Top

Published in:

01-12-2020 | Intracranial Aneurysm | Neuro

Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm

Authors: Chengcheng Zhu, Xinrui Wang, Laura Eisenmenger, Zhang Shi, Andrew Degnan, Bing Tian, Qi Liu, Christopher Hess, David Saloner, Jianping Lu

Published in: European Radiology | Issue 12/2020

Abstract

Objective

This study aims to investigate whether aneurysm wall enhancement (AWE) is independently associated with symptomatic status of unruptured intracranial aneurysms (UIAs).

Methods

One hundred thirty-nine consecutive patients (67 male, mean age 58 ± 11 years) with 79 symptomatic and 87 asymptomatic UIAs were imaged using black-blood MRI pre- and post-gadolinium contrast administration and 3D DSA. Symptoms related to aneurysms were identified including cranial nerve deficits and headache. AWE grade and area were characterized, and aneurysm size was measured on DSA. Multivariate binary logistic regression analysis was used to identify factors associated with symptoms. Further subgroup analysis was performed for aneurysms size < 10 mm.

Results

Symptomatic UIAs had significantly larger aneurysm size (11.2 ± 6.2 mm vs. 6.4 ± 3.3 mm), enhancement grade (1.3 ± 0.6 vs. 0.4 ± 0.6), enhancement area (2.0 ± 0.9 vs. 0.4 ± 0.7), and higher prevalence of thick enhancement (39% vs. 3%) compared with asymptomatic UIAs, all p < 0.001. In multivariate analysis, only AWE area (odds ratio [OR] 6.9, 95% confidence interval [4.0, 11.7]) was independently associated with symptoms. AWE area had an area under curve (AUC) value of 0.888, with 72.2% sensitivity and 92.0% specificity for symptoms, which was superior to aneurysm size (AUC of 0.771, with 75.9% sensitivity and 65.5% specificity). In the subgroup analysis of aneurysms smaller than 10 mm (n = 118), AWE area (OR, 7.0, p < 0.001) remained the only independent risk factor associated with symptoms.

Conclusions

Larger AWE area is independently associated with symptomatic UIAs, which may provide additional value to guide UIA management and improve patient outcomes.

Key Points

• Symptomatic intracranial aneurysms are larger and more often demonstrate significant wall enhancement than asymptomatic aneurysms.

• Larger wall enhancement area is independently associated with symptomatic intracranial aneurysm.

Available only for authorised users

Wiebers DO, Whisnant JP, Huston J 3rd et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110CrossRefPubMed

Thompson BG, Brown RD Jr, Amin-Hanjani S et al (2015) Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2368–2400CrossRefPubMed

Teo M, St George EJ (2016) Radiologic surveillance of untreated unruptured intracranial aneurysms: a single surgeon’s experience. World Neurosurg 90:20–28CrossRefPubMed

Wang X, Zhu C, Leng Y, Degnan AJ, Lu J (2019) Intracranial aneurysm wall enhancement associated with aneurysm rupture: a systematic review and meta-analysis. Acad Radiol 26:664–673CrossRefPubMed

Edjlali M, Guédon A, Ben Hassen W et al (2018) Circumferential thick enhancement at vessel wall MRI has high specificity for intracranial aneurysm instability. Radiology 289:181–187CrossRefPubMed

Vergouwen MDI, Backes D, van der Schaaf IC et al (2019) Gadolinium enhancement of the aneurysm wall in unruptured intracranial aneurysms is associated with an increased risk of aneurysm instability: a follow-up study. AJNR Am J Neuroradiol 40:1112–1116CrossRefPubMedPubMedCentral

Matsushige T, Shimonaga K, Ishii D et al (2019) Vessel Wall imaging of evolving unruptured intracranial aneurysms. Stroke 50:1891–1894CrossRefPubMed

Fu Q, Guan S, Liu C, Wang K, Cheng J (2018) Clinical significance of circumferential Aneurysmal Wall enhancement in symptomatic patients with unruptured intracranial aneurysms: a high-resolution MRI study. Clin Neuroradiol 28:509–514CrossRefPubMed

Larsen N, von der Brelie C, Trick D et al (2018) 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 39:1617–1621CrossRefPubMedPubMedCentral

10.

Quan K, Song J, Yang Z et al (2019) Validation of wall enhancement as a new imaging biomarker of unruptured cerebral aneurysm. Stroke 50:1570–1573CrossRefPubMed

11.

Cianfoni A, Pravatà E, De Blasi R, Tschuor CS, Bonaldi G (2013) Clinical presentation of cerebral aneurysms. Eur J Radiol 82:1618–1622CrossRefPubMed

12.

Liu X, Zhang Z, Zhu C et al (2020) Wall enhancement of intracranial saccular and fusiform aneurysms may differ in intensity and extension: a pilot study using 7-T high-resolution black-blood MRI. Eur Radiol 30:301–307CrossRefPubMed

13.

Zhu C, Wang X, Degnan AJ et al (2018) Wall enhancement of intracranial unruptured aneurysm is associated with increased rupture risk and traditional risk factors. Eur Radiol 28:5019–5026CrossRefPubMed

14.

Tian B, Toossi S, Eisenmenger L et al (2019) Visualizing wall enhancement over time in unruptured intracranial aneurysms using 3D vessel wall imaging. J Magn Reson Imaging 50:193–200CrossRefPubMed

15.

Portanova A, Hakakian N, Mikulis DJ, Virmani R, Abdalla WM, Wasserman BA (2013) Intracranial vasa vasorum: insights and implications for imaging. Radiology 267:667–679CrossRefPubMed

16.

Kalsoum E, Chabernaud Negrier A, Tuilier T et al (2018) Blood flow mimicking aneurysmal wall enhancement: a diagnostic pitfall of vessel wall MRI using the postcontrast 3D Turbo spin-echo MR imaging sequence. AJNR Am J Neuroradiol 39:1065–1067CrossRefPubMedPubMedCentral

17.

Xie Y, Yang Q, Xie G, Pang J, Fan Z, Li D (2016) Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation. Magn Reson Med 75:2286–2294CrossRefPubMed

18.

Zhu C, Graves MJ, Yuan J, Sadat U, Gillard JH, Patterson AJ (2014) Optimization of improved motion-sensitized driven-equilibrium (iMSDE) blood suppression for carotid artery wall imaging. J Cardiovasc Magn Reson 16:61CrossRefPubMedPubMedCentral

Title: Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm
Authors: Chengcheng Zhu
Xinrui Wang
Laura Eisenmenger
Zhang Shi
Andrew Degnan
Bing Tian
Qi Liu
Christopher Hess
David Saloner
Jianping Lu
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Intracranial Aneurysm
Aneurysm
Aneurysm
Headache
Published in: European Radiology / Issue 12/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07063-6

At a glance: The STEP trials

Springer Medicine

Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm

Abstract

Objective

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 12/2020

Does transient arterial-phase respiratory-motion-related artifact impact on diagnostic performance? An intra-patient comparison of extracellular gadolinium versus gadoxetic acid

Using decision curve analysis to benchmark performance of a magnetic resonance imaging–based deep learning model for prostate cancer risk assessment

Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy

Impact of coronavirus disease 2019 (COVID-19) emergency on Italian radiologists: a national survey

Automated identification of chest radiographs with referable abnormality with deep learning: need for recalibration

The combination of hepatobiliary phase with Gd-EOB-DTPA and DWI is highly accurate for the detection and characterization of liver metastases from neuroendocrine tumor