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Wall enhancement of intracranial unruptured aneurysm is associated with increased rupture risk and traditional risk factors

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

Aneurysm wall enhancement (AWE) on MRI has been considered an imaging marker to indicate active aneurysm inflammation, but no prospective studies have assessed the ability of AWE to predict rupture risk or growth. We aim to study the association of AWE with traditional risk factors and the estimated rupture risk.

Methods

Seventy-seven patients (mean age, 58.4 ± 10.8 years; 57% female) with 88 asymptomatic intracranial saccular aneurysms underwent both 3-T high-resolution MRI and three-dimensional (3D) rotational digital subtraction angiography (DSA). Geometric and morphologic parameters were measured on DSA, and the degree of AWE on MRI was graded. One- and 5-year rupture risks of aneurysms were estimated using the UCAS and PHASES calculator. Parameters associated with AWE were analyzed using uni- and multivariate logistic regression.

Results

Non-internal carotid artery location (OR 3.4, 95% CI 1.6-7.1) and aneurysm size (OR 1.9, 95% CI 1.3-2.7) were independently associated with AWE (p < 0.05). Aneurysms with AWE had significantly higher estimated rupture risk (1 and 5 year, 1.9% and 5.8%) than aneurysms without AWE (0.5% and 2.1%) (p < 0.001). Stronger and larger areas of AWE were correlated with the aneurysm size, size ratio and estimated rupture risk (R2 ≥ 0.30) (p < 0.01).

Conclusions

Prospective assessment of asymptomatic intracranial aneurysms with MRI suggests that AWE is associated with traditional risk factors and estimated short- and medium-term rupture risk.

Key Points

• AWE independently associates with aneurysm location and size.

• Aneurysms with AWE have higher rupture risk than aneurysms without AWE.

• Stronger and larger areas of AWE correlated with the aneurysm size, size ratio and rupture risk.

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Abbreviations

3D:

Three-dimensional

AR:

Aspect ratio

AWE:

Aneurysm wall enhancement

CI:

Confidence interval

CV:

Coefficient of variance

DSA:

Digital subtraction angiography

IA:

Intracranial aneurysm

ICA:

Internal carotid artery

ICC:

Intra-class correlation coefficient

MCA:

Middle cerebral artery

OR:

Odds ratio

SPACE:

Fast spin echo with variable flip angle trains

SR:

Size ratio

TOF:

Time of flight

UIA:

Unruptured intracranial aneurysm

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Funding

This study has received funding by National Natural Science Foundation of China (nos. 81670396, 31470910) and NIH grant K99HL136883.

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Author notes

  1. Chengcheng Zhu and Xinrui Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA

    Chengcheng Zhu, Christopher Hess & David Saloner

  2. Department of Radiology, Changhai Hospital, Shanghai, China

    Xinrui Wang, Zhang Shi, Bing Tian, Qi Liu & Jianping Lu

  3. Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Andrew J. Degnan

Authors
  1. Chengcheng Zhu
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  2. Xinrui Wang
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  3. Andrew J. Degnan
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  4. Zhang Shi
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  5. Bing Tian
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  6. Qi Liu
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  7. Christopher Hess
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  8. David Saloner
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  9. Jianping Lu
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Corresponding author

Correspondence to Jianping Lu.

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Guarantor

The scientific guarantor of this publication is Prof. Jianping Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

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Zhu, C., Wang, X., Degnan, A.J. et al. Wall enhancement of intracranial unruptured aneurysm is associated with increased rupture risk and traditional risk factors. Eur Radiol 28, 5019–5026 (2018). https://doi.org/10.1007/s00330-018-5522-z

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  • DOI: https://doi.org/10.1007/s00330-018-5522-z

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