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Hao L, Ya X, Wu J, Tao C, Ma R, Zheng Z, Mou S, Ling Y, Yang Y, Wang J, Zhang Y, Lin Q, Zhao J. Somatic PDGFRB activating variants promote smooth muscle cell phenotype modulation in intracranial fusiform aneurysm. J Biomed Sci 2024; 31:51. [PMID: 38741091 PMCID: PMC11092182 DOI: 10.1186/s12929-024-01040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The fusiform aneurysm is a nonsaccular dilatation affecting the entire vessel wall over a short distance. Although PDGFRB somatic variants have been identified in fusiform intracranial aneurysms, the molecular and cellular mechanisms driving fusiform intracranial aneurysms due to PDGFRB somatic variants remain poorly understood. METHODS In this study, single-cell sequencing and immunofluorescence were employed to investigate the phenotypic changes in smooth muscle cells within fusiform intracranial aneurysms. Whole-exome sequencing revealed the presence of PDGFRB gene mutations in fusiform intracranial aneurysms. Subsequent immunoprecipitation experiments further explored the functional alterations of these mutated PDGFRB proteins. For the common c.1684 mutation site of PDGFRβ, we established mutant smooth muscle cell lines and zebrafish models. These models allowed us to simulate the effects of PDGFRB mutations. We explored the major downstream cellular pathways affected by PDGFRBY562D mutations and evaluated the potential therapeutic effects of Ruxolitinib. RESULTS Single-cell sequencing of two fusiform intracranial aneurysms sample revealed downregulated smooth muscle cell markers and overexpression of inflammation-related markers in vascular smooth muscle cells, which was validated by immunofluorescence staining, indicating smooth muscle cell phenotype modulation is involved in fusiform aneurysm. Whole-exome sequencing was performed on seven intracranial aneurysms (six fusiform and one saccular) and PDGFRB somatic mutations were detected in four fusiform aneurysms. Laser microdissection and Sanger sequencing results indicated that the PDGFRB mutations were present in smooth muscle layer. For the c.1684 (chr5: 149505131) site mutation reported many times, further cell experiments showed that PDGFRBY562D mutations promoted inflammatory-related vascular smooth muscle cell phenotype and JAK-STAT pathway played a crucial role in the process. Notably, transfection of PDGFRBY562D in zebrafish embryos resulted in cerebral vascular anomalies. Ruxolitinib, the JAK inhibitor, could reversed the smooth muscle cells phenotype modulation in vitro and inhibit the vascular anomalies in zebrafish induced by PDGFRB mutation. CONCLUSION Our findings suggested that PDGFRB somatic variants played a role in regulating smooth muscle cells phenotype modulation in fusiform aneurysms and offered a potential therapeutic option for fusiform aneurysms.
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Affiliation(s)
- Li Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Joint Laboratory of School of Pharmacy, Capital Medical University and National Clinical Research Center for Nervous System Diseases, Beijing, China
| | - Xiaolong Ya
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Joint Laboratory of School of Pharmacy, Capital Medical University and National Clinical Research Center for Nervous System Diseases, Beijing, China
| | - Jiaye Wu
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Chuming Tao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Ruochen Ma
- HKUST Shenzhen-Hong Kong Collaborative Innovation Research Institute, Futian, Shenzhen, China
- Department of Chemical and Biological Engineering, Division of Life Science, State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Hong Kong SAR, China
- Hong Kong Center for Neurodegenerative Diseases, InnoHK, HKSAR, China
| | - Zhiyao Zheng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Siqi Mou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yiming Ling
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Yingxi Yang
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Jiguang Wang
- HKUST Shenzhen-Hong Kong Collaborative Innovation Research Institute, Futian, Shenzhen, China
- Department of Chemical and Biological Engineering, Division of Life Science, State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Hong Kong SAR, China
- Hong Kong Center for Neurodegenerative Diseases, InnoHK, HKSAR, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
| | - Qing Lin
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
- Joint Laboratory of School of Pharmacy, Capital Medical University and National Clinical Research Center for Nervous System Diseases, Beijing, China.
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Sanchez S, Gudino-Vega A, Guijarro-Falcon K, Miller JM, Noboa LE, Samaniego EA. MR Imaging of the Cerebral Aneurysmal Wall for Assessment of Rupture Risk. Neuroimaging Clin N Am 2024; 34:225-240. [PMID: 38604707 DOI: 10.1016/j.nic.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The evaluation of unruptured intracranial aneurysms requires a comprehensive and multifaceted approach. The comprehensive analysis of aneurysm wall enhancement through high-resolution MRI, in tandem with advanced processing techniques like finite element analysis, quantitative susceptibility mapping, and computational fluid dynamics, has begun to unveil insights into the intricate biology of aneurysms. This enhanced understanding of the etiology, progression, and eventual rupture of aneurysms holds the potential to be used as a tool to triage patients to intervention versus observation. Emerging tools such as radiomics and machine learning are poised to contribute significantly to this evolving landscape of diagnostic refinement.
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Affiliation(s)
- Sebastian Sanchez
- Department of Neurology, Yale University, LLCI 912, New Haven, CT 06520, USA
| | - Andres Gudino-Vega
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | | | - Jacob M Miller
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Luis E Noboa
- Universidad San Francisco de Quito, Quito, Ecuador
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Radiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Matsukawa H, Uchida K, Sowlat MM, Elawady SS, Cunningham C, Alawieh A, Al Kasab S, Jabbour P, Mascitelli J, Levitt MR, Cuellar H, Brinjikji W, Samaniego E, Burkhardt JK, Kan P, Fox WC, Moss M, Ezzeldin M, Grandhi R, Altschul DJ, Spiotta AM, Yoshimura S. Impact of Race on Outcomes in the Endovascular and Microsurgical Treatment in Patients With Intracranial Aneurysms. Neurosurgery 2024:00006123-990000000-01138. [PMID: 38651917 DOI: 10.1227/neu.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/30/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The impact of race on outcomes in the treatment of intracranial aneurysm (IA) remains unclear. We aimed to investigate the relationship between race classified into White, Black, Hispanic, and other and treatment outcomes in patients with ruptured and unruptured IAs. METHODS The study population consisted of 2836 patients with IA with endovascular treatment or microsurgical treatment (MST) from 16 centers in the United States and Asia, all participating in the observational "STAR" registry. The primary outcome was a 90-day modified Rankin Scale of 0 to 2. Secondary outcomes included periprocedural cerebral infarction and intracranial hemorrhage, perioperative symptomatic cerebral vasospasm in ruptured IA and mortality, and all causes of mortality within 90 days. RESULTS One thousand fifty-three patients were White (37.1%), 350 were Black (12.3%), 264 were Hispanic (9.3%), and 1169 were other (41.2%). Compared with White patients, Hispanic patients had a significantly lower proportion of primary outcome (adjusted odds ratio [aOR] 0.36, 95% CI, 0.23-0.56) and higher proportion of the periprocedural cerebral infarction, perioperative mortality, and all causes of mortality (aOR 2.53, 95% CI, 1.40-4.58, aOR 1.84, 95% CI, 1.00-3.38, aOR 1.83, 95% CI, 1.06-3.17, respectively). Outcomes were not significantly different in Black and other patients. The subgroup analysis showed that Hispanic patients with age ≥65 years (aOR 0.19, 95% CI, 0.10-0.38, interaction P = .048), Hunt-Hess grades 0 to 3 (aOR 0.29, 95% CI, 0.19-0.46, interaction P = .03), and MST (aOR 0.24, 95% CI, 0.13-0.44, interaction P = .04) had a significantly low proportion of primary outcome. CONCLUSION This study demonstrates that Hispanic patients with IA are more likely to have a poor outcome at 90 days after endovascular treatment or MST than White patients. Physicians have to pay attention to the selection of treatment modalities, especially for Hispanic patients with specific factors to reduce racial discrepancies.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Conor Cunningham
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Hugo Cuellar
- Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, Louisiana, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Edgar Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadlphia, Pennsylvania, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - W Christopher Fox
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark Moss
- Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, Arkansas, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, Houston, Texas, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, Utah, USA
| | - David J Altschul
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
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Peng F, Xu B, Xia J, Chen X, Liu A. Association Between Serum Homocysteine Concentration, Aneurysm Wall Inflammation, and Aneurysm Symptoms in Intracranial Fusiform Aneurysm. Acad Radiol 2024; 31:168-179. [PMID: 37211477 DOI: 10.1016/j.acra.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023]
Abstract
RATIONALE AND OBJECTIVES The pathophysiology of fusiform intracranial aneurysm (FIA) involves inflammatory processes, and homocysteine plays a role in the inflammatory processes in the vessel wall. Moreover, aneurysm wall enhancement (AWE) has emerged as a new imaging biomarker of aneurysm wall inflammatory pathologies. To investigate the pathophysiological mechanisms of aneurysm wall inflammation and FIA instability, we aimed to determine the associations between the homocysteine concentration, AWE, and FIAs' related symptoms. MATERIALS AND METHODS We retrospectively reviewed the data of 53 patients with FIA who underwent both high-resolution magnetic resonance imaging and serum homocysteine concentration measurement. FIAs' related symptoms were defined as ischemic stroke or transient ischemic attack, cranial nerve compression, brainstem compression, and acute headache. The contrast ratio of the signal intensity of the aneurysm wall to the pituitary stalk (CRstalk) was used to indicate AWE. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine how well the independent factors could predict FIAs' related symptoms. Predictors of CRstalk were also investigated. Spearman's correlation coefficient was used to identify the potential associations between these predictors. RESULTS Fifty-three patients were included, of whom 23 (43.4%) presented with FIAs' related symptoms. After adjusting for baseline differences in the multivariate logistic regression analysis, the CRstalk (odds ratio [OR]=3.207, P = .023) and homocysteine concentration (OR=1.344, P = .015) independently predicted FIAs' related symptoms. The CRstalk was able to differentiate between FIAs with and without symptoms (area under the ROC curve [AUC]=0.805), with an optimal cutoff value of 0.76. The homocysteine concentration could also differentiate between FIAs with and without symptoms (AUC=0.788), with an optimal cutoff value of 13.13. The combination of the CRstalk and homocysteine concentration had a better ability to identify symptomatic FIAs (AUC=0.857). Male sex (OR=0.536, P = .018), FIAs' related symptoms (OR=1.292, P = .038), and homocysteine concentration (OR=1.254, P = .045) independently predicted the CRstalk. CONCLUSION A higher serum homocysteine concentration and greater AWE indicate FIA instability. Serum homocysteine concentration may be a useful biomarker of FIA instability; however, this needs to be verified in future studies.
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Affiliation(s)
- Fei Peng
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (F.P., B.X., J.X., X.C., A.L.)
| | - Boya Xu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (F.P., B.X., J.X., X.C., A.L.)
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (F.P., B.X., J.X., X.C., A.L.)
| | - Xuge Chen
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (F.P., B.X., J.X., X.C., A.L.)
| | - Aihua Liu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (F.P., B.X., J.X., X.C., A.L.).
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Raghuram A, Patel R, Varon A, Sabotin R, Sanchez S, Derdeyn CP, Jabbour P, Hasan DM, Samaniego EA. Volumetric surveillance of brain aneurysms: Pitfalls of MRA. Interv Neuroradiol 2023; 29:532-539. [PMID: 35549745 PMCID: PMC10549707 DOI: 10.1177/15910199221100619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Untreated brain aneurysms are usually surveilled with serial MR imaging and evaluated with 2D multiplanar measurements. The assessment of aneurysm growth may be more accurate with volumetric analysis. We evaluated the accuracy of a magnetic resonance angiography (MRA) segmentation pipeline for aneurysm volume measurement and surveillance. METHODS A pipeline to determine aneurysm volume was developed and tested on two aneurysm phantoms imaged with time-of flight (TOF) MRA and 3D rotational angiography (3DRA). The accuracy of the pipeline was then evaluated by reconstructing 10 aneurysms imaged with contrast enhanced-MRA (CE-MRA) and 3DRA. This calibrated and refined post-processing pipeline was subsequently used to analyse aneurysms from our prospectively acquired database. Volume changes above the threshold of error were considered true volume changes. The accuracy of these measurements was analysed. RESULTS TOF-MRA reconstructions were not as accurate as CE-MRA reconstructions. When compared to 3DRA, CE-MRA underestimated aneurysm volume by 7.8% and did not accurately register the presence of blebs. Eighteen aneurysms (13 saccular and 5 fusiform) were analysed with the optimized 3D volume reconstruction pipeline, with a mean follow-up time of 11 months. Artifact accounted for 10.2% error in volume measurements using serial CE-MRA. When this margin of error was used to assess aneurysms volume in serial imaging with CE-MRA, only two fusiform aneurysms changed in volume. The variations in volume of these two fusiform aneurysms were caused by intra-mural and intrasaccular thrombosis. CONCLUSIONS CE-MRA and TOF-MRA 3D volume reconstructions may not register minor morphological changes such as the appearance of blebs. CE-MRA underestimates volume by 7.8% compared to 3DRA. Serial CE-MRA volume measurements had a larger margin of error of approximately 10.2%. MRA-based volumetric measurements may not be appropriate for aneurysm surveillance.
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Affiliation(s)
- Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Rishi Patel
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alberto Varon
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ryan Sabotin
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sebastian Sanchez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David M. Hasan
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Edgar A. Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Xia J, Peng F, Chen X, Yang F, Feng X, Niu H, Xu B, Liu X, Guo J, Zhong Y, Sui B, Ju Y, Kang S, Zhao X, Liu A, Zhao J. Statins may Decrease Aneurysm wall Enhancement of Unruptured Fusiform Intracranial Aneurysms: A high-resolution 3T MRI Study. Transl Stroke Res 2023:10.1007/s12975-023-01190-0. [PMID: 37673834 DOI: 10.1007/s12975-023-01190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
Inflammation plays an integral role in the formation, growth, and progression to rupture of unruptured intracranial aneurysms. Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) has emerged as a surrogate biomarker of vessel wall inflammation and unruptured intracranial aneurysm instability. We investigated the correlation between anti-inflammatory drug use and three-dimensional AWE of fusiform intracranial aneurysms (FIAs). We retrospectively analyzed consecutive patients with FIAs in our database who underwent 3T HR-MRI at three Chinese centers. FIAs were classified as fusiform-type, dolichoectatic-type, or transitional-type. AWE was objectively defined using the aneurysm-to-pituitary stalk contrast ratio in three-dimensional space by determining the contrast ratio of the average signal intensity in the aneurysmal wall and pituitary stalk on post-contrast T1-weighted images. Data on aneurysm size, morphology, and location, as well as patient demographics and comorbidities, were collected. Univariate and multivariate logistic regression analyses were performed to determine factors independently associated with AWE of FIAs on HR-MRI. In total, 127 FIAs were included. In multivariate analysis, statin use (β = -0.236, P = 0.007) was the only independent factor significantly associated with decreased AWE. In the analysis of three FIA subtypes, the fusiform and transitional types were significantly associated with statin use (rs = -0.230, P = 0.035; and rs = -0.551, P = 0.010; respectively). It establishes an incidental correlation between the use of statins daily for ≥ 6 months and decreased AWE of FIAs. The findings also indicate that the pathophysiology may differ among the three FIA subtypes.
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Affiliation(s)
- Jiaxiang Xia
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Peng
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuge Chen
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fan Yang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hao Niu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Boya Xu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiahuan Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yao Zhong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Aihua Liu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Center for Neurological Diseases, China National Clinical Research, Beijing, China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China.
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Chen X, Peng F, Liu X, Xia J, Niu H, He X, Xu B, Bai X, Li Z, Xu P, Duan Y, Sui B, Zhao X, Liu A. Three-dimensional aneurysm wall enhancement in fusiform intracranial aneurysms is associated with aneurysmal symptoms. Front Neurosci 2023; 17:1171946. [PMID: 37214386 PMCID: PMC10196058 DOI: 10.3389/fnins.2023.1171946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Background and purpose Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) is a potential biomarker for evaluating unstable aneurysms. Fusiform intracranial aneurysms (FIAs) frequently have a complex and curved structure. We aimed to develop a new three-dimensional (3D) aneurysmal wall enhancement (AWE) characterization method to enable comprehensive FIA evaluation and to investigate the ability of 3D-AWE to predict symptomatic FIA. Methods We prospectively recruited patients with unruptured FIAs and received 3 T HR-MRI imaging from September 2017 to January 2019. 3D models of aneurysms and parent arteries were generated. Boundaries of the FIA were determined using 3D vessel diameter measurements. Dmax was the greatest diameter in the cross-section, while Lmax was the length of the centerline of the aneurysm. Signal intensity of the FIA was normalized to the pituitary stalk and then mapped onto the 3D model, then the average enhancement (3D-AWEavg), maximum enhancement (3D-AWEmax), enhancement area (AWEarea), and enhancement ratio (AWEratio) were calculated as AWE indicators, and the surface area of the entire aneurysm (Aarea) was also calculated. Areas with high AWE were defined as those with a value >0.9 times the signal intensity of the pituitary stalk. Multivariable logistic regression analyses were performed to determine independent predictors of aneurysm-related symptoms. FIA subtypes were defined as fusiform, dolichoectasia, and transitional. Differences between the three FIA subtypes were also examined. Results Forty-seven patients with 47 FIAs were included. Mean patient age was 55 ± 12.62 years and 74.5% were male. Twenty-nine patients (38.3%) were symptomatic. After adjusting for baseline differences in age, hypertension, Lmax, and FIA subtype, the multivariate logistics regression models showed that 3D-AWEavg (odds ratio [OR], 4.029; p = 0.019), 3D-AWEmax (OR, 3.437; p = 0.022), AWEarea (OR, 1.019; p = 0.008), and AWEratio (OR, 2.490; p = 0.045) were independent predictors of aneurysm-related symptoms. Dmax and Aarea were larger and 3D-AWEavg, 3D-AWEmax, AWEarea, and AWEratio were higher with the transitional subtype than the other two subtypes. Conclusion The new 3D AWE method, which enables the use of numerous new metrics, can predict symptomatic FIAs. Different 3D-AWE between the three FIA subtypes may be helpful in understanding the pathophysiology of FIAs.
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Affiliation(s)
- Xuge Chen
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
| | - Xinmin Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
| | - Xiaoyan Bai
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiye Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Xu
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yonghong Duan
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Binbin Sui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
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Liang X, Peng F, Yao Y, Yang Y, Liu A, Chen D. Aneurysm wall enhancement, hemodynamics, and morphology of intracranial fusiform aneurysms. Front Aging Neurosci 2023; 15:1145542. [PMID: 36993906 PMCID: PMC10040612 DOI: 10.3389/fnagi.2023.1145542] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
Background and objectiveIntracranial fusiform aneurysms (IFAs) are considered to have a complex pathophysiology process and poor natural history. The purpose of this study was to investigate the pathophysiological mechanisms of IFAs based on the characteristics of aneurysm wall enhancement (AWE), hemodynamics, and morphology.MethodsA total of 21 patients with 21 IFAs (seven fusiform types, seven dolichoectatic types, and seven transitional types) were included in this study. Morphological parameters of IFAs were measured from the vascular model, including the maximum diameter (Dmax), maximum length (Lmax), and centerline curvature and torsion of fusiform aneurysms. The three-dimensional (3D) distribution of AWE in IFAs was obtained based on high-resolution magnetic resonance imaging (HR-MRI). Hemodynamic parameters including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), gradient oscillatory number (GON), and relative residence time (RRT) were extracted by computational fluid dynamics (CFD) analysis of the vascular model, and the relationship between these parameters and AWE was investigated.ResultsThe results showed that Dmax (p = 0.007), Lmax (p = 0.022), enhancement area (p = 0.002), and proportion of enhancement area (p = 0.006) were significantly different among three IFA types, and the transitional type had the largest Dmax, Lmax, and enhancement area. Compared with the non-enhanced regions of IFAs, the enhanced regions had lower TAWSS but higher OSI, GON, and RRT (p < 0.001). Furthermore, Spearman’s correlation analysis showed that AWE was negatively correlated with TAWSS, but positively correlated with OSI, GON, and RRT.ConclusionThere were significant differences in AWE distributions and morphological features among the three IFA types. Additionally, AWE was positively associated with the aneurysm size, OSI, GON, and RRT, while negatively correlated with TAWSS. However, the underlying pathological mechanism of the three fusiform aneurysm types needs to be further studied.
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Affiliation(s)
- Xinyu Liang
- School of Life Sciences, Beijing Institute of Technology, Beijing, China
| | - Fei Peng
- Neurointerventional Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunchu Yao
- School of Life Sciences, Beijing Institute of Technology, Beijing, China
| | - Yuting Yang
- School of Life Sciences, Beijing Institute of Technology, Beijing, China
| | - Aihua Liu
- Neurointerventional Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Aihua Liu,
| | - Duanduan Chen
- School of Life Sciences, Beijing Institute of Technology, Beijing, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
- Duanduan Chen,
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Feasibility and intra-and interobserver reproducibility of quantitative susceptibility mapping with radiomic features for intracranial dissecting intramural hematomas and atherosclerotic calcifications. Sci Rep 2023; 13:3651. [PMID: 36871117 PMCID: PMC9985647 DOI: 10.1038/s41598-023-30745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Quantitative susceptibility mapping (QSM) for 61 patients with dissecting intramural hematomas (n = 36) or atherosclerotic calcifications (n = 25) in intracranial vertebral arteries were collected to assess intra- and interobserver reproducibility in a 3.0-T MR system between January 2015 and December 2017. Two independent observers each segmented regions of interest for lesions twice. The reproducibility was evaluated using intra-class correlation coefficients (ICC) and within-subject coefficients of variation (wCV) for means and concordance correlation coefficients (CCC) and ICC for radiomic features (CCC and ICC > 0.85) were used. Mean QSM values were 0.277 ± 0.092 ppm for dissecting intramural hematomas and - 0.208 ± 0.078 ppm for atherosclerotic calcifications. ICCs and wCVs were 0.885-0.969 and 6.5-13.7% in atherosclerotic calcifications and 0.712-0.865 and 12.4-18.7% in dissecting intramural hematomas, respectively. A total of 9 and 19 reproducible radiomic features were observed in dissecting intramural hematomas and atherosclerotic calcifications, respectively. QSM measurements in dissecting intramural hematomas and atherosclerotic calcifications were feasible and reproducible between intra- and interobserver comparisons, and some reproducible radiomic features were demonstrated.
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10
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Aneurysm wall enhancement, atherosclerotic proteins, and aneurysm size may be related in unruptured intracranial fusiform aneurysms. Eur Radiol 2023:10.1007/s00330-023-09456-9. [PMID: 36840766 DOI: 10.1007/s00330-023-09456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/25/2022] [Accepted: 01/20/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE This cross-sectional study aimed to investigate the associations between aneurysm wall enhancement (AWE), atherosclerotic protein levels, and aneurysm size in unruptured intracranial fusiform aneurysms (IFAs). METHODS Patients with IFAs underwent high-resolution magnetic resonance imaging (HR-MRI) and atherosclerotic protein examinations from May 2015 to December 2021 were collected. A CRstalk (signal intensity [SI] of IFA wall/SI of pituitary stalk) > 0.60 was considered to indicate AWE. Atherosclerotic protein data was obtained from the peripheral blood. Aneurysmal characteristics included the maximal diameter of the cross-section (Dmax), location, type of IFA, presence of mural thrombus, and mural clots. Statistical analyses were performed with univariate analysis, logistic regression analysis, and Spearman's correlation coefficient. RESULTS Seventy-one IFAs from 71 patients were included in the study. Multivariate analysis revealed statin use (OR = 0.189, p = 0.026) and apolipoprotein B (Apo-B) level (OR = 6.019, p = 0.026) were the independent predictors of AWE in IFAs. In addition, statin use (OR = 0.813, p = 0.036) and Apo-B level (OR = 1.610, p = 0.003) were also the independent predictors of CRstalk. Additionally, we found that CRstalk and AWE were significantly positively associated with Dmax (rs = 0.409 and 0.349, respectively; p < 0.001 and p = 0.003, respectively). CONCLUSIONS There may be correlations between AWE, atherosclerotic protein levels, and aneurysm size in patients with IFAs. Apo-B and statin use were independent predictors of AWE in IFAs, which have the potential to be new therapeutic targets for IFAs. KEY POINTS • There may be correlations between aneurysm wall enhancement, atherosclerotic protein levels in the peripheral blood, and aneurysm size in patients with intracranial fusiform aneurysms. • Apolipoprotein B and statin use were independent predictors of aneurysm wall enhancement in intracranial fusiform aneurysms.
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11
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Peng F, Xia J, Niu H, Feng X, Zheng T, He X, Xu B, Chen X, Xu P, Zhang H, Chen J, Tong X, Bai X, Li Z, Duan Y, Sui B, Zhao X, Liu A. Systemic immune-inflammation index is associated with aneurysmal wall enhancement in unruptured intracranial fusiform aneurysms. Front Immunol 2023; 14:1106459. [PMID: 36776878 PMCID: PMC9911448 DOI: 10.3389/fimmu.2023.1106459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction Inflammation plays a key role in the progression of intracranial aneurysms. Aneurysmal wall enhancement (AWE) correlates well with inflammatory processes in the aneurysmal wall. Understanding the potential associations between blood inflammatory indices and AWE may aid in the further understanding of intracranial aneurysm pathophysiology. Methods We retrospectively reviewed 122 patients with intracranial fusiform aneurysms (IFAs) who underwent both high-resolution magnetic resonance imaging and blood laboratory tests. AWE was defined as a contrast ratio of the signal intensity of the aneurysmal wall to that of the pituitary stalk ≥ 0.90. The systemic immune-inflammation (SII) index (neutrophils × platelets/lymphocytes) was calculated from laboratory data and dichotomized based on whether or not the IFA had AWE. Aneurysmal symptoms were defined as sentinel headache or oculomotor nerve palsy. Multivariable logistic regression and receiver operating characteristic curve analyses were performed to determine how well the SII index was able to predict AWE and aneurysmal symptoms. Spearman's correlation coefficients were used to explore the potential associations between variables. Results This study included 95 patients, of whom 24 (25.3%) presented with AWE. After adjusting for baseline differences in neutrophil to lymphocyte ratios, leukocytes, and neutrophils in the multivariable logistic regression analysis, smoking history (P = 0.002), aneurysmal symptoms (P = 0.047), maximum diameter (P = 0.048), and SII index (P = 0.022) all predicted AWE. The SII index (P = 0.038) was the only independent predictor of aneurysmal symptoms. The receiver operating characteristic curve analysis revealed that the SII index was able to accurately distinguish IFAs with AWE (area under the curve = 0.746) and aneurysmal symptoms (area under the curve = 0.739). Discussion An early elevation in the SII index can independently predict AWE in IFAs and is a potential new biomarker for predicting IFA instability.
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Affiliation(s)
- Fei Peng
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tianheng Zheng
- College of Integrated Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuge Chen
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Hong Zhang
- Operating Room, Heze Municipal Hospital, Heze, Shandong, China
| | - Jigang Chen
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhiye Li
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yonghong Duan
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,*Correspondence: Aihua Liu, ; Xingquan Zhao,
| | - Aihua Liu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China,*Correspondence: Aihua Liu, ; Xingquan Zhao,
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Peng F, Liu L, Niu H, Feng X, Zhang H, He X, Xia J, Xu B, Bai X, Li Z, Sui B, Liu A. Comparisons between cross-section and long-axis-section in the quantification of aneurysmal wall enhancement of fusiform intracranial aneurysms in identifying aneurysmal symptoms. Front Neurol 2022; 13:945526. [PMID: 35959406 PMCID: PMC9361002 DOI: 10.3389/fneur.2022.945526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background To investigate the quantification of aneurysmal wall enhancement (AWE) in fusiform intracranial aneurysms (FIAs) and to compare AWE parameters based on different sections of FIAs in identifying aneurysm symptoms. Methods Consecutive patients were prospectively recruited from February 2017 to November 2019. Aneurysm-related symptoms were defined as sentinel headache and oculomotor nerve palsy. All patients underwent high resolution magnetic resonance imaging (HR-MRI) protocol, including both pre and post-contrast imaging. CRstalk (signal intensity of FIAs' wall divided by pituitary infundibulum) was evaluated both in the cross-section (CRstalk−cross) and the long-axis section (CRstalk−long) of FIAs. Aneurysm characteristics include the maximal diameter of the cross-section (Dmax), the maximal length of the long-axis section (Lmax), location, type, and mural thrombus. The performance of parameters for differentiating symptomatic and asymptomatic FIAs was obtained and compared by a receiver operating characteristic (ROC) curve. Results Forty-three FIAs were found in 43 patients. Eighteen (41.9%) patients who presented with aneurysmal symptoms were classified in the symptomatic group. In univariate analysis, male sex (P = 0.133), age (P = 0.013), FIAs type (P = 0.167), mural thrombus (P = 0.130), Lmax (P = 0.066), CRstalk−cross (P = 0.027), and CRstalk−long (P = 0.055) tended to be associated with aneurysmal symptoms. In the cross-section model of multivariate analysis, male (P = 0.038), age (P = 0.018), and CRstalk−cross (P = 0.048) were independently associated with aneurysmal symptoms. In the long-axis section model of multivariate analysis, male (P = 0.040), age (P = 0.010), CRstalk−long (P = 0.046), and Lmax (P = 0.019) were independently associated with aneurysmal symptoms. In the combination model of multivariate analysis, male (P = 0.027), age (P = 0.011), CRstalk−cross (P = 0.030), and Lmax (P = 0.020) were independently associated with aneurysmal symptoms. CRstalk−cross has the highest accuracy in predicting aneurysmal symptoms (AUC = 0.701). The combination of CRstalk−cross and Lmax exhibited the highest performance in discriminating symptomatic from asymptomatic FIAs (AUC = 0.780). Conclusion Aneurysmal wall enhancement is associated with symptomatic FIAs. CRstalk−cross and Lmax were independent risk factors for aneurysmal symptoms. The combination of these two factors may improve the predictive performance of aneurysmal symptoms and may also help to stratify the instability of FIAs in future studies.
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Affiliation(s)
- Fei Peng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hao Niu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Zhang
- Operating Room, Heze Municipal Hospital, Heze, China
| | - Xiaoxin He
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Xia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Boya Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiye Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- *Correspondence: Binbin Sui
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
- Aihua Liu
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13
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Peng F, Fu M, Xia J, Niu H, Liu L, Feng X, Xu P, Bai X, Li Z, Chen J, Tong X, He X, Xu B, Chen X, Liu H, Sui B, Duan Y, Li R, Liu A. Quantification of aneurysm wall enhancement in intracranial fusiform aneurysms and related predictors based on high-resolution magnetic resonance imaging: a validation study. Ther Adv Neurol Disord 2022; 15:17562864221105342. [PMID: 35847373 PMCID: PMC9280813 DOI: 10.1177/17562864221105342] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) has emerged as a new imaging biomarker of intracranial aneurysm instability. Objective: To determine a standard method of AWE quantification for predicting fusiform intracranial aneurysms (FIAs) stability by comparing the sensitivity of each parameter in identifying symptomatic FIAs. The predictors of AWE and FIA types were also identified. Methods: We retrospectively analyzed consecutive fusiform aneurysm patients who underwent HR-MRI from two centers. The aneurysm-to-pituitary stalk contrast ratio (CRstalk), aneurysm enhancement ratio, and aneurysm enhancement index were extracted, and their sensitivities in discriminating aneurysm symptoms were compared using the receiver-operating characteristic curve. Morphological parameters of fusiform aneurysm were extracted based on 3D vessel model. Uni- and multivariate analyses of related predictors for AWE, CRstalk, and FIA types were performed, respectively. Results: Overall, 117 patients (mean age, 53.3 ± 11.7 years; male, 75.2%) with 117 FIAs underwent HR-MRI were included. CRstalk with the maximum signal intensity (CRstalk-max) had the highest sensitivity in identifying symptomatic FIAs with an area under the curve value (0.697) and a cut-off value of 0.90. The independent predictors of AWE were aneurysm symptoms [(odds ratio) OR = 3.754, p = 0.003], aspirin use (OR = 0.248, p = 0.037), and the maximum diameter of the cross-section (OR = 1.171, p = 0.043). The independent predictors of CRstalk-max were aneurysm symptoms (OR = 1.289, p = 0.003) and posterior circulation aneurysm (OR = 1.314, p = 0.001). Transitional-type showed higher rates of hypertension and mural thrombus over both dolichoectatic- and fusiform-type FIAs. Conclusion: CRstalk-max may be the most reliable parameter to quantify AWE to distinguish symptomatic FIAs. It also has the potential to identify unstable FIAs. Several factors contribute to the complex pathophysiology of FIAs and need further validation in a larger cohort.
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Affiliation(s)
- Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiye Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jigang Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xuge Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hongyi Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yonghong Duan
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing 100070, China
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Raghuram A, Varon A, Sanchez S, Ishii D, Wu C, Magnotta VA, Hasan DM, Koscik TR, Samaniego EA. Topographical Analysis of Aneurysm Wall Enhancement With 3-Dimensional Mapping. STROKE (HOBOKEN, N.J.) 2022; 2:e000309. [PMID: 36061513 PMCID: PMC9432773 DOI: 10.1161/svin.121.000309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/09/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Aneurysm wall enhancement has been identified as a potential biomarker for aneurysm instability. Enhancement has been determined by different approaches on 2D multiplanar views. This study describes a new method to quantify enhancement through 3D heatmaps and histograms. METHODS A custom algorithm was developed using orthogonal probes extending from the aneurysm lumen into the wall to create 3D heatmaps and histograms of wall enhancement on 7T-MRI. Three quantitative metrics for general, specific, and focal wall enhancement were generated from the histograms. RESULTS Thirty-two aneurysms were analyzed and classified based on 3D heatmaps and histograms. Larger aneurysms were more enhancing (Spearman's r=0.472, p=0.006), and had more heterogeneous enhancement (Spearman's r=0.557, p<0.001) than smaller aneurysms. Patterns of enhancement differed between saccular, fusiform, and thrombosed aneurysms. Fusiform aneurysms were larger (p=0.015) and had more heterogenous enhancement compared to saccular aneurysms. Fusiform aneurysms had more areas of focal enhancement (p<0.001) and right skewed histograms (p=0.003). CONCLUSIONS The 3D analysis of aneurysm wall enhancement provides topographic data of the entire aneurysm wall. New metrics developed based on this method showed that large and fusiform aneurysms have heterogenous enhancement.
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Affiliation(s)
- Ashrita Raghuram
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Alberto Varon
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sebastian Sanchez
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Daizo Ishii
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Chaorong Wu
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - David M Hasan
- Department of Neurosurgery, Duke University, Durham, NC
| | - Timothy R Koscik
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
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Saalfeld S, Stahl J, Korte J, Miller Marsh LM, Preim B, Beuing O, Cherednychenko Y, Behme D, Berg P. Can Endovascular Treatment of Fusiform Intracranial Aneurysms Restore the Healthy Hemodynamic Environment?–A Virtual Pilot Study. Front Neurol 2022; 12:771694. [PMID: 35140672 PMCID: PMC8818669 DOI: 10.3389/fneur.2021.771694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Numerous studies assess intracranial aneurysm rupture risk based on morphological and hemodynamic parameter analysis in addition to clinical information such as aneurysm localization, age, and sex. However, intracranial aneurysms mostly occur with a saccular shape located either lateral to the parent artery or at a bifurcation. In contrast, fusiform intracranial aneurysms (FIAs), i.e., aneurysms with a non-saccular, dilated form, occur in approximately 3–13% of all cases and therefore have not yet been as thoroughly studied. To improve the understanding of FIA hemodynamics, this pilot study contains morphological analyses and image-based blood flow simulations in three patient-specific cases. For a precise and realistic comparison to the pre-pathological state, each dilation was manually removed and the time-dependent blood flow simulations were repeated. Additionally, a validated fast virtual stenting approach was applied to evaluate the effect of virtual endovascular flow-diverter deployment focusing on relevant hemodynamic quantities. For two of the three patients, post-interventional information was available and included in the analysis. The results of this numerical pilot study indicate that complex flow structures, i.e., helical flow phenomena and the presence of high oscillating flow features, predominantly occur in FIAs with morphologically differing appearances. Due to the investigation of the individual healthy states, the original flow environment could be restored which serves as a reference for the virtual treatment target. It was shown that the realistic deployment led to a considerable stabilization of the individual hemodynamics in all cases. Furthermore, a quantification of the stent-induced therapy effect became feasible for the treating physician. The results of the morphological and hemodynamic analyses in this pilot study show that virtual stenting can be used in FIAs to quantify the effect of the planned endovascular treatment.
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Affiliation(s)
- Sylvia Saalfeld
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
- *Correspondence: Sylvia Saalfeld
| | - Janneck Stahl
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
| | - Jana Korte
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Laurel Morgan Miller Marsh
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Oliver Beuing
- Department of Radiology, AMEOS Hospital Bernburg, Bernburg, Germany
| | - Yurii Cherednychenko
- Endovascular Centre, Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, Dnipro, Ukraine
| | - Daniel Behme
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
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Raz E, Goldman-Yassen A, Derman A, Derakhshani A, Grinstead J, Dehkharghani S. Vessel wall imaging with advanced flow suppression in the characterization of intracranial aneurysms following flow diversion with Pipeline embolization device. J Neurointerv Surg 2022; 14:1264-1269. [PMID: 34987073 DOI: 10.1136/neurintsurg-2021-018086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-resolution vessel wall MRI (VWI) is increasingly used to characterize intramural disorders of the intracranial vasculature unseen by conventional arteriography. OBJECTIVE To evaluate the use of VWI for surveillance of flow diverter (FD) treated aneurysms. MATERIALS AND METHODS Retrospective study of 28 aneurysms (in 21 patients) treated with a FD (mean 57 years; 14 female). All examinations included VWI and a contemporaneously obtained digital subtraction angiogram. Multiplanar pre- and post-gadolinium 3D, variable flip-angle T1 black-blood VWI was obtained using delay alternating nutation for tailored excitation (DANTE) at 3T. 3D time-of-flight MR angiography (MRA) was also carried out. Images were assessed for in-stent stenosis, aneurysm occlusion, presence and pattern/distribution of aneurysmal or parent vessel gadolinium enhancement. RESULTS The VWI-MRI was performed on average at 361±259 days after the intervention. Follow-up DSA was performed at 338±254 days postintervention. Good or excellent black-blood angiographic quality was recorded in 22/28 (79%) pre-contrast and 21/28 (75%) post-contrast VWI, with no cases excluded for image quality. Aneurysm enhancement was noted in 24/28 (85.7%) aneurysms, including in 79% of angiographically occluded aneurysms and 100% of angiographically non-occluded aneurysms. Enhancement of the stented parent-vessel wall occurred significantly more often when aneurysm enhancement was present (92% vs 33%, p=0.049). CONCLUSION Advanced VWI produces excellent depiction of FD-treated aneurysms, with robust evaluation of the parent vessel and aneurysm wall to an extent not achievable with conventional MRI/MRA. Gadolinium enhancement may, however, continue even after enduring catheter angiographic occlusion, confounding interpretation, and requiring cognizance of this potentially prolonged effect in such patients.
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Affiliation(s)
- Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | | | - Anna Derman
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Ahrya Derakhshani
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | | | - Seena Dehkharghani
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
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Raghuram A, Varon A, Roa JA, Ishii D, Lu Y, Raghavan ML, Wu C, Magnotta VA, Hasan DM, Koscik TR, Samaniego EA. Semiautomated 3D mapping of aneurysmal wall enhancement with 7T-MRI. Sci Rep 2021; 11:18344. [PMID: 34526579 PMCID: PMC8443635 DOI: 10.1038/s41598-021-97727-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
Aneurysm wall enhancement (AWE) after the administration of contrast gadolinium is a potential biomarker of unstable intracranial aneurysms. While most studies determine AWE subjectively, this study comprehensively quantified AWE in 3D imaging using a semi-automated method. Thirty patients with 33 unruptured intracranial aneurysms prospectively underwent high-resolution imaging with 7T-MRI. The signal intensity (SI) of the aneurysm wall was mapped and normalized to the pituitary stalk (PS) and corpus callosum (CC). The CC proved to be a more reliable normalizing structure in detecting contrast enhancement (p < 0.0001). 3D-heatmaps and histogram analysis of AWE were used to generate the following metrics: specific aneurysm wall enhancement (SAWE), general aneurysm wall enhancement (GAWE) and focal aneurysm wall enhancement (FAWE). GAWE was more accurate in detecting known morphological determinants of aneurysm instability such as size ≥ 7 mm (p = 0.049), size ratio (p = 0.01) and aspect ratio (p = 0.002). SAWE and FAWE were aneurysm specific metrics used to characterize enhancement patterns within the aneurysm wall and the distribution of enhancement along the aneurysm. Blebs were easily identified on 3D-heatmaps and were more enhancing than aneurysm sacs (p = 0.0017). 3D-AWE mapping may be a powerful objective tool in characterizing different biological processes of the aneurysm wall.
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Affiliation(s)
- Ashrita Raghuram
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52246, USA
| | - Alberto Varon
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52246, USA
| | - Jorge A Roa
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52246, USA.,Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daizo Ishii
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Yongjun Lu
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Madhavan L Raghavan
- Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Chaorong Wu
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - David M Hasan
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Timothy R Koscik
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52246, USA. .,Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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