A neurysmAl subarachnoid hemorrhage (aSAH) occurs in 9-14 per 100,000 population in the United States. 2 Up to two-thirds of patients with aSAH develop angiographic vasospasm and one-third develop delayed cerebral ischemia (DCI), leading to poor outcomes. 4,10 Although the precise pathophysiology of vasospasm is incompletely understood, previous studies have demonstrated that angiographic vasospasm is induced by adjacent aSAH and correlates with the volume of adjacent hemorrhage. 8,17 Intracranial vessel wall MRI (IVWM) has emerged as a useful technique to characterize intracranial vasculopathies, particularly inflammatory changes in the vessel wall, 12-15 and may more directly identify vascular inflammation that may be associated with subsequent vasospasm in the setting of aSAH. 11,16 The purpose of our study was to characterize IVWM findings in patients with acute endovascularly treated ruptured and unruptured aneurysms, characterize the IVWM features of different treatment techniques, and determine any association with angiographic vasospasm. Methods Patient CohortAfter institutional review board approval, consecutive patients with a ruptured or unruptured intracranial aneu-ABBREVIATIONS ACA = anterior cerebral artery; aSAH = aneurysmal SAH; DCI = delayed cerebral ischemia; GEE = generalized estimating equations; ICA = internal carotid artery; IVWM = intracranial vessel wall MRI; MCA = middle cerebral artery; SAH = subarachnoid hemorrhage; SPACE = sampling perfection with application of optimized contrast enhancement; TCD = transcranial Doppler.OBJECTIVE The aim of this paper was to evaluate the association between intracranial vessel wall MRI enhancement characteristics and the development of angiographic vasospasm in endovascularly treated aneurysm patients. METHODS Consecutive cases of both ruptured and unruptured intracranial aneurysms that were treated endovascularly, followed by intracranial vessel wall MRI in the immediate postoperative period, were included. Two raters blinded to clinical data and follow-up imaging independently evaluated for the presence, pattern, and intensity of wall enhancement. Development of angiographic vasospasm was independently evaluated. Delayed cerebral ischemia; cerebral infarct; procedural details; and presence and grade of subarachnoid, parenchymal, and intraventricular hemorrhage were evaluated. Statistical associations were determined on a per-vessel segment and per-patient basis. RESULTS Twenty-nine patients with 30 treated aneurysms (8 unruptured and 22 ruptured) were included in this study. Interobserver agreement was substantial for the presence of enhancement (k = 0.67) and nearly perfect for distribution (k = 0.87) and intensity (k = 0.84) of wall enhancement. Patients with ruptured aneurysms had a significantly greater number of enhancing segments than those with unruptured aneurysms (29.9% vs 7.2%; OR 5.5, 95% CI 2.2-13.7). For ruptured cases, wall enhancement was significantly associated with subsequent angiographic vasospasm while controlling for grade of hem...

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Knowledge of the treatment-induced imaging abnormalities is essential in the accurate interpretation and diagnosis from the most routine to most challenging of clinical situations. We provide a pictorial review for the radiologist to employ in order to be an invaluable provider to our clinical colleagues and patients.