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Background Vessel‐wall enhancement (VWE) on black‐blood MRI (BB MRI) has been proposed as an imaging marker for a higher risk of rupture and associated with wall inflammation. Whether VWE is causally linked to inflammation or rather induced by flow phenomena has been a subject of debate. Purpose To study the effects of slow flow, spatial resolution, and motion‐sensitized driven equilibrium (MSDE) preparation on signal intensities in BB MRI of patient‐specific aneurysm flow models. Study Type Prospective. Subjects/Flow Aneurysm Model/Virtual Vessels Aneurysm flow models based on 3D rotational angiography datasets of three patients with intracranial aneurysms were 3D printed and perfused at two different flow rates, with and without Gd‐containing contrast agent. Field Strength/Sequence Variable refocusing flip angle 3D fast‐spin echo sequence at 3 T with and without MSDE with three voxel sizes ((0.5 mm)3, (0.7 mm)3, and (0.9 mm)3); time‐resolved with phase‐contrast velocity‐encoding 3D spoiled gradient echo sequence (4D flow MRI). Assessment Three independent observers performed a qualitative visual assessment of flow patterns and signal enhancement. Quantitative analysis included voxel‐wise evaluation of signal intensities and magnitude velocity distributions in the aneurysm. Statistical Tests Kruskal–Wallis test, potential regressions. Results A hyperintense signal in the lumen and adjacent to the aneurysm walls on BB MRI was colocalized with slow flow. Signal intensities increased by a factor of 2.56 ± 0.68 (P < 0.01) after administering Gd contrast. After Gd contrast administration, the signal was suppressed most in conjunction with high flows and with MSDE (2.41 ± 2.07 for slow flow without MSDE, and 0.87 ± 0.99 for high flow with MSDE). A clear result was not achieved by modifying the spatial resolution . Data Conclusions Slow‐flow phenomena contribute substantially to aneurysm enhancement and vary with MRI parameters. This should be considered in the clinical setting when assessing VWE in patients with an unruptured aneurysm. Evidence Level 2 Technical Efficacy Stage 2

Purpose The anatomy of the circle of Willis (CoW), the brain’s main arterial blood supply system, strongly differs between individuals, resulting in highly variable flow fields and intracranial vascularization patterns. To predict subject-specific hemodynamics with high certainty, we propose a data assimilation (DA) approach that merges fully 4D phase-contrast magnetic resonance imaging (PC-MRI) data with a numerical model in the form of computational fluid dynamics (CFD) simulations. Methods To the best of our knowledge, this study is the first to provide a transient state estimate for the three-dimensional velocity field in a subject-specific CoW geometry using DA. High-resolution velocity state estimates are obtained using the local ensemble transform Kalman filter (LETKF). Results Quantitative evaluation shows a considerable reduction (up to 90%) in the uncertainty of the velocity field state estimate after the data assimilation step. Velocity values in vessel areas that are below the resolution of the PC-MRI data (e.g., in posterior communicating arteries) are provided. Furthermore, the uncertainty of the analysis-based wall shear stress distribution is reduced by a factor of 2 for the data assimilation approach when compared to the CFD model alone. Conclusion This study demonstrates the potential of data assimilation to provide detailed information on vascular flow, and to reduce the uncertainty in such estimates by combining various sources of data in a statistically appropriate fashion.

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Purpose Intracranial aneurysm (IA) wall enhancement on post-contrast vessel wall magnetic resonance imaging (VW-MRI) is assumed to be a biomarker for vessel wall inflammation and aneurysm instability. However, the exact factors contributing to enhancement are not yet clarified. This study investigates the relationship between luminal enhancement and intra-aneurysmal flow behaviour to assess the suitability of VW-MRI as a surrogate method for determining quantitative and qualitative flow behaviour in the aneurysm sac. Methods VW-MRI signal is measured in the lumen of three patient-specific IA flow models and compared with the intra-aneurysmal flow fields obtained using phase-contrast magnetic resonance imaging (PC-MRI) and computational fluid dynamics (CFD). The IA flow models were supplied with two different time-varying flow regimes. Results Overall, the velocity fields acquired using PC-MRI or CFD were in good agreement with the VW-MRI enhancement patterns. Generally, the regions with slow-flowing blood show higher VW-MRI signal intensities, whereas high flow leads to a suppression of the signal. For all aneurysm models, a signal value above three was associated with velocity values below three cm/s. Conclusion Regions with lower enhancements have been correlated with the slow and high flow at the same time. Thus, further factors like flow complexity and stability can contribute to flow suppression in addition to the flow magnitude. Nevertheless, VW-MRI can qualitatively assess intra-aneurysmal flow phenomena and estimate the velocity range present in the corresponding region.