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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REFERENCES
- Growth and rupture risk of small unruptured intracranial aneurysms: a systematic review.Ann Intern Med. 2017 Jul 4; 167: 26-33https://doi.org/10.7326/M17-0246
- Risk factors for three phases of 12-month mortality in 1657 patients from a defined population after acute aneurysmal subarachnoid hemorrhage.World Neurosurg. 2012; 78: 631-639https://doi.org/10.1016/j.wneu.2011.08.033
- ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms.Neurology. 2017; 88: 1600-1606https://doi.org/10.1212/WNL.0000000000003865
- Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies.Lancet Neurol. 2014; 13: 59-66https://doi.org/10.1016/S1474-4422(13)70263-1
- Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI.Neurology. 2009; 72: 627-634https://doi.org/10.1212/01.wnl.0000342470.69739.b3
- High-resolution intracranial vessel wall imaging: imaging beyond the lumen.J Neurol Neurosurg Psychiatry. 2016; 87: 589-597https://doi.org/10.1136/jnnp-2015-312020
- Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle.Neurosurgery. 2013; 72 (discussion 496): 492-496https://doi.org/10.1227/NEU.0b013e31827d1012
- Vessel wall MRI and intracranial aneurysms.J Neurointerv Surg. 2016; 8: 1160-1162https://doi.org/10.1136/neurintsurg-2015-012130
- Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm?.Clin Neuroradiol. 2016; 26: 277-283https://doi.org/10.1007/s00062-014-0353-z
- Decreased contrast enhancement on high-resolution vessel wall imaging of unruptured intracranial aneurysms in patients taking aspirin.J Neurosurg. 2020; 134: 902-908https://doi.org/10.3171/2019.12.JNS193023
- Wall enhancement ratio determined by vessel wall MRI associated with symptomatic intracranial aneurysms.Eur J Radiol. 2019; 112: 88-92https://doi.org/10.1016/j.ejrad.2019.01.016
- Wall enhancement ratio and partial wall enhancement on MRI associated with the rupture of intracranial aneurysms.J Neurointerv Surg. 2018; 10: 566-570https://doi.org/10.1136/neurintsurg-2017-013308
- The clinical and morphologic features related to aneurysm wall enhancement and enhancement pattern in patients with anterior circulation aneurysms.World Neurosurg. 2020; 134: e649-e656https://doi.org/10.1016/j.wneu.2019.10.156
- Risk factors for the rupture of middle cerebral artery bifurcation aneurysms using CT angiography.PLoS One. 2016; 11e0166654https://doi.org/10.1371/journal.pone.0166654
- Risk factors for the rupture of bifurcation intracranial aneurysms using CT angiography.Yonsei Med J. 2016; 57: 1178-1184https://doi.org/10.3349/ymj.2016.57.5.1178
- The unruptured intracranial aneurysm treatment score as a predictor of aneurysm growth or rupture.Eur J Neurol. 2021; 28: 837-843https://doi.org/10.1111/ene.14636
- Circumferential wall enhancement on magnetic resonance imaging is useful to identify rupture site in patients with multiple cerebral aneurysms.Neurosurgery. 2018; 82: 638-644https://doi.org/10.1093/neuros/nyx267
- Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging.J Neurosurg. 2018; 1: 1-7https://doi.org/10.3171/2018.5.JNS18322
- Does aneurysmal wall enhancement on vessel wall MRI help to distinguish stable from unstable intracranial aneurysms?.Stroke. 2014; 45: 3704-3706https://doi.org/10.1161/STROKEAHA.114.006626
- Vessel Wall Enhancement in Unruptured Intracranial Aneurysms: An Indicator for Higher Risk of Rupture? High-Resolution MR Imaging and Correlated Histologic Findings.AJNR Am J Neuroradiol. 2018; 39: 1617-1621https://doi.org/10.3174/ajnr.A5731
- Review of cerebral aneurysm formation, growth, and rupture.Stroke. 2013; 44: 3613-3622https://doi.org/10.1161/STROKEAHA.113.002390
- Size is the most important predictor of aneurysm rupture among multiple cerebral aneurysms: post hoc subgroup analysis of unruptured cerebral aneurysm study Japan.Neurosurgery. 2018 Jun 1; 82: 864-869https://doi.org/10.1093/neuros/nyx307
- Unruptured intracranial aneurysms: incidence of rupture and risk factors.Stroke. 2009; 40: 313-316https://doi.org/10.1161/STROKEAHA.108.521674
- Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms.Stroke. 2014; 45: 1299-1303https://doi.org/10.1161/STROKEAHA.113.004421
- Vessel wall imaging of intracranial aneurysms: systematic review and meta-analysis.World Neurosurg. 2018; 117: 453-458https://doi.org/10.1016/j.wneu.2018.06.008
- Lack of baseline intracranial aneurysm wall enhancement predicts future stability: a systematic review and meta-analysis of longitudinal studies.AJNR Am J Neuroradiol. 2020; 41: 1606-1610https://doi.org/10.3174/ajnr.A6690
- Circumferential thick enhancement at vessel wall MRI has high specificity for intracranial aneurysm instability.Radiology. 2018; 289: 181-187https://doi.org/10.1148/radiol.2018172879
- Wall enhancement, hemodynamics, and morphology in unruptured intracranial aneurysms with high rupture risk.Transl Stroke Res. 2020; 11: 882-889https://doi.org/10.1007/s12975-020-00782-4
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Publication history
Published online: November 15, 2022
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© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
