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 ◽  
...  

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.

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jorge A Roa ◽  
Mario Zanaty ◽  
Avery Pazour ◽  
Carlos Osorno-Cruz ◽  
Daizo Ishii ◽  
...  

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.


2020 ◽  
pp. 1-8 ◽  
Author(s):  
Jorge A. Roa ◽  
Mario Zanaty ◽  
Carlos Osorno-Cruz ◽  
Daizo Ishii ◽  
Girish Bathla ◽  
...  

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.


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 ◽  
...  

2021 ◽  
Vol 12 ◽  
Author(s):  
Adam E. Galloy ◽  
Ashrita Raghuram ◽  
Marco A. Nino ◽  
Alberto Varon Miller ◽  
Ryan Sabotin ◽  
...  

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.


Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1891-1894 ◽  
Author(s):  
Toshinori Matsushige ◽  
Koji Shimonaga ◽  
Daizo Ishii ◽  
Shigeyuki Sakamoto ◽  
Masahiro Hosogai ◽  
...  

2021 ◽  
Vol 05 (01) ◽  
Author(s):  
Jorge A Roa ◽  
Mario Zanaty ◽  
Anthony J Piscopo ◽  
Timothy W Morris ◽  
Ryan Sabotin ◽  
...  

Stroke ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 2516-2519 ◽  
Author(s):  
Koji Shimonaga ◽  
Toshinori Matsushige ◽  
Daizo Ishii ◽  
Shigeyuki Sakamoto ◽  
Masahiro Hosogai ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document