Abstract
Objective
To investigate the association between chronic headache outcome and aneurysmal wall enhancement (AWE) on high-resolution vessel wall imaging (HR-VWI) in patients with unruptured intracranial aneurysms (UIAs) who underwent microsurgical clipping.
Methods
Two hundred seventy-four UIA patients were retrospectively analyzed. Patients were grouped according to presence of AWE. AWE was subclassified as focal or uniform. Clinical and imaging data were recorded. Headache was evaluated using the 10-point numerical rating scale and Headache Impact Test-6 before and 6 months after surgery.
Results
The proportions of patients reporting chronic headache in the no AWE, focal wall enhancement (FWE), and uniform wall enhancement (UWE) groups were 5.7%, 24.8%, and 41.8%, respectively. All patients in the UWE group who reported headache before surgery experienced headache improvement after surgery. Decrease in headache severity was greater in the UWE group than in the FWE group. Multivariate binary logistic regression showed that FWE (odds ratio (OR) 0.490; 95% confidence interval (CI), 0.262–0.917; p = 0.026) and small intraluminal thrombus (OR 0.336; 95% CI, 0.142–0.795; p = 0.013) were independent factors protective against preoperative headache. FWE (OR 0.377; 95% CI, 0.195–0.728; p = 0.004) and small intraluminal thrombus (OR 0.235; 95% CI, 0.088–0.630; p = 0.004) were independent predictors of no headache relief after surgery.
Conclusions
AWE on HR-VWI is associated with relief of chronic headache after surgical clipping in patients with UIAs. Incidence of chronic headache was highest in patients exhibiting UWE. These patients also experienced the greatest improvement in headache after surgical clipping.
Clinical relevance statement
This study revealed that high-resolution vessel wall imaging can demonstrate aneurysmal wall plaque and intraluminal thrombus, which may be prognostic imaging markers for chronic headache in patients with unruptured intracranial aneurysms.
Key Points
• Aneurysmal wall enhancement may be associated with chronic headache.
• Incidence of chronic headache was highest in patients with aneurysms exhibiting uniform wall enhancement.
• Patients with aneurysms exhibiting uniform wall enhancement experienced the greatest improvement in headache after clipping.
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Abbreviations
- AWE:
-
Aneurysmal wall enhancement
- CI:
-
Confidence interval
- CNS:
-
Central nervous system
- FWE:
-
Focal wall enhancement
- HAMA:
-
Hamilton Anxiety Rating Scale
- HIT-6:
-
Headache Impact Test-6
- HR-VWI:
-
High-resolution vessel wall magnetic resonance imaging
- mRS:
-
Modified Rankin scale
- NRS:
-
Numerical rating scale
- NSAIDs:
-
Non-steroidal anti-inflammatory drugs
- OR:
-
Odds ratio
- SAH:
-
Subarachnoid hemorrhage
- UIAs:
-
Unruptured intracranial aneurysms
- UWE:
-
Uniform wall enhancement
References
Vlak MHM, Algra A, Brandenburg R, Rinkel GJE (2011) Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 10:626–636. https://doi.org/10.1016/S1474-4422(11)70109-0
England TN (1998) Unruptured intracranial aneurysms — risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733. https://doi.org/10.1056/NEJM199812103392401
Park JH, Kim H, Kim SR et al (2018) Headache outcomes after coil embolization in patients with unruptured intracranial aneurysms: do they get better or worse? A prospective analysis. World Neurosurg 114:e191–e198. https://doi.org/10.1016/j.wneu.2018.02.138
Maragkos GA, Cordell S, Gomez-Paz S et al (2020) Flow diversion endovascular treatment improves headaches in patients with unruptured intracranial aneurysms. World Neurosurg 140:e140–e147. https://doi.org/10.1016/j.wneu.2020.04.206
Schwedt TJ, Gereau RW, Frey K, Kharasch ED (2011) Headache outcomes following treatment of unruptured intracranial aneurysms: a prospective analysis. Cephalalgia 31:1082–1089. https://doi.org/10.1177/0333102411398155
Dandurand C, Parhar HS, Naji F et al (2019) Headache outcomes after treatment of unruptured intracranial aneurysm a systematic review and meta-analysis. Stroke 50:3628–3631. https://doi.org/10.1161/STROKEAHA.119.026864
Kong DS, Hong SC, Jung YJ, Kim JS (2007) Improvement of chronic headache after treatment of unruptured intracranial aneurysms. Headache 47:693–697. https://doi.org/10.1111/j.1526-4610.2006.00630.x
Quan K, Song J, Yang Z et al (2019) Validation of wall enhancement as a new imaging biomarker of unruptured cerebral aneurysm. Stroke 50:1570–1573. https://doi.org/10.1161/STROKEAHA.118.024195
Lehman VT, Brinjikji W, Mossa-Basha M et al (2018) Conventional and high-resolution vessel wall MRI of intracranial aneurysms: current concepts and new horizons. J Neurosurg 128:969–981. https://doi.org/10.3171/2016.12.JNS162262
Zhu C, Wang X, Eisenmenger L et al (2020) Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm. Eur Radiol 30:6413–6420. https://doi.org/10.1007/s00330-020-07063-6
Kwon OK (2019) Headache and aneurysm. Neuroimaging Clin N Am 29:255–260. https://doi.org/10.1016/j.nic.2019.01.004
Nichols FT, Mawad M, Mohr JP et al (1990) Focal headache during balloon inflation in the internal carotid and middle cerebral arteries. Stroke 21:555–559. https://doi.org/10.1161/01.STR.21.4.555
Li H, Zhang X, Zhang Q-R, Hang C-H (2014) Resolution of migraine-like headache by coil embolization of a primitive trigeminal artery aneurysm. Pain Med 15:1052–1055. https://doi.org/10.1111/pme.12394
Arena JE, Hawkes MA, Farez MF et al (2017) Headache and treatment of unruptured intracranial aneurysms. J Stroke Cerebrovasc Dis 26:1098–1103. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.12.026
Gu DQ, Duan CZ, Li XF et al (2013) Effect of endovascular treatment on headache in elderly patients with unruptured intracranial aneurysms. AJNR Am J Neuroradiol 34:1227–1231. https://doi.org/10.3174/ajnr.A3353
Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x
Olesen J (2018) Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1–211. https://doi.org/10.1177/0333102417738202
Heldner MR, Nedelcheva M, Yan X et al (2015) Dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection. Int J Stroke 10:887–892. https://doi.org/10.1111/ijs.12553
Kosinski M, Bayliss MS, Bjorner JB et al (2003) A six-item short-form survey for measuring headache impact: the HIT-6™. Qual Life Res 12:963–974. https://doi.org/10.1023/A:1026119331193
Zhu C, Wang X, Degnan AJ et al (2018) Wall enhancement of intracranial unruptured aneurysm is associated with increased rupture risk and traditional risk factors. Eur Radiol 28:5019–5026. https://doi.org/10.1007/s00330-018-5522-z
Merli E, Rustici A, Gramegna LL et al (2022) Vessel-wall MRI in primary headaches: the role of neurogenic inflammation. Headache 1–8. https://doi.org/10.1111/head.14253
Van Os HJA, Mulder IA, Van Der Schaaf IC et al (2016) Role of atherosclerosis, clot extent, and penumbra volume in headache during ischemic stroke. Neurology 87:1124–1130. https://doi.org/10.1212/WNL.0000000000003092
Mitsias PD, Ramadan NM, Levine SR et al (2006) Factors determining headache at onset of acute ischemic stroke. Cephalalgia 26:150–157. https://doi.org/10.1111/j.1468-2982.2005.01012.x
Shimonaga K, Matsushige T, Ishii D et al (2018) Clinicopathological insights from vessel wall imaging of unruptured intracranial aneurysms. Stroke 49:2516–2529. https://doi.org/10.1161/STROKEAHA.118.021819
Rodríguez-Catarino M, Frisén L, Wikholm G et al (2003) Internal carotid artery aneurysms, cranial nerve dysfunction and headache: the role of deformation and pulsation. Neuroradiology 45:236–240. https://doi.org/10.1007/s00234-002-0934-4
Iversen HK, Nielsen TH, Olesen J, Tfelt-Hansen P (1990) Arterial responses during migraine headache. Lancet 336:837–839. https://doi.org/10.1016/0140-6736(90)92339-J
Restuccia G, Cavazza A, Boiardi L et al (2012) Small-vessel vasculitis surrounding an uninflamed temporal artery and isolated vasa vasorum vasculitis of the temporal artery: two subsets of giant cell arteritis. Arthritis Rheum 64:549–556. https://doi.org/10.1002/art.33362
Masutani EM, Bahrami N, Hsiao A (2020) Deep learning single-frame and multiframe super-resolution for cardiac MRI. Radiology 295:552–561. https://doi.org/10.1148/radiol.2020192173
Acknowledgements
We thank Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the language of this manuscript.
Funding
This study was supported by the National Natural Science Foundation of China (No. 82171311, No. 81801148), Shanghai Excellent Academic Leader Program (No. 21XD1400600), Shanghai Science and Technology Commission Project (No. 23ZR1408700), Clinical Research Plan of SHDC (No. SHDC2020CR2034B, No. SHDC2020CR4033) and ZJ Lab, and CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5–008).
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The scientific guarantor of this publication is “Wei Zhu,” and the institution is “Department of Neurosurgery, Huashan Hospital, Fudan University.”
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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
“Jianfeng Luo” kindly provided statistical advice for this manuscript.
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Written informed consent was obtained from all subjects in this study.
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Institutional Review Board approval was obtained (IRB 2017-D386).
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Quan, K., Hu, L., Zhang, S. et al. Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10303-0
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DOI: https://doi.org/10.1007/s00330-023-10303-0