Quantitative Assessment of Circumferential Enhancement along the Wall of Cerebral Aneurysms Using MR Imaging

Omodaka, Shunsuke; Endo, Hidenori; Niizuma, Kuniyasu; Fujimura, Miki; Inoue, Takashi; Sato, Kenichi; Sugiyama, Shin; Tominaga, Teiji

doi:10.3174/ajnr.a4722

Cited by 69 publications

(62 citation statements)

References 15 publications

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“…CEAW has been shown to be a characteristic of ruptured aneurysms using MR vessel wall imaging. 6,19,21,23 The strong CEAW in ruptured aneurysms can be explained by the physical disruption of the aneurysm wall and/or the inflammatory healing process following the rupture event, in addition to the preexisting inflammatory activity prior to rupture. 9,13,14,19 Evolving unruptured aneurysms can also show CEAW because of their inflammatory activity, which is hypothesized to contribute to aneurysm progression to- ward rupture.…”

Section: Discussionmentioning

confidence: 99%

“…The contrast ratio of the aneurysm wall against the pituitary stalk (CR stalk ) was used to characterize the extent of CEAW as described elsewhere. 22,23 We defined the volume of interest with the highest signal intensity (SI) in the circumference of the aneurysm and those in the whole pituitary stalk on postcontrast imaging, and the averaged SI of the aneurysm circumferential wall (SI wall ) and pituitary stalk (SI stalk ) in each of the volumes of interest was measured. Then, the CR stalk was calculated as SI wall /SI stalk .…”

Section: Measurement Of Aneurysm Wall Enhancementmentioning

confidence: 99%

“…The detailed calculation procedure and excellent reproducibility of this parameter have been previously described. 22,23 Statistical Analysis Aneurysm status was categorized as evolving, stable, or ruptured. Continuous variables are presented as median (range), and categorical variables are presented as a number and corresponding percentage.…”

Section: Measurement Of Aneurysm Wall Enhancementmentioning

confidence: 99%

“…We have reported CR stalk as a convenient indicator of CEAW in daily practice, which can be obtained from single postcontrast scanning. 23 Attention should be given to assessing CR stalk because structures adjacent to the aneurysms with high intensity on T1-weighted imaging, such as fatty tissues in the skull and hematomas in the methemoglobin phase, could be confusing. In addition, slow flow and turbulent flow can result in a hyperintense signal that may be misinterpreted as enhancement.…”

Section: Figmentioning

confidence: 99%

“…wall (CEAW) on MR vessel wall imaging has been described to be higher in ruptured intracranial aneurysms than in unruptured aneurysms. 6,19,23 However, reports on CEAW in evolving unruptured aneurysms have been limited and only investigated as unstable aneurysms, including ruptured aneurysms. 6 Evolving aneurysms can exhibit wall enhancement because wall enhancement reflects inflammation activity that is considered to play an important role in aneurysm evolution.…”

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confidence: 99%

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Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging

Omodaka¹,

Endo

Niizuma

et al. 2019

Journal of Neurosurgery

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OBJECTIVERecent MR vessel wall imaging studies have indicated intracranial aneurysms in the active state could show circumferential enhancement along the aneurysm wall (CEAW). While ruptured aneurysms frequently show CEAW, CEAW in unruptured aneurysms at the evolving state (i.e., growing or symptomatic) has not been studied in detail. The authors quantitatively assessed the degree of CEAW in evolving unruptured aneurysms by comparing it separately to that in stable unruptured and ruptured aneurysms.METHODSA quantitative analysis of CEAW was performed in 26 consecutive evolving aneurysms using MR vessel wall imaging. Three-dimensional T1-weighted fast spin echo sequences were obtained before and after contrast media injection, and the contrast ratio of the aneurysm wall against the pituitary stalk (CRstalk) was calculated as the indicator of CEAW. Aneurysm characteristics of evolving aneurysms were compared with those of 69 stable unruptured and 67 ruptured aneurysms.RESULTSThe CRstalk values in evolving aneurysms were significantly higher than those in stable aneurysms (0.54 vs 0.34, p < 0.0001), and lower than those in ruptured aneurysms (0.54 vs 0.83, p < 0.0002). In multivariable analysis, CRstalk remained significant when comparing evolving with stable aneurysms (odds ratio [OR] 12.23, 95% confidence interval [CI] 3.53–42.41), and with ruptured aneurysms (OR 0.083, 95% CI 0.022–0.310).CONCLUSIONSThe CEAW in evolving aneurysms was higher than those in stable aneurysms, and lower than those in ruptured aneurysms. The degree of CEAW may indicate the process leading to rupture of intracranial aneurysms, which can be useful additional information to determine an indication for surgical treatment of unruptured aneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Measurement Of Aneurysm Wall Enhancementmentioning

confidence: 99%

Section: Measurement Of Aneurysm Wall Enhancementmentioning

confidence: 99%

Section: Figmentioning

confidence: 99%

mentioning

confidence: 99%

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Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging

Omodaka¹,

Endo

Niizuma

et al. 2019

Journal of Neurosurgery

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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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Clinical Significance of Circumferential Aneurysmal Wall Enhancement in Symptomatic Patients with Unruptured Intracranial Aneurysms: a High-resolution MRI Study

Guan

Liu

et al. 2017

Clin Neuroradiol

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Quantitative Assessment of Circumferential Enhancement along the Wall of Cerebral Aneurysms Using MR Imaging

Cited by 69 publications

References 15 publications

Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging

Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging

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

Clinical Significance of Circumferential Aneurysmal Wall Enhancement in Symptomatic Patients with Unruptured Intracranial Aneurysms: a High-resolution MRI Study

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