High-Resolution Vessel Wall Magnetic Resonance Imaging of Small Unruptured Intracranial Aneurysms

Zwarzany, Łukasz; Tyburski, Ernest; Poncyljusz, Wojciech

doi:10.3390/jcm10020225

Cited by 14 publications

(22 citation statements)

References 41 publications

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“…It is also presumed to be an imaging marker of aneurysm instability, indicating lesions with higher risk of rupture [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. This hypothesis is consistent with the results of our previous study, in which we have shown a statistically significant association between AWE and conventional risk factors for aneurysm rupture [27]. Similar to our previous study, most of Tomography 2022, 8 304 the published literature on the use of HR-VW MRI in patients with intracranial aneurysms focuses on unruptured intracranial aneurysms (UIA) and determining whether AWE is an imaging marker of aneurysm instability.…”

Section: Introductionsupporting

confidence: 91%

High-Resolution Vessel Wall MRI of Endovascularly Treated Intracranial Aneurysms

et al. 2022

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(1) Background: The aim of this study was to determine the frequency and the pattern of post-procedural intracranial aneurysm contrast enhancement on high-resolution vessel wall magnetic resonance imaging (HR-VW MRI). We investigated the possible association between this imaging finding and factors such as time elapsed since embolization or aneurysm occlusion grade on baseline and follow-up imaging. (2) Methods: Consecutive patients presenting for follow-up after endovascular treatment of intracranial aneurysms were included. HR-VW MRI was acquired and interpreted independently by two radiologists. (3) Results: This study included 40 aneurysms in 39 patients. Contrast enhancement was detected in 30 (75%) aneurysms. It was peripheral in 12 (30.0%), central in 9 (22.5%), and both peripheral and central in 9 (22.5%) aneurysms. The statistical analysis did not reveal any relationship between follow-up period and the presence of contrast enhancement (p = 0.277). There were no statistically significant differences in the frequency of contrast enhancement between aneurysms with total occlusion and those with remnant flow on follow-up MR angiography (p = 0.850) nor between aneurysms with different interval changes in the aneurysm occlusion grade (p = 0.536). Multivariate analysis did not demonstrate aneurysm size, ruptured aneurysm status, nor initial complete aneurysm occlusion to be a predictor of contrast enhancement (p = 0.080). (4) Conclusions: Post-procedural aneurysm contrast enhancement is a common imaging finding on HR-VW MRI. The clinical utility of this imaging finding, especially in the prediction of aneurysm recurrence, seems limited. The results of our study do not support routine use of HR-VW MRI in the follow-up of patients after endovascular treatment of intracranial aneurysms.

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Section: Introductionsupporting

confidence: 91%

High-Resolution Vessel Wall MRI of Endovascularly Treated Intracranial Aneurysms

et al. 2022

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“…The ISUIA study showed that the risk of rupture in UIAs smaller than 7 mm was low, and the role of HR-VWI in evaluating aneurysms smaller than 7 mm remained unclear. In our study, 25.3% (21/83) aneurysms showed wall enhancement, and 9.6% (8/83) showed CAWE, which was similar to previous studies investigating small UIAs (Zhu et al, 2018;Zwarzany et al, 2021). Zhu et al (2018) found that AWE was an independent predictor of ruptured aneurysms, and CAWE was significantly associated with ruptured aneurysms instead of AWE in aneurysms smaller than 7 mm.…”

Section: Discussionsupporting

confidence: 90%

Circumferential wall enhancement with contrast ratio measurement in unruptured intracranial aneurysm for aneurysm instability

Zhong

Wang

et al. 2022

Brain and Behavior

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Background Aneurysm wall enhancement on high‐resolution vessel wall imaging (HR‐VWI) may represent vessel wall inflammation for unruptured intracranial aneurysms (UIAs). Further evidence for the role of circumferential aneurysm wall enhancement (CAWE) in evaluating the instability of UIAs is required, especially in small aneurysms (<7 mm). Methods We analyzed patients with saccular UIAs who prospectively underwent HR‐VWI on a 3.0 T MRI scanner in our center from September 2017 to August 2021. The presence of AWE was identified and quantitatively measured using the aneurysm‐to‐pituitary stalk contrast ratio (CRstalk) with maximal signal intensity value. The PHASES and ELAPSS scores were used to assess the risk of aneurysm rupture and growth. We evaluated the association of CAWE and CRstalk value with intracranial aneurysm instability. Results One hundred patients with 109 saccular UIAs were included in this study. Eighty‐three UIAs (76.1%) had a size smaller than 7 mm. PHASES and ELAPSS scores were significantly higher in UIAs with CAWE than in UIAs without CAWE (p < .01). The association of CAWE with PHASES and ELAPSS scores remained in small UIAs (<7 mm). The optimal cutoff value of CRstalk for CAWE was 0.5. PHASES and ELAPSS scores were significantly higher in UIAs with CRstalk ≥0.5 than in UIAs with CRstalk <0.5 (p < .01). Conclusions CAWE on HR‐VWI is a valuable imaging marker for aneurysm instability in UIAs. CRstalk value ≥0.5 may be associated with a higher risk of intracranial aneurysm rupture and growth.

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“…VW-MRI may depict these processes and aneurysm wall enhancement (AWE) extent has been associated with the degree of histological inflammatory markers, as well as atherosclerosis, neovascularization, and macrophage infiltration [ 8 , 99 , 100 ].…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…VW-MRI has demonstrated its utility in a wide range of clinical situations, including differential diagnosis of intracranial vasculopathies, identification and evaluation of intracranial atherosclerotic disease and also risk stratification in patients with intracranial aneurysms [ 7 , 8 ]. When applied to patients with cryptogenic stroke, it allows for the definition of the stroke etiology in a significant percentage of them, often revealing findings compatible with vasculitis or complicated atherosclerotic disease [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases

et al. 2022

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Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.

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High-Resolution Vessel Wall Magnetic Resonance Imaging of Small Unruptured Intracranial Aneurysms

Cited by 14 publications

References 41 publications

High-Resolution Vessel Wall MRI of Endovascularly Treated Intracranial Aneurysms

High-Resolution Vessel Wall MRI of Endovascularly Treated Intracranial Aneurysms

Circumferential wall enhancement with contrast ratio measurement in unruptured intracranial aneurysm for aneurysm instability

Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases

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