Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm

Hu, Peng; Yang, Qi; Wang, Dandan; Guan, Shaochen; Zhang, Hongqi

doi:10.1007/s00234-016-1729-3

Cited by 105 publications

(84 citation statements)

References 20 publications

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“…5,9 Hu et al 5 found evidence of inflammation of the aneurysm wall through pathological studies and proved that aneurysm wall enhancement on HRMRI is highly consistent with pathological changes of inflammation. According to a report by Iihara et al 6 regarding resection of a VBDA with a huge IMH, pathological evidence of inflammatory cell infiltration was present in the IMH.…”

Section: Discussionmentioning

confidence: 95%

“…4,15 Wall enhancement of a saccular aneurysm on HRMRI is a proven sign of inflammatory change and might predict an unsteady state of an intracranial saccular aneurysm. 5,9 However, few studies have focused on wall enhancement of VBDAs. We hypothesized that wall enhancement might also predict an unsteady state of a VBDA as well as its progression after reconstructive EVT.…”

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confidence: 99%

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

Zhang

Sui

Liu

et al. 2018

Journal of Neurosurgery

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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...

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Section: Discussionmentioning

confidence: 95%

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confidence: 99%

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

Zhang

Sui

Liu

et al. 2018

Journal of Neurosurgery

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“…Intracranial vessel wall imaging was initially developed to aid in the diagnosis of CNS angiitis; subsequently, it was used for intracranial atherosclerosis, Moyamoya disease and intracranial aneurysms 3. Several papers have reported partial or circumferential wall enhancement in ruptured aneurysms but also in aneurysms exerting mass effect, partial thrombosis and evolving size/morphology 2 3.…”

Section: Discussionmentioning

confidence: 99%

“…Several papers have reported partial or circumferential wall enhancement in ruptured aneurysms but also in aneurysms exerting mass effect, partial thrombosis and evolving size/morphology 2 3. In all situations, enhancement is considered to be a sign of wall inflammation.…”

Section: Discussionmentioning

confidence: 99%

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Republished: Aneurysmal wall imaging in a case of cortical superficial siderosis and multiple unruptured aneurysms

Yalo

Pop

Зинченко

et al. 2016

J NeuroIntervent Surg

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We report a case of interhemispheric and bifrontal cortical superficial siderosis in association with two intracranial aneurysms. The patient had no clinical history suggestive of aneurysm rupture, no feature of amyloid angiopathy or other apparent etiology for cortical siderosis. We performed high resolution brain MRI with dark blood T1 sequences before and after IV contrast injection. An anterior communicating aneurysm showed partial wall enhancement on the posterior wall whereas a left posterior communicating aneurysm did not. In the light of recent reports of the association of wall enhancement with unstable aneurysms, we considered wall enhancement to be a marker of inflammation and remodeling of the aneurysm wall, resulting in chronic hemorrhagic suffusion in the subarachnoid spaces. To our knowledge, this is the first report offering proof for a possible link between apparently unruptured aneurysms and cortical siderosis.

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Circumferential wall enhancement with contrast ratio measurement in unruptured intracranial aneurysm for aneurysm instability

Zhong

Wang

et al. 2022

Brain and Behavior

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Background Aneurysm wall enhancement on high‐resolution vessel wall imaging (HR‐VWI) may represent vessel wall inflammation for unruptured intracranial aneurysms (UIAs). Further evidence for the role of circumferential aneurysm wall enhancement (CAWE) in evaluating the instability of UIAs is required, especially in small aneurysms (<7 mm). Methods We analyzed patients with saccular UIAs who prospectively underwent HR‐VWI on a 3.0 T MRI scanner in our center from September 2017 to August 2021. The presence of AWE was identified and quantitatively measured using the aneurysm‐to‐pituitary stalk contrast ratio (CRstalk) with maximal signal intensity value. The PHASES and ELAPSS scores were used to assess the risk of aneurysm rupture and growth. We evaluated the association of CAWE and CRstalk value with intracranial aneurysm instability. Results One hundred patients with 109 saccular UIAs were included in this study. Eighty‐three UIAs (76.1%) had a size smaller than 7 mm. PHASES and ELAPSS scores were significantly higher in UIAs with CAWE than in UIAs without CAWE (p < .01). The association of CAWE with PHASES and ELAPSS scores remained in small UIAs (<7 mm). The optimal cutoff value of CRstalk for CAWE was 0.5. PHASES and ELAPSS scores were significantly higher in UIAs with CRstalk ≥0.5 than in UIAs with CRstalk <0.5 (p < .01). Conclusions CAWE on HR‐VWI is a valuable imaging marker for aneurysm instability in UIAs. CRstalk value ≥0.5 may be associated with a higher risk of intracranial aneurysm rupture and growth.

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Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm

Cited by 105 publications

References 20 publications

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

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

Republished: Aneurysmal wall imaging in a case of cortical superficial siderosis and multiple unruptured aneurysms

Circumferential wall enhancement with contrast ratio measurement in unruptured intracranial aneurysm for aneurysm instability

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