Determinants of Gadolinium-Enhancement of the Aneurysm Wall in Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 719-725 ◽  
Author(s):  
Daan Backes ◽  
Jeroen Hendrikse ◽  
Irene van der Schaaf ◽  
Ale Algra ◽  
Antti E Lindgren ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Gadolinium Enhancement ◽  
Adjusted Risk ◽  
Aneurysm Size ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Growth ◽  
Risk Ratios ◽  
Aneurysm Shape ◽  
Wall Imaging

Abstract BACKGROUND Recent studies suggest that gadolinium-enhancement of the aneurysm wall may reflect aneurysm wall inflammation, which might increase the risk of aneurysm growth or rupture. OBJECTIVE To determine the prevalence of gadolinium-enhancement and its determinants in patients with predominantly small (<7 mm) unruptured intracranial aneurysms. METHODS We performed 3 T MRI aneurysm wall imaging in patients with ≥1 unruptured aneurysm. With Poisson regression analysis, we calculated crude and adjusted risk ratios (RRs) with 95% confidence intervals (CI) to assess determinants of gadolinium-enhancement. RESULTS Gadolinium-enhancement was observed in 25/79 patients (32%; 95% CI: 21%-42%) and 26/89 aneurysms (29%; 95% CI: 20%-39%). With aneurysms 1.0-2.9 mm as reference, RRs were 4.6 (95% CI: 0.6-36.5) for 3.0 to 4.9 mm, 9.4 (95% CI: 1.3-67.2) for 5.0 to 6.9 mm, and 14.8 (95% CI: 2.1-104.6) for ≥7.0 mm. With internal carotid artery as reference, RRs adjusted for aneurysm size were 3.6 (95% CI: 1.1-11.4) for posterior communicating artery and 3.0 (95% CI: 1.0-8.6) for middle cerebral artery. RRs were 0.8 (95% CI: 0.4-1.8) for acetylsalicylic acid use, 0.9 (95% CI: 0.5-1.8) for statin use, 1.4 (95% CI: 0.7-2.8) for hypertension, 0.9 (95% CI: 0.4-1.8) for previous smoking, 0.9 (95% CI: 0.3-2.6) for never smoking, and 1.4 (95% CI: 0.7-2.7) for irregular aneurysm shape. CONCLUSION Approximately one-third of patients had gadolinium-enhancement. Because aneurysm size is the strongest determinant of gadolinium-enhancement and also an established predictor for aneurysm growth and rupture, prospective studies with serial imaging need to investigate if gadolinium-enhancement predicts aneurysm growth and rupture.

Segmentation of aneurysm wall enhancement in evolving unruptured intracranial aneurysms

2021 ◽  
pp. 1-7
Author(s):  
Yukishige Hashimoto ◽  
Toshinori Matsushige ◽  
Reo Kawano ◽  
Koji Shimonaga ◽  
Michitsura Yoshiyama ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Morphological Changes ◽  
Growth Patterns ◽  
Maximum Diameter ◽  
Aneurysm Formation ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Growth ◽  
Wall Imaging

OBJECTIVE Morphological changes in unruptured intracranial aneurysms (UIAs) are an imaging marker of aneurysm instability. Recent studies have indicated the ability of MR vessel wall imaging (VWI) to stratify unstable UIAs based on a correlation with histopathological aneurysm wall inflammation. In the present study the authors investigated the relationships between aneurysm growth patterns and the segmentation of aneurysm wall enhancement (AWE) in VWI. METHODS A total of 120 aneurysms with serial angiography from a follow-up period of at least 2 years (mean 65 months, range 24–215 months) were assessed by VWI. Two readers independently evaluated the patterns of morphological changes (stable, whole sac expansion, and secondary aneurysm formation) and the segmentation of AWE (no, focal, and circumferential AWE). The contrast enhancement ratio of the aneurysm wall versus the pituitary stalk (CRstalk) was calculated for the quantitative assessment of AWE. Statistical analyses were performed to investigate the relationships between AWE patterns and patient baseline profiles, aneurysm characteristics, and morphological modifications. RESULTS Forty-one of 120 UIAs (34%) exhibited aneurysm growth (whole sac expansion in 19 and secondary aneurysm formation in 22). AWE was detected in 35 of 120 UIAs (focal AWE in 25 and circumferential AWE in 10). The maximum diameter of, irregularities in, and morphological modifications in aneurysms were associated with the segmentation of AWE. Focal AWE correlated with secondary aneurysm formation, and circumferential AWE correlated with whole sac expansion. In focal AWE, CRstalk was significantly higher in secondary aneurysm formation than in stable UIAs. UIAs without AWE (categorized as no AWE) correlated with aneurysm stability. CONCLUSIONS The segmentation of AWE was associated with aneurysm growth scenarios and may provide a novel insight into the evaluation of unstable UIAs.

scholarly journals Detection of wall and neck calcification of unruptured intracranial aneurysms with flat-detector computed tomography

2016 ◽  
Vol 22 (3) ◽  
pp. 293-298 ◽  
Author(s):  
Osman Kizilkilic ◽  
Eldeniz Huseynov ◽  
Sedat G Kandemirli ◽  
Naci Kocer ◽  
Civan Islak
Keyword(s):  
Computed Tomography ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Flat Detector ◽  
Patient Age ◽  
Flat Detector Computed Tomography ◽  
Aneurysm Size ◽  
Aneurysm Wall ◽  
Patient Âgé ◽  
Unruptured Intracranial Aneurysms

Object Microsurgical clipping is a widely used surgical technique in intracranial aneurysm treatment. It can be difficult in large sized aneurysms, and those with wide necks, thick walls and calcification located in the vicinity of the neck. This study reviewed calcification of the intracranial aneurysm wall and its relation to patient age, gender, location and size of the aneurysm. A possible cut-off value after which the aneurysm calcification rate increases was also investigated to classify patients’ risk factors for microclipping. Methods A retrospective review of all unruptured intracranial aneurysms that underwent digital subtraction angiography at a single centre was performed. Flat-detector computed tomography images of the aneurysm were reviewed for aneurysm location, size and calcification. The independent samples t test and χ2 test were used to show the relation between aneurysm wall calcification and patient age, gender, aneurysm localisation and size. Results None of the reviewed factors were statistically significantly related to aneurysm calcification except aneurysm size ( P < 0.01). Receiver operating characteristic curves showed aneurysms greater than 10.5 mm could be predicted to be calcified with a sensitivity of 80% and specificity of 63%. Conclusion In this study, the presence of calcification was related to aneurysm size. Larger aneurysms were more likely to be calcified. Aneurysms greater than 10.5 mm should be further investigated with a modality such as flat-detector computed tomography to show the calcification in detail, especially if microclipping is considered.

scholarly journals Objective quantification of contrast enhancement of unruptured intracranial aneurysms: a high-resolution vessel wall imaging validation study

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Jorge A. Roa ◽  
Mario Zanaty ◽  
Carlos Osorno-Cruz ◽  
Daizo Ishii ◽  
Girish Bathla ◽  
...  
Keyword(s):  
High Resolution ◽  
Contrast Enhancement ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Pituitary Stalk ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
The Mean ◽  
Objective Quantification ◽  
Wall Imaging

OBJECTIVEHigh-resolution vessel wall imaging (HR-VWI) has emerged as a valuable tool in assessing unruptured intracranial aneurysms (UIAs). There is no standardized method to quantify contrast enhancement of the aneurysm wall. Contrast enhancement can be objectively measured as signal intensity (SI) or subjectively adjudicated. In this study, the authors compared the different methods to quantify wall enhancement of UIAs and determined the sensitivity and specificity of each method as a surrogate of aneurysm instability. They also compared SI quantification between scanners from different manufacturers.METHODSThe University of Iowa HR-VWI Project database was analyzed. This database compiles patients with UIAs who prospectively underwent HR-VWI using a 3T MRI scanner. The mean and maximal SI values of the aneurysm wall, pituitary stalk, and genu of the corpus callosum were used to compare 3 different measurement methods: 1) aneurysm enhancement ratio AER = (SIwall post − SIwall pre)/SIwall pre; 2) aneurysm-to–pituitary stalk contrast ratio CRstalk = SIwall post/SIstalk post; and 3) aneurysm enhancement index AEI = ([SIwall post/SIbrain post] − [SIwall pre/SIbrain pre])/(SIwall pre/SIbrain pre) (where “pre” indicates precontrast images and “post” indicates postcontrast images). Size ≥ 7 mm was used as a surrogate of aneurysm instability for receiver operating characteristic (ROC) curve analysis. To determine if the objective quantification of SI varies among scanners from different manufacturers, 9 UIAs underwent the same HR-VWI protocol using a 3T General Electric (GE) scanner and a 3T Siemens scanner. Three UIAs also underwent a third scanning procedure on a unit with a different magnet strength (7T GE).RESULTSEighty patients with 102 UIAs were included in the study. The mean age was 64.5 ± 12.2 years, and 64 (80%) patients were women. UIAs ≥ 7 mm had significantly higher SIs than smaller UIAs (< 7 mm): AER = 0.82 vs 0.49, p < 0.001; CRstalk = 0.84 vs 0.61, p < 0.001; and AEI = 0.81 vs 0.48, p < 0.001. ROC curves demonstrated optimal sensitivity of 81.5% for CRstalk ≥ 0.60, 75.9% for AEI ≥ 0.50, and 74.1% for AER ≥ 0.49. Intermanufacturer correlation between 3T GE and 3T Siemens MRI scanners for CRstalk using mean and maximal SI values was excellent (Pearson coefficients > 0.80, p < 0.001). A similar correlation was identified among the 3 UIAs that underwent 7T imaging.CONCLUSIONSCRstalk using maximal SI values was the most reliable objective method to quantify enhancement of UIAs on HR-VWI. The same ratios were obtained between different manufacturers and on scans obtained using magnets of different strengths.

scholarly journals Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

2020 ◽  
pp. 159101992095953
Author(s):  
Dylan Noblett ◽  
Lotfi Hacein-Bey ◽  
Ben Waldau ◽  
Jordan Ziegler ◽  
Brian Dahlin ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Methamphetamine Use ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
History Of

Background Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. Objective We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Materials and methods Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. Results A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Conclusions Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

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

2019 ◽  
Vol 131 (4) ◽  
pp. 1262-1268 ◽  
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.

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ashrita Raghuram ◽  
Alberto Varon ◽  
Jorge A. Roa ◽  
Daizo Ishii ◽  
Yongjun Lu ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
3D Imaging ◽  
High Resolution Imaging ◽  
Biological Processes ◽  
Automated Method ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Potential Biomarker ◽  
Resolution Imaging ◽  
Objective Tool

AbstractAneurysm wall enhancement (AWE) after the administration of contrast gadolinium is a potential biomarker of unstable intracranial aneurysms. While most studies determine AWE subjectively, this study comprehensively quantified AWE in 3D imaging using a semi-automated method. Thirty patients with 33 unruptured intracranial aneurysms prospectively underwent high-resolution imaging with 7T-MRI. The signal intensity (SI) of the aneurysm wall was mapped and normalized to the pituitary stalk (PS) and corpus callosum (CC). The CC proved to be a more reliable normalizing structure in detecting contrast enhancement (p < 0.0001). 3D-heatmaps and histogram analysis of AWE were used to generate the following metrics: specific aneurysm wall enhancement (SAWE), general aneurysm wall enhancement (GAWE) and focal aneurysm wall enhancement (FAWE). GAWE was more accurate in detecting known morphological determinants of aneurysm instability such as size ≥ 7 mm (p = 0.049), size ratio (p = 0.01) and aspect ratio (p = 0.002). SAWE and FAWE were aneurysm specific metrics used to characterize enhancement patterns within the aneurysm wall and the distribution of enhancement along the aneurysm. Blebs were easily identified on 3D-heatmaps and were more enhancing than aneurysm sacs (p = 0.0017). 3D-AWE mapping may be a powerful objective tool in characterizing different biological processes of the aneurysm wall.

scholarly journals Vessel wall imaging in intracranial aneurysms

2019 ◽  
Vol 11 (11) ◽  
pp. 1105-1112 ◽  
Author(s):  
Edgar A Samaniego ◽  
Jorge A Roa ◽  
David Hasan
Keyword(s):  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Current Evidence ◽  
Clinical Use ◽  
Quantitative Susceptibility Mapping ◽  
Aneurysm Wall ◽  
Brain Aneurysms ◽  
Wall Imaging

High-resolution vessel wall imaging (HR-VWI) is becoming a useful tool in the characterization and identification of unstable unruptured brain aneurysms. However, it has not been validated for clinical use. The current evidence on HR-VWI techniques for characterization of brain aneurysms is described in this review. Specific imaging approaches such as aneurysm wall contrast enhancement, MRI-quantitative susceptibility mapping, and 7T MRI are described in detail.

Vessel Wall Imaging Predicts the Presence of Atherosclerotic Lesions in Unruptured Intracranial Aneurysms

2019 ◽  
Vol 132 ◽  
pp. e775-e782 ◽  
Author(s):  
Yukishige Hashimoto ◽  
Toshinori Matsushige ◽  
Koji Shimonaga ◽  
Masahiro Hosogai ◽  
Mayumi Kaneko ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Atherosclerotic Lesions ◽  
Unruptured Intracranial Aneurysms ◽  
Wall Imaging
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