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A Prospective Follow-up Study on Risk Factors to Predict the Progression of Unruptured Intracranial Aneurysms on Enhanced HR-MRI

  • Cheng-yu Yang
    Affiliations
    Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
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  • Li Wen
    Affiliations
    Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
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  • Chun Cui
    Affiliations
    Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
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  • Tong-sheng Shu
    Affiliations
    Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
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  • Zhi-ping Wang
    Affiliations
    Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
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  • Author Footnotes
    # These authors contributed equally to the work and should be regarded as co-corresponding authors.
    Guang-xian Wang
    Footnotes
    # These authors contributed equally to the work and should be regarded as co-corresponding authors.
    Affiliations
    Department of Radiology, Banan People's Hospital, Chongqing Medical University, Chongqing, 401320, China
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  • Author Footnotes
    # These authors contributed equally to the work and should be regarded as co-corresponding authors.
    Dong Zhang
    Correspondence
    Address correspondence to: Dong Zhang, Department of Radiology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China. Tel: +86-023-68774036.
    Footnotes
    # These authors contributed equally to the work and should be regarded as co-corresponding authors.
    Affiliations
    Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to the work and should be regarded as co-corresponding authors.
Published:November 15, 2022DOI:https://doi.org/10.1016/j.acra.2022.10.014

      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)
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