2018
DOI: 10.1002/jmri.26553
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Visualizing wall enhancement over time in unruptured intracranial aneurysms using 3D vessel wall imaging

Abstract: Background Few studies directed at assessing the visualization of the walls of unruptured aneurysms have used higher‐resolution 3D MRI vessel wall imaging. Prospective longitudinal studies are also needed to screen vessel wall changes in unruptured aneurysms. Purpose To compare the aneurysm wall visualization on pre‐ and post‐3D isotropic T1‐weighted Sampling Perfection with Application‐optimized Contrasts by using different flip angle Evolutions (SPACE) images and to explore whether there is a change in wall … Show more

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Cited by 13 publications
(9 citation statements)
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“…Although many studies support the relationship between vessel wall “enhancement” and vessel rupture and/or instability, several complicating factors exist in the imaging of vascular lesions. For one, some studies are now finding that a proportion of vascular malformations that enhance demonstrate persistent and stable “enhancement” over time with no symptomatology or subsequent rupture ( Tian et al, 2019 ). This persistent hyperintensity on imaging could indicate remodeled vessel wall without active inflammation as well as true persistent inflammatory changes; however, more studies and larger, longitudinal studies are needed to investigate if symptomology, rupture, and/or mortality are associated with vessel wall hyperintensity as well as histopathologic correlation with sites of enhancement versus non-enhancement.…”
Section: Discussionmentioning
confidence: 99%
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“…Although many studies support the relationship between vessel wall “enhancement” and vessel rupture and/or instability, several complicating factors exist in the imaging of vascular lesions. For one, some studies are now finding that a proportion of vascular malformations that enhance demonstrate persistent and stable “enhancement” over time with no symptomatology or subsequent rupture ( Tian et al, 2019 ). This persistent hyperintensity on imaging could indicate remodeled vessel wall without active inflammation as well as true persistent inflammatory changes; however, more studies and larger, longitudinal studies are needed to investigate if symptomology, rupture, and/or mortality are associated with vessel wall hyperintensity as well as histopathologic correlation with sites of enhancement versus non-enhancement.…”
Section: Discussionmentioning
confidence: 99%
“…Some of the most commonly employed VW-MRI sequences are variable refocusing flip angle (VRFA) sequences with T1 or proton density-weighted pre- and post-contrast imaging (VISTA; Philips Healthcare), sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE; Siemens), and CUBE software (GE Healthcare) ( Young et al, 2019 ). While VRFA sequences are adequate in most cases, because gadolinium shortens T1 relaxation time, “black blood” suppression in areas of abnormal or even normal in-plane flow can be diminished, potentially causing unsuppressed contrast in flowing blood, artifactually appearing as vessel wall contrast “enhancement.” Examples of this are seen with turbulence and recirculation within aneurysms, slow flow within dilated lumens, and retrograde filling of distal collateral branches with proximal occlusion ( Mandell et al, 2017 ; Tian et al, 2019 ); however, this altered blood flow leading to potential incomplete suppression on VFRA sequences may in and off itself be a high risk feature, such as areas of low wall sheer stress in aneurysms ( Boussel et al, 2008 ), although this hypothesis has yet to be well investigated. Preparation pulses can be helpful in cases where this flow-related artifact is occurring, such as motion-sensitized driven equilibrium (MSDE) which uses flow-sensitive dephasing gradients ( Young et al, 2019 ).…”
Section: Discussionmentioning
confidence: 99%
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“…Viewing the two studies side by side will allow rapid identification of the territory of interest from the CE-MRA and represents an approach that would be useful in the clinical setting. [20][21][22] Two neuroradiologists (with >10 years and >5 years of experience in vascular neuroimaging, respectively), who will be blinded to the clinical data but aware of the patients' aneurysm location(s), will independently review the images with a workstation (syngo workstation; Siemens Healthineers, Erlangen, Germany). Qualitative wall enhancement scores and quantitative parameters will be assigned.…”
Section: Image Analysismentioning
confidence: 99%
“…Aneurysm wall signal intensity equal to or greater than that of the pituitary infundibulum will be regarded as enhancement. A scale of 0-5 will be used to grade the aneurysm wall enhancement, with 0 signifying that the aneurysm wall has significant artefacts and/or it is not possible to determine whether the vessel wall is enhanced, 22 1 signifying no enhancement, 2 signifying aneurysm wall enhancement over <25% of the aneurysm surface, 3 signifying wall enhancement over 25%-50% of the aneurysm surface, 4 signifying wall enhancement over 50%-75% of the aneurysm surface and 5 signifying wall enhancement over >75% of the aneurysm surface.…”
Section: Image Analysismentioning
confidence: 99%