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

Stroke ◽  
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.

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

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.

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.

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

Stroke ◽  
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.

scholarly journals Practical Value of Three-dimensional High Resolution Magnetic Resonance Vessel Wall Imaging in Identifying Suspicious Intracranial Vertebrobasilar Dissecting Aneurysms

2019 ◽  
Author(s):  
Xianjin Zhu ◽  
Hancheng Qiu ◽  
Ferdinand K Hui ◽  
Yiqun Zhang ◽  
Yun-e Liu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
High Resolution ◽  
Vessel Wall ◽  
Three Dimensional ◽  
Vessel Wall Imaging ◽  
Catheter Angiography ◽  
Double Lumen ◽  
Post Contrast ◽  
Dissecting Aneurysms ◽  
Wall Imaging

Abstract Background: Direct evidence of intimal flaps, double lumen and intramural haematomas (IMH) is difficult to detect on conventional angiography in most intracranial vertebrobasilar dissecting aneurysms (VBDAs). Our purpose was to assess the value of three-dimensional high-resolution magnetic resonance vessel wall imaging (3D HRMR VWI) for identifying VBDAs. Methods: Between August 2013 and January 2016, consecutive patients with suspicious VBDAs were prospectively enrolled to undergo catheter angiography and VWI (pre- and post-contrast). The lesion was diagnosed as definite VBDA when presenting direct signs of dissection; as possible when only presenting indirect signs; and as segmental ectasia when there was local dilation and wall thickness similar to adjacent normal artery’s without mural thrombosis. Results: Twenty-one patients with 27 lesions suspicious for VBDAs were finally included. Based on findings of VWI and catheter angiography, definite VBDA was diagnosed in 25 and 7 lesions (92.6%, vs 25.9%, p = 0.000), respectively; possible VBDA in 0 and 20 (0 vs 74.1%), respectively; and segmental ectasia in 2 and 0 (7.4% vs 0%), respectively. On VWI and catheter angiography, intimal flap was detected in 21 and 7 lesions (77.8% vs 25.9%, p=0.001), respectively; double lumen sign in 18 and 7 (66.7% vs 25.9%, p=0.003), respectively; and IMH sign in 14 and 0 (51.9% vs 0), respectively. Conclusions: 3D HRMR VWI was superior to catheter angiography in achieving definite diagnosis of intracranial VBDAs with higher rate of detection of direct dissection signs; and allowed a promising way to differentiate between VBDA and segmental ectasia.

scholarly journals Insufficient slow-flow suppression mimicking aneurysm wall enhancement in magnetic resonance vessel wall imaging: a phantom study

2019 ◽  
Vol 47 (1) ◽  
pp. E19 ◽  
Author(s):  
Bart M. W. Cornelissen ◽  
Eva L. Leemans ◽  
Bram F. Coolen ◽  
Eva S. Peper ◽  
René van den Berg ◽  
...  
Keyword(s):  
Contrast Agent ◽  
Vessel Wall ◽  
Vessel Wall Imaging ◽  
Phantom Study ◽  
Slow Flow ◽  
Clinical Implementation ◽  
Aneurysm Wall ◽  
Contrast Agent Injection ◽  
Inflow Conditions ◽  
Wall Imaging

OBJECTIVEMR vessel wall imaging (VWI) is increasingly performed in clinical settings to support treatment decision-making regarding intracranial aneurysms. Aneurysm wall enhancement after contrast agent injection is expected to be related to aneurysm instability and rupture status. However, the authors hypothesize that slow-flow artifacts mimic aneurysm wall enhancement. Therefore, in this phantom study they assess the effect of slow flow on wall-like enhancement by using different MR VWI techniques.METHODSThe authors developed an MR-compatible aneurysm phantom model, which was connected to a pump to enable pulsatile inflow conditions. For VWI, 3D turbo spin echo sequences—both with and without motion-sensitized driven equilibrium (MSDE) and delay alternating with nutation for tailored excitation (DANTE) preparation pulses—were performed using a 3-T MR scanner. VWI was acquired both before and after Gd contrast agent administration by using two different pulsatile inflow conditions (2.5 ml/sec peak flow at 77 and 48 beats per minute). The intraluminal signal intensity along the aneurysm wall was analyzed to assess the performance of slow-flow suppression.RESULTSThe authors observed wall-like enhancement after contrast agent injection, especially in low pump rate settings. Preparation pulses, in particular the DANTE technique, improved the performance of slow-flow suppression.CONCLUSIONSNear-wall slow flow mimics wall enhancement in VWI protocols. Therefore, VWI should be carefully interpreted. Preparation pulses improve slow-flow suppression, and therefore the authors encourage further development and clinical implementation of these techniques.

scholarly journals Analysis of Cerebral Aneurysm Wall Tension and Enhancement Using Finite Element Analysis and High-Resolution Vessel Wall Imaging

2021 ◽  
Vol 12 ◽  
Author(s):  
Adam E. Galloy ◽  
Ashrita Raghuram ◽  
Marco A. Nino ◽  
Alberto Varon Miller ◽  
Ryan Sabotin ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
High Resolution ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Wall Tension ◽  
Element Analysis ◽  
Aneurysm Wall ◽  
Wall Imaging

Biomechanical computational simulation of intracranial aneurysms has become a promising method for predicting features of instability leading to aneurysm growth and rupture. Hemodynamic analysis of aneurysm behavior has helped investigate the complex relationship between features of aneurysm shape, morphology, flow patterns, and the proliferation or degradation of the aneurysm wall. Finite element analysis paired with high-resolution vessel wall imaging can provide more insight into how exactly aneurysm morphology relates to wall behavior, and whether wall enhancement can describe this phenomenon. In a retrospective analysis of 23 unruptured aneurysms, finite element analysis was conducted using an isotropic, homogenous third order polynomial material model. Aneurysm wall enhancement was quantified on 2D multiplanar views, with 14 aneurysms classified as enhancing (CRstalk≥0.6) and nine classified as non-enhancing. Enhancing aneurysms had a significantly higher 95th percentile wall tension (μ = 0.77 N/cm) compared to non-enhancing aneurysms (μ = 0.42 N/cm, p &lt; 0.001). Wall enhancement remained a significant predictor of wall tension while accounting for the effects of aneurysm size (p = 0.046). In a qualitative comparison, low wall tension areas concentrated around aneurysm blebs. Aneurysms with irregular morphologies may show increased areas of low wall tension. The biological implications of finite element analysis in intracranial aneurysms are still unclear but may provide further insights into the complex process of bleb formation and aneurysm rupture.

Quantitative assessment of microstructural evolution of intracranial aneurysm wall by vessel wall imaging

2022 ◽  
Author(s):  
Hidenori Endo ◽  
Naoko Mori ◽  
Shunji Mugikura ◽  
Kuniyasu Niizuma ◽  
Shunsuke Omodaka ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Microstructural Evolution ◽  
Vessel Wall ◽  
Quantitative Assessment ◽  
Vessel Wall Imaging ◽  
Aneurysm Wall ◽  
Wall Imaging
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