Abstract WP117: Quantitative Susceptibility Mapping (QSM) and Vessel Wall Imaging (VWI) MRI Sequences in Identifying Subjects With Intracranial Aneurysms Who Have Microbleeds

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.

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Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tools to Detect Microbleed in Sentinel Headache

Journal of Clinical Medicine ◽

10.3390/jcm9040979 ◽

2020 ◽

Vol 9 (4) ◽

pp. 979

Author(s):

Daizo Ishii ◽

Daichi Nakagawa ◽

Mario Zanaty ◽

Jorge A. Roa ◽

Sami Al Kasab ◽

...

Keyword(s):

Predictive Value ◽

Vessel Wall ◽

Susceptibility Mapping ◽

Vessel Wall Imaging ◽

Screening Tools ◽

Diagnostic Strategy ◽

Quantitative Susceptibility Mapping ◽

Post Contrast ◽

Aneurysm Wall ◽

Wall Imaging

Background: MR-quantitative susceptibility mapping (QSM) can identify microbleeds (MBs) in intracranial aneurysm (IA) wall associated with sentinel headache (SH) preceding subarachnoid hemorrhage. However, its use is limited, due to associated skull base bonny and air artifact. MR-vessel wall imaging (VWI) is not limited by such artifact and therefore could be an alternative to QSM. The purpose of this study was to investigate the correlation between QSM and VWI in detecting MBs and to help develop a diagnostic strategy for SH. Methods: We performed a prospective study of subjects with one or more unruptured IAs in our hospital. All subjects underwent evaluation using 3T-MRI for MR angiography (MRA), QSM, and pre- and post-contrast VWI of the IAs. Presence/absence of MBs detected by QSM was correlated with aneurysm wall enhancement (AWE) on VWI. Results: A total of 40 subjects harboring 51 unruptured IAs were enrolled in the study. MBs evident on the QSM sequence was detected in 12 (23.5%) IAs of 11 subjects. All these subjects had a history of severe headache suggestive of SH. AWE was detected in 22 (43.1%) IAs. Using positive QSM as a surrogate for MBs, the sensitivity, specificity, positive predictive value, and negative predictive value of AWE on VWI for detecting MBs were 91.7%, 71.8%, 50%, and 96.6%, respectively. Conclusions: Positive QSM findings strongly suggested the presence of MBs with SH, whereas, the lack of AWE on VWI can rule it out with a probability of 96.6%. If proven in a larger cohort, combining QSM and VWI could be an adjunctive tool to help diagnose SH, especially in cases with negative or non-diagnostic CT and lumbar puncture.

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Abstract 142: Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tool to Detect Microbleed in Sentinel Headache

Stroke ◽

10.1161/str.51.suppl_1.142 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Daizo Ishii ◽

Daichi Nakagawa ◽

Mario Zanaty ◽

Jorge A Roa ◽

Sami A Kasab ◽

...

Keyword(s):

Predictive Value ◽

Vessel Wall ◽

Severe Headache ◽

Susceptibility Mapping ◽

Vessel Wall Imaging ◽

Quantitative Susceptibility Mapping ◽

Post Contrast ◽

Aneurysm Wall ◽

Sensitivity Specificity ◽

Wall Imaging

Objective: Imaging via MR-quantitative susceptibility mapping (QSM) can identify reliably microbleeds (MBs) associated with intracranial aneurysms (IAs) in subjects presenting with severe headache suggestive of sentinel headache (SH) preceding subarachnoid hemorrhage. However, its use is limited due to associated skull base bonny artifact. Vessel wall imaging (VWI) is not limited by bonny artifact and therefore could be an alternative to QSM in detecting MBs. The purpose of this study is to examine the correlation between QSM and the MR-VWI in detecting MBs associated with severe headache suggestive of SH. Methods: We performed a prospective single-center study of subjects with unruptured IAs with initial presentation of headaches. All subjects underwent evaluation using 3T-MRI protocol which included MRA, QSM, and pre- and post-contrast VWI of the IAs. Presence/absence of MBs detected by QSM was correlated with aneurysm wall enhancement (AWE) on MR-VWI. Results: In the interval of November 2017 to June 2019, a total of 40 subjects harboring 51 unruptured IAs were enrolled in the study. MBs and AWE were detected in 12 (23.5%) and 22 (43.1%) IAs, respectively. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of QSM detecting MBs associated with recent/remote SH was 100% for all, respectively. The sensitivity, specificity, PPV, and NPV of AWE on VWI for detecting MBs confirmed by QSM was 91.7%, 71.8%, 50%, and 96.6%, respectively. Conclusions: The combination of imaging findings of MR-VWI and QSM can be used reliably for detection of MBs in subjects with IAs whose presentation is suggestive of SH. If proven in larger cohort, this could eliminate the need for lumbar puncture to screen for SH in subjects with IAs presenting to the emergency department with headaches.

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Response by Shimonaga et al to Letter Regarding Article, “Clinicopathological Insights From Vessel Wall Imaging of Unruptured Intracranial Aneurysms”

Stroke ◽

10.1161/strokeaha.118.023850 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Koji Shimonaga ◽

Daizo Ishii ◽

Toshinori Matsushige

Keyword(s):

Vessel Wall ◽

Intracranial Aneurysms ◽

Vessel Wall Imaging ◽

Unruptured Intracranial Aneurysms ◽

Wall Imaging

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Magnetic Resonance Vessel Wall Imaging in Human Intracranial Aneurysms

Stroke ◽

10.1161/strokeaha.118.023701 ◽

2019 ◽

Vol 50 (1) ◽

Cited By ~ 12

Author(s):

Joseph S. Hudson ◽

Mario Zanaty ◽

Daichi Nakagawa ◽

David K. Kung ◽

Pascal Jabbour ◽

...

Keyword(s):

Magnetic Resonance ◽

Vessel Wall ◽

Intracranial Aneurysms ◽

Vessel Wall Imaging ◽

Wall Imaging

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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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