Performance of Aneurysm Wall Enhancement Compared with Clinical Predictive Scales: PHASES, ELAPSS, and UIATS

Roa, Jorge A; Sabotin, Ryan; Varón, Alberto Rodríguez; Raghuram, Ashrita; Patel, Devanshee; Morris, Timothy W.; Ishii, Daizo; Lu, Yongjun; Hasan, David; Samaniego, Edgar A

doi:10.1016/j.wneu.2020.12.123

Cited by 15 publications

(11 citation statements)

References 24 publications

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“…To standardize the analysis of AWE, we previously analyzed multiple enhancement metrics and determined that a PS ratio ≥ 0.60 had a sensitivity of 81% in detecting aneurysms ≥ 7 mm in diameter. This threshold correlated well with clinical predictive scales of aneurysm growth and rupture 31 . However, AWE analysis was performed in multiplanar reconstructions at best and did not capture the 3D structure of the aneurysm.…”

Section: Discussionsupporting

confidence: 57%

Semiautomated 3D mapping of aneurysmal wall enhancement with 7T-MRI

Raghuram

Varón

Roa

et al. 2021

Sci Rep

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Aneurysm wall enhancement (AWE) after the administration of contrast gadolinium is a potential biomarker of unstable intracranial aneurysms. While most studies determine AWE subjectively, this study comprehensively quantified AWE in 3D imaging using a semi-automated method. Thirty patients with 33 unruptured intracranial aneurysms prospectively underwent high-resolution imaging with 7T-MRI. The signal intensity (SI) of the aneurysm wall was mapped and normalized to the pituitary stalk (PS) and corpus callosum (CC). The CC proved to be a more reliable normalizing structure in detecting contrast enhancement (p < 0.0001). 3D-heatmaps and histogram analysis of AWE were used to generate the following metrics: specific aneurysm wall enhancement (SAWE), general aneurysm wall enhancement (GAWE) and focal aneurysm wall enhancement (FAWE). GAWE was more accurate in detecting known morphological determinants of aneurysm instability such as size ≥ 7 mm (p = 0.049), size ratio (p = 0.01) and aspect ratio (p = 0.002). SAWE and FAWE were aneurysm specific metrics used to characterize enhancement patterns within the aneurysm wall and the distribution of enhancement along the aneurysm. Blebs were easily identified on 3D-heatmaps and were more enhancing than aneurysm sacs (p = 0.0017). 3D-AWE mapping may be a powerful objective tool in characterizing different biological processes of the aneurysm wall.

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Section: Discussionsupporting

confidence: 57%

Semiautomated 3D mapping of aneurysmal wall enhancement with 7T-MRI

Raghuram

Varón

Roa

et al. 2021

Sci Rep

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“…Recently, high-resolution vessel wall imaging (HR-VWI) has received attention as an effective, non-invasive way to study aneurysm wall dynamics and inflammatory responses (14)(15)(16). Wall enhancement may indicate increased risk of rupture in aneurysms (17)(18)(19). However, many open questions remain about the etiology of wall enhancement and its relation to aneurysm rupture and instability.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Cerebral Aneurysm Wall Tension and Enhancement Using Finite Element Analysis and High-Resolution Vessel Wall Imaging

et al. 2021

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Biomechanical computational simulation of intracranial aneurysms has become a promising method for predicting features of instability leading to aneurysm growth and rupture. Hemodynamic analysis of aneurysm behavior has helped investigate the complex relationship between features of aneurysm shape, morphology, flow patterns, and the proliferation or degradation of the aneurysm wall. Finite element analysis paired with high-resolution vessel wall imaging can provide more insight into how exactly aneurysm morphology relates to wall behavior, and whether wall enhancement can describe this phenomenon. In a retrospective analysis of 23 unruptured aneurysms, finite element analysis was conducted using an isotropic, homogenous third order polynomial material model. Aneurysm wall enhancement was quantified on 2D multiplanar views, with 14 aneurysms classified as enhancing (CRstalk≥0.6) and nine classified as non-enhancing. Enhancing aneurysms had a significantly higher 95th percentile wall tension (μ = 0.77 N/cm) compared to non-enhancing aneurysms (μ = 0.42 N/cm, p < 0.001). Wall enhancement remained a significant predictor of wall tension while accounting for the effects of aneurysm size (p = 0.046). In a qualitative comparison, low wall tension areas concentrated around aneurysm blebs. Aneurysms with irregular morphologies may show increased areas of low wall tension. The biological implications of finite element analysis in intracranial aneurysms are still unclear but may provide further insights into the complex process of bleb formation and aneurysm rupture.

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“…Presence of AWE has been correlated to anatomical characteristics of IAs such as size, location, and shape [ 52 , 65 , 70 , 73 , 76 , 100 , 108 , 109 ]. AWE is described to be higher in larger IAs [ 65 , 73 , 76 ]. However, AWE can also be observed in small IAs (size < 7 mm) [ 76 ].…”

Section: High-resolution Vessel Wall Magnetic Resonance Imaging To Ev...mentioning

confidence: 99%

“…However, AWE can also be observed in small IAs (size < 7 mm) [ 76 ]. High depth/neck width aspect ratio is shown to be associated with higher AWE [ 73 , 100 ]. Larger AWE values are more often obtained from IAs located in anterior cerebral artery, posterior communicating artery, posterior circulation artery, or middle cerebral artery [ 76 ].…”

Section: High-resolution Vessel Wall Magnetic Resonance Imaging To Ev...mentioning

confidence: 99%

“…Some studies have investigated whether AWE correlates with scores used in clinics to evaluate the risk of rupture of a specific IA. Positive correlations have been observed between AWE and PHASES score [ 33 , 47 , 65 , 73 , 108 ], UIAT score [ 65 ], or ELAPSS score [ 73 , 108 ]. However, absence of correlation between UIAT score and AWE has also been shown [ 73 ].…”

Section: High-resolution Vessel Wall Magnetic Resonance Imaging To Ev...mentioning

confidence: 99%

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Intracranial aneurysm wall (in)stability–current state of knowledge and clinical perspectives

2021

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Intracranial aneurysm (IA), a local outpouching of cerebral arteries, is present in 3 to 5% of the population. Once formed, an IA can remain stable, grow, or rupture. Determining the evolution of IAs is almost impossible. Rupture of an IA leads to subarachnoid hemorrhage and affects mostly young people with heavy consequences in terms of death, disabilities, and socioeconomic burden. Even if the large majority of IAs will never rupture, it is critical to determine which IA might be at risk of rupture. IA (in)stability is dependent on the composition of its wall and on its ability to repair. The biology of the IA wall is complex and not completely understood. Nowadays, the risk of rupture of an IA is estimated in clinics by using scores based on the characteristics of the IA itself and on the anamnesis of the patient. Classification and prediction using these scores are not satisfying and decisions whether a patient should be observed or treated need to be better informed by more reliable biomarkers. In the present review, the effects of known risk factors for rupture, as well as the effects of biomechanical forces on the IA wall composition, will be summarized. Moreover, recent advances in high-resolution vessel wall magnetic resonance imaging, which are promising tools to discriminate between stable and unstable IAs, will be described. Common data elements recently defined to improve IA disease knowledge and disease management will be presented. Finally, recent findings in genetics will be introduced and future directions in the field of IA will be exposed.

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Performance of Aneurysm Wall Enhancement Compared with Clinical Predictive Scales: PHASES, ELAPSS, and UIATS

Cited by 15 publications

References 24 publications

Semiautomated 3D mapping of aneurysmal wall enhancement with 7T-MRI

Semiautomated 3D mapping of aneurysmal wall enhancement with 7T-MRI

Analysis of Cerebral Aneurysm Wall Tension and Enhancement Using Finite Element Analysis and High-Resolution Vessel Wall Imaging

Intracranial aneurysm wall (in)stability–current state of knowledge and clinical perspectives

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