Increased contrast enhancement of the parent vessel of unruptured intracranial aneurysms in 7T MR imaging

2020 ◽  
Vol 12 (10) ◽  
pp. 1018-1022 ◽  
Author(s):  
Edgar A Samaniego ◽  
Jorge A Roa ◽  
Honghai Zhang ◽  
Timothy R Koscik ◽  
Santiago Ortega-Gutierrez ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Parent Vessel ◽  
Good Reliability ◽  
Post Contrast ◽  
Aneurysmal Wall ◽  
Aneurysm Formation ◽  
Unruptured Intracranial Aneurysms ◽  
Vessel Enhancement

BackgroundInflammation of the arterial wall may lead to aneurysm formation. The presence of aneurysm enhancement on high-resolution vessel wall imaging (HR-VWI) is a marker of wall inflammation and instability. We aim to determine if there is any association between increased contrast enhancement in the aneurysmal wall and its parent artery.MethodsPatients with unruptured intracranial aneurysms (UIAs) prospectively underwent 7T HR-VWI. Regions of interest were selected manually and with a semi-automated protocol based on gradient algorithms of intensity patterns. Mean signal intensities in pre- and post-contrast T1-weighted sequences were adjusted to the enhancement of the pituitary stalk and then subtracted to objectively determine: circumferential aneurysmal wall enhancement (CAWE); parent vessel enhancement (PVE); and reference vessel enhancement (RVE). PVE was assessed over regions located 3- and 5 mm from the aneurysm’s neck. RVE was assessed in arteries located in a different vascular territory.ResultsTwenty-five UIAs were analyzed. There was a significant moderate correlation between CAWE and 5 mm PVE (Pearson R=0.52, P=0.008), whereas no correlation was found between CAWE and RVE (Pearson R=0.20, P=0.33). A stronger correlation was found between CAWE and 3 mm PVE (Pearson R=0.78, P<0.001). Intra-class correlation analysis demonstrated good reliability between measurements obtained using semi-automated and manual segmentation (ICC coefficient=0.790, 95% CI 0.58 to 0.90).ConclusionParent arteries exhibit higher contrast enhancement in regions closer to the aneurysm’s neck, especially in aneurysms≥7 mm. A localized inflammatory/vasculopathic process in the wall of the parent artery may lead to aneurysm formation and growth.

Abstract 143: Increased Contrast Enhancement of the Parent Vessel of Unruptured Intracranial Aneurysms in 7T Magnetic Resonance Imaging

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jorge A Roa ◽  
Mario Zanaty ◽  
Carlos Osorno-Cruz ◽  
Avery Pazour ◽  
Daizo Ishii ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Strong Positive Correlation ◽  
Parent Vessel ◽  
Post Contrast ◽  
Aneurysm Formation ◽  
Unruptured Intracranial Aneurysms ◽  
Vessel Enhancement ◽  
Measuring Signal

Background: Aneurysm formation and growth might be explained by a local inflammatory/vasculopathic process that debilitates the wall of the parent artery. Recently, the presence of aneurysm enhancement on high-resolution vessel wall imaging (HR-VWI) has been proposed as a surrogate for vessel wall inflammation. However, no studies have correlated circumferential aneurysm wall enhancement (CAWE) and aneurysm-to-pituitary enhancement ratio (CR stalk ) on HR-VWI with parent vessel enhancement (PVE) and reference vessel enhancement (RVE). Methods: Patients with unruptured intracranial aneurysms prospectively underwent HR-VWI using 7T MRI. CAWE, CR stalk , PVE and RVE were objectively analyzed by measuring signal intensity in T1 post-contrast sequences using manual 3D co-registration and segmentation of the vessel wall. CR stalk was calculated as the ratio of post-contrast CAWE over pituitary stalk enhancement. RVE was assessed in the mid-BA for aneurysms in the anterior circulation, and the MCA (M1 segment) for posterior circulation aneurysms. Correlation statistics were performed to find any significant association between CAWE, CR stalk , PVE and RVE. Results: Nineteen patients with 20 aneurysms were included. Mean age was 68.9 ± 9.9 years old, and 16 (84.2%) were women. Pearson and Spearman coefficients’ analyses demonstrated a strong positive correlation between post-contrast CAWE and PVE (0.72 and 0.73, both P <.001), whereas the correlation between post-contrast CAWE and RVE was low (both 0.47, P =.04). A stronger correlation was found between CR stalk and post-contrast PVE (Pearson = 0.82, Spearman = 0.71, both P <.001), while the correlation between CR stalk and post-contrast RVE was negligible (Pearson = 0.33, P =.15; Spearman = 0.38, P =.09). Conclusion: This HR-VWI study shows that the parent vessel of unruptured intracranial aneurysms enhances more with contrast than vessels located in other vascular territories. This finding suggests that a local inflammatory/vasculopathic process in the wall of the parent artery may lead to aneurysm formation.

scholarly journals MR Derived Volumetric Flow Rate Waveforms of Internal Carotid Artery in Patients Treated for Unruptured Intracranial Aneurysms by Flow Diversion Technique

2015 ◽  
Vol 35 (12) ◽  
pp. 2070-2079 ◽  
Author(s):  
Omer F Eker ◽  
Karim Zouaoui Boudjeltia ◽  
Ricardo A Corredor Jerez ◽  
Emmanuelle Le Bars ◽  
Mathieu Sanchez ◽  
...  
Keyword(s):  
Flow Rate ◽  
Intracranial Aneurysms ◽  
Arterial Compliance ◽  
Cerebral Aneurysms ◽  
Volumetric Flow Rate ◽  
Control Group ◽  
Parent Artery ◽  
Parent Vessel ◽  
Corrective Effect ◽  
Unruptured Intracranial Aneurysms

Little is known about the hemodynamic disturbances induced by the cerebral aneurysms in the parent artery and the effect of flow diverter stents (FDS) on these latter. A better understanding of the aneurysm-parent vessel complex relationship may aid our understanding of this disease and to optimize its treatment. The ability of volumetric flow rate (VFR) waveform to reflect the arterial compliance modifications is well known. By analyzing the VFR waveform and the pulsatility in the parent vessel, this study aimed to test the hypotheses that (1) intracranial aneurysms might disrupt the blood flow of the parent vessel and (2) the treatment by FDS might have measurable corrective effect on these changes. Ten patients followed for unruptured intracranial aneurysms treated by FDS and ten healthy volunteers as control group were included in this study. Two-dimensional quantitative phase-contrast magnetic resonance imaging (MRI) was performed on each patient on the ICA artery upstream and downstream to the aneurysm, and on each volunteer at similar locations. The aneurysms altered significantly the parent vessel pulsatility and this effect was correlated to their volume. The aneurysms treatment by FDS allowed for the restoration of a normally modulated flow and pulsatility correction in the parent vessel.

Abstract WMP29: Contrast Enhancement Measurement of Unruptured Intracranial Aneurysms: A 3T High-Resolution Vessel Wall Imaging Validation Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jorge A Roa ◽  
Mario Zanaty ◽  
Avery Pazour ◽  
Carlos Osorno-Cruz ◽  
Daizo Ishii ◽  
...  
Keyword(s):  
High Resolution ◽  
Contrast Enhancement ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Roc Curves ◽  
Vessel Wall Imaging ◽  
Enhancement Ratio ◽  
Post Contrast ◽  
Unruptured Intracranial Aneurysms ◽  
Wall Imaging

Background: High-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 aneurysmal wall. Contrast enhancement is reflected as signal intensity (SI) at the time of objective quantification. This study compares all the existing methods to objectively quantify contrast enhancement of UIAs. Methods: 3T HR-VWI was used to prospectively image patients with UIAs. Three different methods were analyzed in T1 pre- and post-contrast sequences: (1) circumferential aneurysm wall enhancement (CAWE) = mean post-contrast SI; (2) aneurysm-to-pituitary enhancement ratio (CR stalk ) = ratio of CAWE over pituitary stalk enhancement; and (3) enhancement ratio (ER) = max post-contrast SI - max pre-contrast SI/max pre-contrast SI x 100%. Known risks factors of aneurysm instability such as size ≥7mm and location in the anterior communicating (ACOM) and basilar arteries (BA) were used for analysis. Results: Forty-seven patients with 53 UIAs were included in the study. Mean age was 63.5 years, and 35 (74.5%) were women. UIAs ≥ 7mm showed significantly higher SI measurements for CAWE (273.1 vs 206.9, P =.05), CR stalk (0.49 vs 0.38, P =.006), and ER (85.7% vs 52.5%, P =.002) compared to smaller UIAs. SI was higher in UIAs located in the ACOM and BA (279.6 vs 235.7; 0.45 vs 0.44; 75.1% vs 61.3%) for CAWE, CR stalk and ER, respectively. ROC curves demonstrated sensitivity/specificity values of 0.74/0.64 for CAWE ≥ 205, 0.74/0.60 for CR stalk ≥ 0.398, and 0.71/0.73 for ER ≥ 62.1%. We found a moderately strong correlation between CAWE and CR stalk (Spearman = 0.69), CAWE and ER (Spearman = 0.52) and CR stalk and ER (Spearman = 0.47), with P <.001 in all cases. Conclusion: Three different methods: CAWE, CR stalk and ER may be used reliably to quantify SI in the wall of UIAs. Figure: ROC curves for (A) CAWE, (B) CR stalk and (C) ER.

Abstract TMP27: Aneurysm Morphology And Prediction Of Rupture In Unruptured Intracranial Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Robert D Brown ◽  
James C Torner ◽  
Ana W Capuano ◽  
Madhavan L Raghavan ◽  
J Mocco ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Maximum Diameter ◽  
Prior History ◽  
Parent Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Morphology ◽  
Morphology Characteristics

Introduction: There is ongoing debate regarding the rupture risk of an unruptured intracranial aneurysm (UIA), and the predictors of rupture. Hypothesis: There are aneurysm morphology characteristics which predict rupture in patients with an UIA. The purpose of this analysis was to assess for such characteristics utilizing the International Study of Unruptured Intracranial Aneurysms (ISUIA) cohort. Methods: Patients were entered prospectively at 61 centers. Patients must have had at least one UIA, which may or may not have been symptomatic. Patients were followed for a median of 9 years and all potential hemorrhages were carefully adjudicated. A case-control design was used. The cases were 57 patients with aneurysmal rupture during followup for whom detailed radiology data were available from arteriography. Controls were 198 size- (+/- 2 mm maximum diameter) and location- (parent artery) matched patients without rupture during followup. Numerous aneurysm morphology characteristics were assessed on arteriogram review. Multivariable condition logistic regression modeling was performed. Results: A total of 57 cases and 198 controls were included. Most (76%) of the 255 cases were women, and 20% had a prior history of SAH from some other aneurysm. There were no differences between cases and controls in aneurysm maximum diameter, aneurysm location, patient age, gender, reason for presentation, or prior medical history. Multivariate analysis identified that only perpendicular height of the aneurysm--the measurement of the aneurysm height at a perpendicular to the center of the aneurysm neck to the aneurysm dome-was an independent predictor of aneurysm rupture. Aspect ratio, size ratio, parent vessel diameter, presence of daughter sac, and aneurysm angle were not independent predictors of rupture. Conclusions: After controlling for aneurysm size and location, the aneurysm perpendicular height remained a predictor of UIA rupture during long-term followup. The assessment of perpendicular height may be helpful in clinical practice, in addition to the other key predictors of UIA rupture, aneurysm maximum diameter and location. Further investigation into the use of perpendicular height as a predictor of rupture in patients with UIA is indicated.

scholarly journals Decreased contrast enhancement on high-resolution vessel wall imaging of unruptured intracranial aneurysms in patients taking aspirin

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Jorge A. Roa ◽  
Mario Zanaty ◽  
Daizo Ishii ◽  
Yongjun Lu ◽  
David K. Kung ◽  
...  
Keyword(s):  
High Resolution ◽  
Contrast Enhancement ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Pituitary Stalk ◽  
Noninvasive Method ◽  
Aneurysmal Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Wall Imaging

OBJECTIVEInflammation plays an integral role in the formation, growth, and progression to rupture of unruptured intracranial aneurysms (UIAs). Animal and human studies have suggested that, due to its antiinflammatory effect, aspirin (ASA) may decrease the risks of growth and rupture of UIAs. High-resolution vessel wall imaging (HR-VWI) has emerged as a noninvasive method to assess vessel wall inflammation and UIA instability. To the authors’ knowledge, to date no studies have found a significant correlation between patient use of ASA and contrast enhancement of UIAs on HR-VWI.METHODSThe University of Iowa HR-VWI Project database was analyzed. This database is a compilation of data on patients with UIAs who prospectively underwent HR-VWI on a 3T Siemens MRI scanner. The presence of aneurysmal wall enhancement was objectively defined using the aneurysm-to–pituitary stalk contrast ratio (CRstalk). This ratio was calculated by measuring the maximal signal intensity in the aneurysmal wall and the pituitary stalk on postcontrast T1-weighted images. Data on aneurysm size, morphology, and location and patient demographics and comorbidities were collected. Use of ASA was defined as daily intake of ≥ 81 mg during the previous 6 months or longer. Univariate and multivariate logistic regression analyses were performed to determine factors independently associated with increased contrast enhancement of UIAs on HR-VWI.RESULTSIn total, 74 patients harboring 96 UIAs were included in the study. The mean patient age was 64.7 ± 12.4 years, and 60 patients (81%) were women. Multivariate analysis showed that age (OR 1.12, 95% CI 1.05–1.19), aneurysm size ≥ 7 mm (OR 21.3, 95% CI 4.88–92.8), and location in the anterior communicating, posterior communicating, and basilar arteries (OR 10.7, 95% CI 2.45–46.5) were significantly associated with increased wall enhancement on HR-VWI. On the other hand, use of ASA was significantly associated with decreased aneurysmal wall enhancement on HR-VWI (OR 0.22, 95% CI 0.06–0.83, p = 0.026).CONCLUSIONSThe study results establish a correlation between use of ASA daily for ≥ 6 months and significant decreases in wall enhancement of UIAs on HR-VWI. The findings also demonstrate that detection of wall enhancement using HR-MRI may be a valuable noninvasive method for assessing aneurysmal wall inflammation and UIA instability.

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

Detachable balloon embolization therapy of posterior circulation intracranial aneurysms

1989 ◽  
Vol 71 (4) ◽  
pp. 512-519 ◽  
Author(s):  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Leslie D. Cahan ◽  
Grant B. Hieshima ◽  
Yoshifumi Konishi
Keyword(s):  
Basilar Artery ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Content Type ◽  
Aneurysm Neck ◽  
Balloon Embolization ◽  
Fine Print

✓ Treatment of complex and surgically difficult intracranial aneurysms of the posterior circulation is now being performed with intravascular detachable balloon embolization techniques. The procedure is carried out under local anesthesia from a transfemoral arterial approach, which allows continuous neurological monitoring. Under fluoroscopic guidance, the balloon is propelled by blood flow through the intracranial circulation and, in most cases, can be guided directly into the aneurysm, thus preserving the parent vessel. If an aneurysm neck is not present, test occlusion of the parent vessel is performed and, if tolerated, the balloon is detached. Twenty-six aneurysms in 25 patients have been treated by this technique. The aneurysms have involved the distal vertebral artery (five cases), the mid-basilar artery (six cases), the distal basilar artery (11 cases), and the posterior cerebral artery (four cases). The aneurysms varied in size and included three small (< 12 mm), 15 large (12 to 25 mm), and eight giant (> 25 mm). Fifteen patients (60%) presented with hemorrhage and 10 patients (40%) with mass effect. In 17 cases (65%) direct balloon embolization of the aneurysm was achieved with preservation of the parent artery. In nine cases (35%), because of aneurysm location and size, occlusion of the parent vessel was performed. Complications from therapy included three cases of transient cerebral ischemia which resolved, three cases of stroke, and five deaths due to immediate or delayed aneurysm rupture. The follow-up period has ranged from 2 months to 43 months (mean 22.5 months). In cases where posterior circulation aneurysms have been difficult to treat by conventional neurosurgical techniques, intravascular detachable balloon embolization may offer an alternative therapeutic option.

Morphological Effect on Wall Shear Stress in Intracranial Aneurysms

2017 ◽  
Vol 79 (02) ◽  
pp. 108-115 ◽  
Author(s):  
Tian-Lun Qiu ◽  
Guo-Liang Jin ◽  
Hai-Tao Lu ◽  
Wu-Qiao Bao
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Intracranial Aneurysms ◽  
Multivariable Analysis ◽  
Morphological Characteristics ◽  
Parent Artery ◽  
Parent Vessel ◽  
Morphological Effect ◽  
Neck Width ◽  
Wall Shear

Background and Study Aims Both high and low wall shear stress (WSS) play important roles in the development and rupture of intracranial aneurysms (IAs). This study aimed to determine the morphological factors that affect WSS in the IA and the parent artery. Material and Methods We studied a total of 66 IAs with three-dimensional imaging. Computational fluid dynamics (CFD) models were constructed and used to characterize the hemodynamics quantitatively. Aneurysms were grouped according to the mean neck width. The associations among hemodynamics and morphology were analyzed. Results Aspect ratio was correlated to lowest WSS (r = − 0.576), aneurysm-to-parent vessel (A-P) WSS ratio (r = − 0.500), and lowest-parent vessel (L-P) WSS ratio (r = − 0.575). Height-to-width ratio and height were correlated to WSS. Mean aneurysm WSS (p = 0.023), lowest WSS (p < 0.0001), highest-to-lowest WSS ratio (p = 0.004), L-P WSS ratio (p < 0.0001), highest-parent vessel (H-P) WSS ratio (p = 0.008), A-P WSS ratio (p < 0.001), and height (p < 0.001) were different between the two groups of aneurysms that were divided by the relationship between the diameters of the aneurysms and the necks. Multivariable analysis showed that the lowest WSS (p = 0.028) and A-P WSS ratio (p = 0.001) were independently associated with neck width. Conclusion Morphological characteristics are associated with IA and parent vessel WSS. Aneurysms with different neck widths have different hemodynamics. These results could help in understanding the progression of IA and in building predictive models for IA rupture.

scholarly journals Early Experiences of Neuroform Stent-Assisted Coiling in Ruptured Intracranial Aneurysms

2007 ◽  
Vol 13 (1) ◽  
pp. 31-44 ◽  
Author(s):  
Young-Joon Kim
Keyword(s):  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Parent Artery ◽  
Parent Vessel ◽  
Single Center Experience ◽  
Early Experiences ◽  
Detachable Coils ◽  
Neuroform Stent ◽  
Ruptured Intracranial Aneurysms

Endovascular treatment of ruptured intracranial aneurysms with detachable coils has proven a favorable alternative to surgical clipping. However, coiling has limitations in the treatment of complex or broad neck aneurysms because of possible coil prolapse or coil migration into the parent vessel and long-term angiographic recurrences. To achieve reconstruction of intracranial vessels with preservation of the parent artery, the use of stents has the greatest potential for assisted coil embolization. Three-dimensional coils and reconstructive techniques such as balloon-assisted remodeling may overcome these problems. But these methods had some drawbacks. The Neuroform stent is the most recently developed endovascular stent with self-expandable and micro-delivery properties that are specially designed for the treatment of unruptured intracranial broad neck aneurysms. Aim of the following working is to report a single center experience of stent-assisted coiling on ruptured intracranial aneurysms with assessment of its efficacy and safety, and follow-up findings.

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