Circumferential Wall Enhancement on Magnetic Resonance Imaging is Useful to Identify Rupture Site in Patients with Multiple Cerebral Aneurysms

Abstract BACKGROUND Identification of rupture sites in patients with multiple intracranial aneurysms is largely based on aneurysm size, location, and shape. Finding circumferential enhancement along the aneurysm wall (CEAW) on magnetic resonance (MR) vessel wall imaging was recently shown to be indicative of ruptured aneurysm. OBJECTIVE To investigate the hypothesis that a higher degree of CEAW would identify the site of rupture in patients with multiple aneurysms. METHODS We prospectively performed quantitative analysis of CEAW in consecutive patients with both aneurysmal subarachnoid hemorrhage and multiple aneurysms (26 patients with a total of 62 aneurysms), using MR vessel wall imaging. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast media, and the wall enhancement index (WEI) was calculated. Aneurysm characteristics (size, location, irregular shape, aspect ratio [neck-to-dome length/neck width], and WEI) were compared between ruptured and unruptured aneurysms. Odds ratios with 95% confidence intervals for ruptures were calculated with conditional univariable logistic regression analysis. Analyses were repeated after adjustment for aneurysm size. RESULTS Large aneurysm size, high aspect ratio, WEI (above the median values), and irregular shape were significantly associated with aneurysm rupture. After adjustment for aneurysm size, WEI (adjusted odds ratio: 8.8; 95% confidence interval, 1.1-72.6) as well as irregular shape and aspect ratio showed a strong association with rupture. CONCLUSION CEAW is associated with rupture of intracranial aneurysm independent of aneurysm size and patient characteristics. Contrast-enhanced MR vessel wall imaging helps to identify the site of rupture in patients with multiple aneurysms.

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Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging

Journal of Neurosurgery ◽

10.3171/2018.5.jns18322 ◽

2019 ◽

Vol 131 (4) ◽

pp. 1262-1268 ◽

Cited By ~ 8

Author(s):

Shunsuke Omodaka ◽

Hidenori Endo ◽

Kuniyasu Niizuma ◽

Miki Fujimura ◽

Takashi Inoue ◽

...

Keyword(s):

Vessel Wall ◽

Intracranial Aneurysms ◽

Contrast Ratio ◽

Multivariable Analysis ◽

Vessel Wall Imaging ◽

Fast Spin Echo ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Aneurysm Wall ◽

Wall Imaging

OBJECTIVERecent MR vessel wall imaging studies have indicated intracranial aneurysms in the active state could show circumferential enhancement along the aneurysm wall (CEAW). While ruptured aneurysms frequently show CEAW, CEAW in unruptured aneurysms at the evolving state (i.e., growing or symptomatic) has not been studied in detail. The authors quantitatively assessed the degree of CEAW in evolving unruptured aneurysms by comparing it separately to that in stable unruptured and ruptured aneurysms.METHODSA quantitative analysis of CEAW was performed in 26 consecutive evolving aneurysms using MR vessel wall imaging. Three-dimensional T1-weighted fast spin echo sequences were obtained before and after contrast media injection, and the contrast ratio of the aneurysm wall against the pituitary stalk (CRstalk) was calculated as the indicator of CEAW. Aneurysm characteristics of evolving aneurysms were compared with those of 69 stable unruptured and 67 ruptured aneurysms.RESULTSThe CRstalk values in evolving aneurysms were significantly higher than those in stable aneurysms (0.54 vs 0.34, p < 0.0001), and lower than those in ruptured aneurysms (0.54 vs 0.83, p < 0.0002). In multivariable analysis, CRstalk remained significant when comparing evolving with stable aneurysms (odds ratio [OR] 12.23, 95% confidence interval [CI] 3.53–42.41), and with ruptured aneurysms (OR 0.083, 95% CI 0.022–0.310).CONCLUSIONSThe CEAW in evolving aneurysms was higher than those in stable aneurysms, and lower than those in ruptured aneurysms. The degree of CEAW may indicate the process leading to rupture of intracranial aneurysms, which can be useful additional information to determine an indication for surgical treatment of unruptured aneurysms.

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Concentration of Lp(a) (Lipoprotein[a]) in Aneurysm Sac Is Associated With Wall Enhancement of Unruptured Intracranial Aneurysm

Stroke ◽

10.1161/strokeaha.120.032304 ◽

2021 ◽

Author(s):

Daizo Ishii ◽

Mario Zanaty ◽

Jorge A. Roa ◽

Luyuan Li ◽

Yongjun Lu ◽

...

Keyword(s):

Magnetic Resonance ◽

Vessel Wall ◽

Degenerative Change ◽

Vessel Wall Imaging ◽

Parent Artery ◽

Lipoprotein A ◽

Aneurysm Wall ◽

Unruptured Intracranial Aneurysms ◽

A Prospective Study ◽

Wall Imaging

Background and Purpose: Atherosclerotic remodeling of the aneurysm wall, which could be detected as aneurysm wall enhancement (AWE) by magnetic resonance–vessel wall imaging, is a part of degenerative change of unruptured intracranial aneurysms (UIAs). The purpose of this study was to determine whether the luminal concentrations of atherosclerotic proteins in the aneurysm sac were associated with increased wall enhancement of UIAs in vessel wall imaging. Methods: We performed a prospective study of subjects undergoing endovascular treatments for UIAs. All subjects underwent evaluation using 3T–magnetic resonance imaging, including pre/postcontrast vessel wall imaging of the UIAs. Blood samples were collected from the aneurysm sac and the parent artery during endovascular procedures. Presence/absence of AWE was correlated with the delta difference in concentration for each atherosclerotic protein between the lumen of UIA and in the parent artery. Results: A total of consecutive 17 patients with 19 UIAs were enrolled. The delta difference of lipoprotein(a) was significantly higher in UIAs with AWE compared with those without AWE (−6.9±16.0 versus −45.4±44.9 μg/mL, P =0.03). Conclusions: Higher luminal concentrations of lipoprotein(a) in the aneurysm sac were significantly associated with increased wall enhancement of UIAs. A larger study is needed to confirm these findings.

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Role of magnetic resonance vessel wall imaging in detecting and managing ruptured aneurysms among multiple intracranial aneurysms

Surgical Neurology International ◽

10.25259/sni_618_2021 ◽

2021 ◽

Vol 12 ◽

pp. 460

Author(s):

Kohei Yoshikawa ◽

Junta Moroi ◽

Kohei Kokubun ◽

Nobuharu Furuya ◽

Yasuyuki Yoshida ◽

...

Keyword(s):

Magnetic Resonance ◽

Vessel Wall ◽

Intracranial Aneurysms ◽

Vessel Wall Imaging ◽

Multiple Intracranial Aneurysms ◽

Unruptured Aneurysms ◽

Multiple Aneurysms ◽

Ruptured Aneurysms ◽

Rupture Site ◽

Wall Imaging

Background: Wall enhancement of intracranial saccular aneurysms in high-resolution magnetic resonance vessel wall imaging (MR-VWI) might indicate a ruptured aneurysm. Therefore, this study aimed to determine the diagnostic ability of wall enhancement to detect the ruptured aneurysms among multiple aneurysms. Methods: Patients with subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms who underwent MR-VWI before craniotomy and clipping were included in the study. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after gadolinium injection. Aneurysm rupture was estimated based on the subarachnoid clot distribution, aneurysmal contours, and MR-VWI findings. We selectively performed surgical clipping and confirmed the rupture site intraoperatively. Results: Thirteen patients with SAH with 13 ruptured and 17 unruptured aneurysms were treated at out facility. The accuracy rate of rupture site diagnosis using MR-VWI was 69.2% (9/13 cases). Each unruptured aneurysm was equally or more strongly enhanced in the other four cases than the ruptured aneurysms. In three of the four unruptured aneurysms with positive MR-VWI findings, atherosclerosis of the aneurysmal wall was observed during simultaneous or elective clipping surgery. Further, clipping surgery was performed without intraoperative rupture in two cases with the help of MR-VWI findings. Conclusion: Correct diagnosis of the rupture site using MR-VWI alone was unreliable due to false positives caused by the wall enhancement of unruptured aneurysms with atherosclerosis. Therefore, ruptured aneurysms should be detected using more information in addition to MR-VWI images. MR-VWI may be advantageous to determine surgical strategies when managing patients with SAH and multiple aneurysms.

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Wall Enhancement in Evolving Cerebral Aneurysms on Magnetic Resonance Vessel Wall Imaging

Neurosurgery ◽

10.1093/neuros/nyz310_300 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Cited By ~ 2

Author(s):

Shunsuke Omodaka ◽

Hidenori Endo ◽

Kuniyasu Niizuma ◽

Miki Fujimura ◽

Takashi Inoue ◽

...

Keyword(s):

Magnetic Resonance ◽

Confidence Interval ◽

Odds Ratio ◽

Vessel Wall ◽

Cerebral Aneurysms ◽

Vessel Wall Imaging ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Aneurysm Wall ◽

Wall Imaging

Abstract INTRODUCTION Recent magnetic resonance (MR) vessel wall imaging studies have indicated cerebral aneurysms in the active state could show wall enhancement along the aneurysm wall (CEAW). While ruptured aneurysms frequently show CEAW, CEAW in the unruptured aneurysms at evolving state, ie growing or symptomatic, has not been studied in detail. We assessed the degree of CEAW in evolving unruptured aneurysms by comparing separately with each of those in stable unruptured aneurysms and ruptured aneurysms. METHODS We performed quantitative analyses of CEAW in consecutive 26 evolving aneurysms using MR vessel wall imaging. Three-dimensional T1-weighted fast spin-echo sequence was obtained before and after contrast media injection, and the contrast ratio of aneurysm wall against the pituitary stalk (CRstalk) was calculated as the indicator of CEAW. We compared aneurysm characteristics of evolving aneurysms with those of 69 stable unruptured and 67 ruptured aneurysms. RESULTS The CRstalk in evolving aneurysms was significantly higher than those in stable aneurysms (0.54 vs 0.34; P < .0001), and lower than those in ruptured aneurysms (0.54 vs 0.83; P < .0002). In multivariable analysis, CRstalk remained significant in comparing evolving with stable aneurysms (odds ratio, 12.23; 95% confidence interval, 3.53-42.41), and with ruptured aneurysms (odds ratio, 0.083; 95% confidence interval, 0.022-0.310). CONCLUSION The CEAW in evolving aneurysms was higher than those in stable aneurysms, and lower than those in ruptured aneurysms.

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