Rationale and Objectives
To prospectively investigate the potential correlation between qualitative and quantitative
assessment of aneurysm wall enhancement (AWE) on initial enhanced high-resolution
magnetic resonance imaging (HR-MRI) and aneurysm progression during follow-up.
Materials and Methods
From June 2016 to January 2021, we prospectively recruited patients with unruptured
intracranial aneurysms (UIAs) for enhanced HR-MRI examination. The patients' demographic
and clinical data and aneurysm characteristics, including AWE features, were collected
and analyzed. Follow-up images were compared to evaluate IA progression. Univariate
and multivariate Cox proportional hazards regression analyses were performed to identify
the risk factors associated with aneurysm progression.
Results
Seventy-seven patients with 95 UIAs met our research criteria, and the median follow-up
time was 15.7 months. Progression was observed in 18 aneurysms; the remaining 77 remained
stable. Progressive UIAs were larger in size, more frequently displayed obvious AWE
and showed a higher enhancement ratio (ER) than nonprogressive UIAs. Multivariate
Cox regression analysis showed that both ER (hazard ratio, 6.304, p < 0.001) and aneurysm size (hazard ratio, 1.343, p = 0.014) were independent risk factors for aneurysm progression. The combination of
ER and aneurysm size had an area under the curve of 0.920 for the prediction of aneurysm
progression, with a sensitivity of 88.9% and specificity of 87.0%.
Conclusion
A higher ER value of the aneurysm wall and a larger aneurysm size on initial HR-MRI
may predict an increased risk of aneurysm progression, which suggests that closer
monitoring by imaging or preventive intervention may be required for the clinical
management of these aneurysms.
KEY WORDS
Abbreviations:
AWE (aneurysm wall enhancement), HR-MRI (high-resolution magnetic resonance imaging), UIA (unruptured intracranial aneurysm), ER (enhancement ratio), HR (hazard ratio), AUC (area under the curve), SAH (subarachnoid hemorrhage), ELAPSS (Earlier subarachnoid hemorrhage (SAH), Location, Age >60 years, Population, Size, Shape), PHASES (Population, Hypertension, Age, Size, Earlier SAH, Site), CTA (computed tomography angiography), MRA (magnetic resonance angiography), 3D-TOF-MRA (time-of-flight magnetic resonance angiography), TR (repetition time), TE (echo time), FOV (field of view), VR (volume rendering), MIP (maximum intensity projection), MPR (multiplanar reconstruction), DP (diameter of the parent artery), AR (aspect ratio), SR (size ratio), SI (signal intensity), CI (confidence interval), ROC (receiver operating characteristic), IQR (interquartile range), PPV (positive predictive value), NPV (negative predictive value)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 15, 2022
Publication stage
In Press Corrected ProofIdentification
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© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
