Neutrophil-to-Lymphocyte Ratio Is Associated With Circumferential Wall Enhancement of Unruptured Intracranial Aneurysm

Abstract

Background and PurposeNeutrophil-lymphocyte ratio (NLR) predicts clinical outcomes in patients with stroke. Aneurysm wall enhancement (AWE) on high-resolution vessel wall magnetic resonance imaging (HR-VWI) is an inflammation marker for intracranial aneurysm (IA). This study aims to evaluate the association of NLR as a peripheral blood inflammatory marker with circumferential AWE in patients with IA.MethodsWe analyzed data of consecutive patients harboring IAs between September 2017 and December 2021 at our institution. The peripheral blood inflammatory indicators were compared between patients with ruptured and unruptured IAs. The presence of circumferential AWE in unruptured IA was identified and quantitatively measured using the aneurysm-to-pituitary stalk contrast ratio (CRstalk) on HR-VWI. We used the optimal cutoff value of 0.5 for CRstalk to differentiate circumferential AWE in unruptured IAs. We assessed the relationship of clinical, laboratory, and radiological characteristics with circumferential AWE and CRstalk ≥0.5 in unruptured IAs.ResultsThe study group was composed of one hundred and twenty-five patients with 142 IAs. NLR level at admission was significantly higher in patients with ruptured IAs than those with unruptured IAs (7.55 vs. 1.81; P < 0.001). AWE on HR-VWI was present in 30 patients with unruptured IAs (38.5%), including 12 with focal AWE and 18 with circumferential AWE. NLR (odds ratio (OR), 2.168; 95% CI, 1.149–4.088) and size (odds ratio, 1.370; 95% CI, 1.126–1.667) were independently associated with circumferential AWE in unruptured IA. NLR was also independently associated with circumferential AWE in small unruptured IA (<7 mm). Furthermore, NLR level at admission was associated with CRstalk ≥.5 in patients with unruptured IA. The optimal cutoff value of NLR for circumferential AWE was 1.86.ConclusionNLR is a valuable peripheral blood inflammatory marker is more often in the rupture status of IA and was associated with circumferential AWE on HR-VWI in unruptured IA.

Circular RNA hsa_circ_0007990 as a blood biomarker for unruptured intracranial aneurysm with aneurysm wall enhancement

“…AWE on HR-VWI has been used as an imaging marker for vessel wall inflammation and aneurysm instability in patients with UIA. Recent studies showed the association of inflammatory blood biomarkers with AWE on HR-VWI in UIA patients (9)(10)(11)(12)(13). The plasma concentration of anti-inflammatory cytokine interleukin (IL)-10 in the aneurysm sac decreased in UIA with AWE (10).…”

“…The plasma concentration of anti-inflammatory cytokine interleukin (IL)-10 in the aneurysm sac decreased in UIA with AWE ( 10 ). Our previous study showed that the neutrophil-lymphocyte ratio as an inflammatory peripheral blood biomarker was associated with AWE on HR-VWI in UIA patients ( 12 ). The up-regulated proinflammatory IL-1β and down-regulated anti-inflammatory IL-1RA in the serum were associated with AWE on HR-VWI in 34 patients with UIA.…”

“…The aneurysm-to-pituitary stalk contrast ratio (CRstalk) was calculated using the maximal signal intensity value of the aneurysm wall (SIwall) and the pituitary stalk (SIstalk) on the 3D postcontrast HR-VWI T1-weighted sequence as CRstalk = SIwall/SIstalk. CRstalk was used as an optimal quantitative analysis of AWE in UIA (8,12). after overnight fasting from all participants.…”

“…Inflammation plays a vital role in the development and progression of intracranial aneurysms (IA), which can be reflected by aneurysm wall enhancement (AWE) on high-resolution vessel wall magnetic resonance imaging (HR-VWI) (3)(4)(5)(6)(7)(8). Recent studies suggest the association of inflammatory blood biomarkers in the aneurysm sac and peripheral blood with AWE on HR-VWI in patients with UIA (9)(10)(11)(12)(13).…”

Systemic immune-inflammation index is associated with aneurysmal wall enhancement in unruptured intracranial fusiform aneurysms

“…Inflammatory processes in the aneurysmal wall also involve the local activation of the immune system, including neutrophil influx followed by the infiltration of macrophages and other inflammatory cells (6,7). It has been reported that cytokine interleukin-10 and the neutrophil to lymphocyte ratio (NLR) are associated with AWE in HR-MRI (8,9). Given that AWE has emerged as an imaging biomarker of IA instability, a blood inflammatory index may reflect inflammatory processes in the aneurysmal wall and might thus serve as a new biomarker of IA instability.…”