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.

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 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.

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

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.

Visualizing wall enhancement over time in unruptured intracranial aneurysms using 3D vessel wall imaging

2018 ◽  
Vol 50 (1) ◽  
pp. 193-200 ◽  
Author(s):  
Bing Tian ◽  
Shahed Toossi ◽  
Laura Eisenmenger ◽  
Farshid Faraji ◽  
Megan K. Ballweber ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Unruptured Intracranial Aneurysms ◽  
Over Time ◽  
Wall Imaging

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.

scholarly journals Vessel Wall Imaging of Evolving Unruptured Intracranial Aneurysms

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1891-1894 ◽  
Author(s):  
Toshinori Matsushige ◽  
Koji Shimonaga ◽  
Daizo Ishii ◽  
Shigeyuki Sakamoto ◽  
Masahiro Hosogai ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Unruptured Intracranial Aneurysms ◽  
Wall Imaging

Contrast Enhancement of Brain Aneurysms on High-Resolution Vessel Wall Imaging [HR-VWI] Correlates with the Presence of Microbleeds

2021 ◽  
Vol 05 (01) ◽  
Author(s):  
Jorge A Roa ◽  
Mario Zanaty ◽  
Anthony J Piscopo ◽  
Timothy W Morris ◽  
Ryan Sabotin ◽  
...  
Keyword(s):  
High Resolution ◽  
Contrast Enhancement ◽  
Vessel Wall ◽  
Vessel Wall Imaging ◽  
Brain Aneurysms ◽  
Wall Imaging

Abstract 48: High-Resolution Vessel Wall Imaging of Cryptogenic Stroke: A 7T MRI Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jorge A Roa ◽  
Mario Zanaty ◽  
Daizo Ishii ◽  
Colin P Derdeyn ◽  
Girish Bathla ◽  
...  
Keyword(s):  
High Resolution ◽  
Vessel Wall ◽  
Cryptogenic Stroke ◽  
Vessel Wall Imaging ◽  
Observer Agreement ◽  
Intraplaque Hemorrhage ◽  
Post Contrast ◽  
Intracranial Atherosclerotic Disease ◽  
Wall Imaging

Background: High-resolution vessel wall imaging (HR-VWI) has emerged as a useful tool for characterization of intracranial vasculopathic processes. HR-VWI allows better characterization of the arterial wall and may aid in the identification of atherosclerotic plaques, intra-arterial hemorrhages such as in the case of dissections and/or increased contrast enhancement such as in vasculitis. 7T HR-VWI may provide additional information in the identification of stroke mechanism in patients with cryptogenic stroke. Methods: Patients with cryptogenic stroke were prospectively imaged with a 7T scan. Strokes were determined to be cryptogenic after an extensive diagnostic work-up was completed. T1-weighted (pre- and post-contrast), T2-weighted, TOF and SWAN sequences were obtained. Demographic and clinical information was gathered from electronic medical charts. Results: Seventeen patients were included. Mean age was 57.8 ± 16.3 years-old, and 10 (58.8%) were women. HR-VWI determined the etiology of AIS in all subjects: 12 (70.6%) intracranial atherosclerotic disease (ICAD), 3 small-vessel disease and 2 arterial dissections. Inter-observer agreement was κ = 0.92. Plaque enhancement was identified in 14 cases, and intraplaque hemorrhage in 1 case of arterial dissection. In a patient with angiography suggestive of Moyamoya disease, HR-VWI determined the presence of diffuse ICAD as the underlying cause of stroke. Conclusion: HR-VWI may be used in patients with cryptogenic stroke to identify the etiologic mechanism and guide treatment. Figure: Axial-DWI (A) shows an acute right-medullary infarct (arrow). (B) Right-VA stenosis (arrow) on CTA. 7T axial-SWAN (C) reveals focal-susceptibility (arrowhead) and intra-vessel hemosiderin (arrow) suggestive of IPH. Axial-T1 pre-contrast (D), post-contrast (E) and sagittal MPR (F) images show eccentric thickening/enhancement of right-VA (arrowheads), compared to normal-appearing left-VA (arrows D-E).

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