Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm

Zhu, Chengcheng; Wang, Xinrui; Eisenmenger, Laura; Shi, Zhang; Degnan, Andrew J.; Tian, Bing; Hess, Christopher P.; Saloner, David; Lu, Jianping

doi:10.1007/s00330-020-07063-6

Cited by 23 publications

(15 citation statements)

References 18 publications

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“…Vessel wall magnetic resonance imaging has been more extensively used to study intracranial aneurysms, identifying the site of aneurysm rupture ( Matouk et al, 2013 ; Kondo et al, 2014 ; Hu et al, 2016 ; Nagahata et al, 2016 ) as well as unstable, symptomatic aneurysms ( Edjlali et al, 2014 ; Edjlali et al, 2018 ; Zhu et al, 2020 ) and sites of aneurysm inflammation ( Hu et al, 2016 ; Larsen et al, 2018 ). Although intracranial AVMs are much more complex shunting vascular malformations, one may speculate that areas of enhancement within AVMs may also be indicative of high risk features.…”

Section: Discussionmentioning

confidence: 99%

“…Initially, the majority of studies were focused on steno-occlusive cerebrovascular disease such as intracranial atherosclerosis ( Vergouwen et al, 2011 ; Skarpathiotakis et al, 2013 ; Mossa-Basha et al, 2015 ), primary central nervous system vasculitis ( Mandell et al, 2012 ; Obusez et al, 2014 ; Mossa-Basha et al, 2015 ), reversible cerebral vasoconstriction syndrome ( Mandell et al, 2012 ; Obusez et al, 2014 ; Mossa-Basha et al, 2015 ), drug-induced vasculopathies ( Han et al, 2008 ), and intracranial dissections ( Chung et al, 2014 ; Natori et al, 2014 ). More recently, there has been increased enthusiasm for the utilization of VW-MRI to further characterize vascular malformations, with intracranial aneurysms being the most commonly studied lesion ( Matouk et al, 2013 , 2016 ; Edjlali et al, 2014 ; Nagahata et al, 2016 ; Tian et al, 2019 ; Wang et al, 2019 ; Liu et al, 2020 ; Zhu et al, 2020 ). Current evidence suggests that vessel wall hyperintensity on post-contrast VW-MRI, often referred to as vessel wall “enhancement,” is associated with ruptured ( Matouk et al, 2013 ; Nagahata et al, 2016 ; Wang et al, 2019 ), symptomatic ( Zhu et al, 2020 ), and unstable ( Edjlali et al, 2014 ; Edjlali et al, 2018 ) aneurysms.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, there has been increased enthusiasm for the utilization of VW-MRI to further characterize vascular malformations, with intracranial aneurysms being the most commonly studied lesion ( Matouk et al, 2013 , 2016 ; Edjlali et al, 2014 ; Nagahata et al, 2016 ; Tian et al, 2019 ; Wang et al, 2019 ; Liu et al, 2020 ; Zhu et al, 2020 ). Current evidence suggests that vessel wall hyperintensity on post-contrast VW-MRI, often referred to as vessel wall “enhancement,” is associated with ruptured ( Matouk et al, 2013 ; Nagahata et al, 2016 ; Wang et al, 2019 ), symptomatic ( Zhu et al, 2020 ), and unstable ( Edjlali et al, 2014 ; Edjlali et al, 2018 ) aneurysms. Given the early evidence that VW-MRI may help in the identification of high risk aneurysms, VW-MRI could also be a tool to improve the identification and characterization of high risk intracranial arteriovenous malformations (AVMs); however, fewer VW-MRI studies have been performed on these more complex vascular malformations, now limited to two case series ( Matouk et al, 2016 ; Petridis et al, 2018 ) and a few case reports ( Omodaka et al, 2015 ; Komatsu et al, 2018 ; Bhogal et al, 2019 ) in only ruptured AVMs.…”

Section: Introductionmentioning

confidence: 99%

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Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall “Enhancement”

et al. 2021

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Purpose: High-resolution vessel wall magnetic resonance imaging (VW-MRI) could provide a way to identify high risk arteriovenous malformation (AVM) features. We present the first pilot study of clinically unruptured AVMs evaluated by high-resolution VW-MRI.Methods: A retrospective review of clinically unruptured AVMs with VW-MRI between January 1, 2016 and December 31, 2018 was performed documenting the presence or absence of vessel wall “hyperintensity,” or enhancement, within the nidus as well as perivascular enhancement and evidence of old hemorrhage (EOOH). The extent of nidal vessel wall “hyperintensity” was approximated into five groups: 0, 1–25, 26–50, 51–75, and 76–100%.Results: Of the nine cases, eight demonstrated at least some degree of vessel wall nidus “hyperintensity.” Of those eight cases, four demonstrated greater than 50% of the nidus with hyperintensity at the vessel wall, and three cases had perivascular enhancement adjacent to nidal vessels. Although none of the subjects had prior clinical hemorrhage/AVM rupture, of the six patients with available susceptibility weighted imaging to assess for remote hemorrhage, only two had subtle siderosis to suggest prior sub-clinical bleeds.Conclusion: Vessel wall “enhancement” occurs in AVMs with no prior clinical rupture. Additional studies are needed to further investigate the implication of these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall “Enhancement”

et al. 2021

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“…It is commonly mentioned in the scientific neurosurgical literature that a warning sign precedes aneurysmal rupture, but none has offered any real-life recommendations or evidence [ 14 ]. In future, aneurysm-targeted specific magnetic resonance imaging sequences might assist in diagnosing sentinel headaches [ 14 , 15 , 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Warning Signs in the Era of Unruptured Intracranial Aneurysms: Report on 2 Cases of Fatal Aneurysmal Hemorrhage

Wójtowicz¹,

Kunert²,

Przepiórka³

et al. 2021

Cerebrovasc Dis Extra

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Introduction: The timing of treatment remains unresolved for patients with unruptured intracranial aneurysms (UIAs) and headaches, particularly when the pain is short term, localized, and related to the aneurysm site. We lack evidence to support the notion that when a headache accompanies an aneurysm, it elevates the risk of rupture. Results: We describe 2 cases of fatal subarachnoid hemorrhage in patients with a history of headache and known aneurysms. Both of these patients had good indications for treatment: a young age and an aneurysm >7 mm, and both were qualified for elective surgery. However, both patients died of fatal aneurysm ruptures before the planned surgery. Conclusion: These cases suggested that treatment should be started as soon as possible, when a UIA is diagnosed based on a short-term period of severe headaches or when a UIA is observed and then severe headaches appear. There is no straightforward guideline for treatment timing in these patients. However, in this era of UIAs, the significance of sentinel headaches should be reevaluated. Given the incidence of headaches in the general population and the very low risk of aneurysm rupture, there may be a tendency to neglect the role of headache as a possible warning sign.

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“…In addition, IVWI helps distinguish intracranial vasculopathies, specifically inflammatory vasculitis from noninflammatory vasculopathies, including ICAD, intracranial dissection, reversible cerebral vasoconstriction syndrome (RCVS), and moyamoya syndrome 38 . Finally, IVWI can differentiate stable and unstable intracranial aneurysms 39 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Intracranial Atherosclerotic Plaques Using 3D Black‐Blood MRI: Comparison With 3D Time‐of‐Flight MRA and DSA

Xia

Tian

Shi

et al. 2020

Magnetic Resonance Imaging

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BackgroundNoninvasive assessment of intracranial stenosis is important to manage ischemic stroke patients. However, few previous studies have compared 3D black‐blood MRI with 3D time‐of‐flight (TOF), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) for intracranial artery plaque assessment.PurposeTo compare 3D black‐blood MRI and 3D TOF‐MRA, using DSA as the reference standard for intracranial stenosis and atherosclerotic plaque assessment in patients with posterior circulation stroke or transient ischemic attacks (TIAs).Study TypeProspective, cohort study.PopulationOne hundred and one patients with posterior circulation stroke and/or TIA (age 63 ± 10 years, 84 male) who underwent DSA and MRI within 4 weeks of each other.Field Strength/Sequence3D fast‐spin‐echo MRI for intracranial vessel wall imaging (IVWI) and 3D TOF at 3T.AssessmentTwo radiologists independently measured the degree of stenosis on 3D IVWI and TOF, using DSA as a reference. Plaque enhancement was recorded when the plaque was stenosis‐free on DSA.Statistical TestsShapiro–Wilk's test, Student's t‐test, Mann–Whitney U‐test, Spearman correlation, Bland–Altman analysis, and interclass correlation coefficient (ICC).ResultsA total of 238 intracranial plaques (203 posterior, 35 anterior) were included. 3D IVWI showed better agreement with DSA in measuring stenosis than TOF (ICC = 0.89 vs. 0.64). 3D IVWI had higher sensitivity and specificity for detecting stenosis >50% and stenosis >75% than TOF, using DSA as the standard. TOF significantly overestimated the degree of stenosis compared to DSA (65 ± 19% vs. 51 ± 15%, P < 0.001). DSA did not observe 62 nonstenotic plaques (26.1%) that were shown only on 3D IVWI, in which 36 plaques (58.1%) showed contrast enhancement. The interreader agreement for measuring stenosis were excellent, with ICCs >0.90 for all three modalities.Data Conclusion3D black‐blood MRI is accurate and reproducible for quantifying intracranial artery stenosis compared with DSA, and performs better than 3D TOF. As compared to DSA, it detects more nonstenotic plaques.Level of Evidence 1Technical Efficacy Stage 2J. MAGN. RESON. IMAGING 2021;53:469–478.

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Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm

Cited by 23 publications

References 18 publications

Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall “Enhancement”

Presence of Vessel Wall Hyperintensity in Unruptured Arteriovenous Malformations on Vessel Wall Magnetic Resonance Imaging: Pilot Study of AVM Vessel Wall “Enhancement”

Warning Signs in the Era of Unruptured Intracranial Aneurysms: Report on 2 Cases of Fatal Aneurysmal Hemorrhage

Assessment of Intracranial Atherosclerotic Plaques Using 3D Black‐Blood MRI: Comparison With 3D Time‐of‐Flight MRA and DSA

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