaccular aneurysms were imaged prospectively with 3T high resolution MRI. 3D-AWE maps of symptomatic (defined as ruptured or presentation with sentinel headache/cranial nerve neuropathy) and asymptomatic aneurysms were created by extending orthogonal probes from the aneurysm lumen into the wall. Three metrics were used to characterize enhancement: 3D circumferential AWE (3D-CAWE), aneurysm-specific contrast uptake (SAWE), and focal AWE (FAWE). Aneurysms with a circumferential AWE higher than the corpus callosum (3D-CAWE ≥1) were classified as 3D-CAWE+. Symptomatic presentation was analyzed with univariate and multivariate logistic models. Aneurysm size, size ratio, aspect ratio, irregular morphology, and PHASES and ELAPSS scores were compared with the new AWE metrics. Bleb and microhemorrhage analyses were also performed.ResultsNinety-three aneurysms were analyzed. 3D-CAWE, SAWE, and FAWE were associated with symptomatic status (OR=1.34, 1.25, and 1.08, respectively). A multivariate model including aneurysm size, 3D-CAWE+, age, female gender, and FAWE detected symptomatic status with 80% specificity and 90% sensitivity (area under the curve=0.914, =0.967). FAWE was also associated with irregular morphology and high-risk location (p=0.043 and p=0.001, respectively). In general, blebs enhanced 56% more than the aneurysm body. Areas of microhemorrhage co-localized with areas of increased SAWE (p=0.047).Conclusions3D-AWE mapping provides a new set of metrics that could potentially improve the identification of symptomatic aneurysms.

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Semiautomated 3D mapping of aneurysmal wall enhancement with 7T-MRI

Cited by 20 publications

References 52 publications

Aneurysmal wall enhancement and hemodynamics: pixel-level correlation between spatial distribution

Aneurysmal wall enhancement and hemodynamics: pixel-level correlation between spatial distribution

Comparisons between cross-section and long-axis-section in the quantification of aneurysmal wall enhancement of fusiform intracranial aneurysms in identifying aneurysmal symptoms

3D aneurysm wall enhancement is associated with symptomatic presentation

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