Vessel wall imaging in intracranial aneurysms

Samaniego, Edgar A; Roa, Jorge A; Hasan, David

doi:10.1136/neurintsurg-2019-014938

Cited by 84 publications

(50 citation statements)

References 54 publications

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“…3,4,12 MR VWI, an increasingly useful tool for the assessment of aneurysm wall pathology, has demonstrated the occurrence of aneurysm wall-enhancement in all cases of peri-aneurysmal edema presenting without the evidence of significant mass effect. 6,13 In line with recent histopathological studies, some authors have attributed wall enhancement occurring with perianeurysmal edema to an inflammatory response of the aneurysm wall with neoangiogenesis of the vasa-vasorum triggered by a "foreign body" reaction to the coils within the aneurysm lumen. 3,4,12 However, only a limited number of aneurysms treated with coils present with vasogenic edema, thus it seems plausible to hypothesize that other factors are needed to trigger and sustain an inflammatory reaction.…”

Section: Discussionmentioning

confidence: 75%

“…Nonetheless, current evidence of MR VWI in a clinical role is limited. 6,13 Lack of longitudinal studies, heterogeneity of MR protocols, imaging pitfalls related to pulsation artifacts, and controversies on the definition of "wall-enhancement" warrant a critical appraisal. 6,13,16 Prospective studies are needed to fully comprehend the potential role of this promising MR technique.…”

Section: Discussionmentioning

confidence: 99%

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Peri-Aneurysmal Brain Edema in Native and Treated Aneurysms: The Role of Thrombosis

et al. 2021

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Cerebral peri-aneurysmal edema (PE) is typically associated with giant partially-thrombosed aneurysms and less frequently with smaller aneurysms treated with endovascular embolization. An understanding of the pathophysiologic mechanism of PE is still limited. We report 3 cases of cerebral aneurysms associated with PE. We describe 2 cases of giant partially thrombosed aneurysms surrounded by vasogenic edema with apposition of an intramural and juxtamural thrombus. Our third case is a smaller aneurysm inciting vasogenic edema several years after coil embolization. Vessel-wall magnetic resonance imaging (MRI) showed avid wall enhancement and an enhancing thrombus embedded within the coils, reflecting inflammation of the aneurysm wall and proliferation of the vasa vasorum. Thrombosis within the aneurysmal sac and walls, both in native and treated aneurysms, may promote inflammatory changes and sustain the occurrence of PE. Vessel-wall MRI has a potential role in the evaluation process of this subgroup of aneurysms.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Peri-Aneurysmal Brain Edema in Native and Treated Aneurysms: The Role of Thrombosis

et al. 2021

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“…32 Wall enhancement is more common in unstable and large aneurysms 33 but may also occur in a low percentage of small unruptured and stable aneurysms. 34 Commonly reported histopathological correlates for enhancement include the presence of atherosclerosis, active macrophages, neovascularisation and decreased elastin. Of interest, UIAs with a PHASES score >3 are more likely to have wall enhancement.…”

Section: Conservative Managementmentioning

confidence: 99%

Management of incidental unruptured intracranial aneurysms

Renowden

Nelson

2020

Pract Neurol

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The widespread use of MR has led to the increasingly frequent diagnosis of unruptured incidental intracranial aneurysms. Most are small (<7 mm diameter) and will never rupture. Yet, their recognition causes much anxiety, and their optimal management remains controversial. This review addresses the difficulties in managing incidental unruptured saccular intracranial aneurysms. Note that our conclusions and recommendations do not apply to symptomatic unruptured aneurysms or to fusiform, dissecting, mycotic, traumatic and paediatric aneurysms, each of which has a different natural history.

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“…The pathophysiological underpinnings of inflammation and abnormal flow dynamics are increasingly well validated, and recently reviewed by Samaniego et al 59 The predictive power of AWE on VW-MRI remains to be determined in larger, multi-center, prospective registries.…”

Section: Unruptured Intracranial Aneurysmsmentioning

confidence: 99%

Vessel wall magnetic resonance imaging in intracranial aneurysms: Principles and emerging clinical applications

et al. 2019

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Intracranial high-resolution vessel wall magnetic resonance imaging is an imaging paradigm that complements conventional imaging modalities used in the evaluation of neurovascular pathology. This review focuses on the emerging utility of vessel wall magnetic resonance imaging in the characterization of intracranial aneurysms. We first discuss the technical principles of vessel wall magnetic resonance imaging highlighting methods to determine aneurysm wall enhancement and how to avoid common interpretive pitfalls. We then review its clinical application in the characterization of ruptured and unruptured intracranial aneurysms, in particular, the emergence of aneurysm wall enhancement as a biomarker of aneurysm instability. We offer our perspective from a high-volume neurovascular center where vessel wall magnetic resonance imaging is in routine clinical use.

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Vessel wall imaging in intracranial aneurysms

Cited by 84 publications

References 54 publications

Peri-Aneurysmal Brain Edema in Native and Treated Aneurysms: The Role of Thrombosis

Peri-Aneurysmal Brain Edema in Native and Treated Aneurysms: The Role of Thrombosis

Management of incidental unruptured intracranial aneurysms

Vessel wall magnetic resonance imaging in intracranial aneurysms: Principles and emerging clinical applications

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