E-079 High intramural signal on T1-weighted vessel wall imaging predicts growth of non-saccular intracranial aneurysms

Author(s):  
Y Fang ◽  
W Brinjikji ◽  
I Radovanovic ◽  
J Byun ◽  
D Mandell ◽  
...  
Stroke ◽  
2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Joseph S. Hudson ◽  
Mario Zanaty ◽  
Daichi Nakagawa ◽  
David K. Kung ◽  
Pascal Jabbour ◽  
...  

2019 ◽  
Vol 131 (4) ◽  
pp. 1262-1268 ◽  
Author(s):  
Shunsuke Omodaka ◽  
Hidenori Endo ◽  
Kuniyasu Niizuma ◽  
Miki Fujimura ◽  
Takashi Inoue ◽  
...  

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.


2019 ◽  
Vol 11 (11) ◽  
pp. 1105-1112 ◽  
Author(s):  
Edgar A Samaniego ◽  
Jorge A Roa ◽  
David Hasan

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.


2019 ◽  
Vol 132 ◽  
pp. e775-e782 ◽  
Author(s):  
Yukishige Hashimoto ◽  
Toshinori Matsushige ◽  
Koji Shimonaga ◽  
Masahiro Hosogai ◽  
Mayumi Kaneko ◽  
...  

2018 ◽  
Vol 50 (1) ◽  
pp. 193-200 ◽  
Author(s):  
Bing Tian ◽  
Shahed Toossi ◽  
Laura Eisenmenger ◽  
Farshid Faraji ◽  
Megan K. Ballweber ◽  
...  

2020 ◽  
Vol 62 (12) ◽  
pp. 1627-1635 ◽  
Author(s):  
Naomi Larsen ◽  
Charlotte Flüh ◽  
Sylvia Saalfeld ◽  
Samuel Voß ◽  
Georg Hille ◽  
...  

Abstract Purpose Circumferential enhancement on MR vessel wall imaging has been proposed as a biomarker of a higher risk of rupture in intracranial aneurysms. Focal enhancement is frequently encountered in unruptured aneurysms, but its implication for risk stratification and patient management remains unclear. This study investigates the association of focal wall enhancement with hemodynamic and morphological risk factors and histologic markers of wall inflammation and degeneration. Methods Patients with an unruptured middle cerebral artery aneurysm who underwent 3D rotational angiography and 3T MR vessel wall imaging showing focal wall enhancement were included. Hemodynamic parameters were calculated based on flow simulations and compared between enhanced regions and the entire aneurysm surface. Morphological parameters were semiautomatically extracted and quantitatively associated with wall enhancement. Histological analysis included detection of vasa vasorum, CD34, and myeloperoxidase staining in a subset of patients. Results Twenty-two aneurysms were analyzed. Enhanced regions were significantly associated with lower AWSS, lower maxOSI, and increased LSA. In multivariate analysis, higher ellipticity index was an independent predictor of wall enhancement. Histologic signs of inflammation and degeneration and higher PHASES score were significantly associated with focal enhancement. Conclusion Focal wall enhancement is colocalized with hemodynamic factors that have been related to a higher rupture risk. It is correlated with morphological factors linked to rupture risk, higher PHASES score, and histologic markers of wall destabilization. The results support the hypothesis that focal enhancement could serve as a surrogate marker for aneurysm instability.


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