Qualitative and Quantitative Wall Enhancement on Magnetic Resonance Imaging Is Associated With Symptoms of Unruptured Intracranial Aneurysms

Author:

Fu Qichang1,Wang Yuting2ORCID,Zhang Yi1,Zhang Yong1,Guo Xinbin3,Xu Haowen3,Yao Zhiqiang3,Wang Meng4,Levitt Michael R.567,Mossa-Basha Mahmud6,Zhu Jinxia8ORCID,Cheng Jingliang8ORCID,Guan Sheng3,Zhu Chengcheng69ORCID

Affiliation:

1. Department of Magnetic Resonance (Q.F., Yi Zhang, Yong Zhang, J.C.), The First Affiliated Hospital of Zhengzhou University, Chinar.

2. Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu (Y.W.).

3. Department of Interventional Neuroradiology (X.G., H.X., Z.Y., S.G.), The First Affiliated Hospital of Zhengzhou University, Chinar.

4. Department of Neurological Surgery (M.W.), The First Affiliated Hospital of Zhengzhou University, Chinar.

5. Department of Neurological Surgery (M.R.L.), University of Washington, Seattle.

6. Department of Radiology (M.R.L., M.M.-B., C.Z.), University of Washington, Seattle.

7. Department of Mechanical Engineering (M.R.L.), University of Washington, Seattle.

8. MR Collaboration, Siemens Healthcare Ltd, Beijing, China (J.Z.).

9. Department of Radiology and Biomedical Imaging, University of California, San Francisco (C.Z.).

Abstract

Background and Purpose: Aneurysmal wall enhancement (AWE) on vessel wall magnetic resonance imaging (VW-MRI) has been described as a new imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). Previous studies of symptomatic UIAs are limited due to small sample sizes and lack of AWE quantification. Our study aims to investigate whether qualitative and quantitative assessment of AWE can differentiate symptomatic and asymptomatic UIAs. Methods: Consecutive patients with UIAs were prospectively recruited for vessel wall magnetic resonance imaging at 3T from October 2014 to October 2019. UIAs were categorized as symptomatic if presenting with sentinel headache or oculomotor nerve palsy directly related to the aneurysm. Evaluation of wall enhancement included enhancement pattern (0=none, 1=focal, and 2=circumferential) and quantitative wall enhancement index (WEI). Univariate and multivariate analyses were used to identify the parameters associated with symptoms. Results: Two hundred sixty-seven patients with 341 UIAs (93 symptomatic and 248 asymptomatic) were included in this study. Symptomatic UIAs more frequently showed circumferential AWE than asymptomatic UIAs (66.7% versus 17.3%, P <0.001), as well as higher WEI (median [interquartile range], 1.3 [1.0–1.9] versus 0.3 [0.1–0.9], P <0.001). In multivariate analysis, both AWE pattern and WEI were independent factors associated with symptoms (odds ratio=2.03 across AWE patterns [95% CI, 1.21–3.39], P =0.01; odds ratio=3.32 for WEI [95% CI, 1.51–7.26], P =0.003). The combination of AWE pattern and WEI had an area under the curve of 0.91 to identify symptomatic UIAs, with a sensitivity of 95.7% and a specificity of 73.4%. Conclusions: In a large cohort of UIAs with vessel wall magnetic resonance imaging, both AWE pattern and WEI were independently associated with aneurysm-related symptoms. The qualitative and quantitative features of AWE can potentially be used to identify unstable intracranial aneurysms.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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