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Zhai S, Wang X. Advanced MR techniques for the vessel wall: towards a better assessment of intracranial aneurysm instability. Eur Radiol 2024; 34:5201-5203. [PMID: 38240807 PMCID: PMC11254957 DOI: 10.1007/s00330-024-10583-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 07/18/2024]
Affiliation(s)
- Shuang Zhai
- Department of Outpatient, General Hospital of Northern Theatre Command, No.83 Wenhua Road, Shenhe District, Shenyang, 110016, China
| | - Xinrui Wang
- Department of Radiology, General Hospital of Northern Theatre Command, No.83, Wenhua Road, Shenhe District, Shenyang, 110016, China.
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Hosseini EM, Zafarshamspour S, Atallah O, Rasekhi A, Rahmanian A, Jamali M. Challenges in identifying ruptured aneurysms in cases of multiple aneurysms: Utilizing MRI with contrast for surgical planning-A case report. Clin Case Rep 2024; 12:e9202. [PMID: 39055091 PMCID: PMC11266116 DOI: 10.1002/ccr3.9202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
Key Clinical Message Accurately identifying the ruptured aneurysm in patients with subarachnoid hemorrhage and multiple aneurysms is critical to prevent rebleeding and optimize outcomes. Vessel wall MRI with contrast can aid in pinpointing the culprit aneurysm, informing a tailored surgical or endovascular management strategy for these complex cases. In patients with subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms, MRI with contrast and DSA are crucial for identifying the ruptured aneurysm, guiding a shift from endovascular to microsurgical clipping. Successful single-session treatment and absence of postsurgical deficits highlight the effectiveness of a multidisciplinary approach. Further research on optimal strategies is needed. Abstract Multiple intracranial aneurysms make up approximately 20% of cases of aneurysmal SAH. In patients with aneurysmal SAH and multiple intracranial aneurysms, definite treatment of the ruptured aneurysm causing SAH is of the highest priority. However, identifying the bleeding source can be challenging, and it may not be recognizable by the hemorrhage pattern. Misdiagnosis and mistreatment of a ruptured aneurysm in a patient with multiple aneurysms can lead to bleeding recurrence and an undesirable outcome. We report a 65-year-old woman who presented with severe sudden onset headache. Neuroimaging studies revealed diffuse SAH and concurrent PICA and ACom aneurysm with triplicate A2. However, the ruptured aneurysm responsible for the patient's symptoms was not obvious based on routine neuroimaging studies. Magnetic resonance imaging with contrast was performed, revealing circumferential enhancement of the PICA aneurysm. In this report, we demonstrate the real-world effect of vessel wall MRI with contrast on decision-making regarding identifying the ruptured aneurysm and surgical planning in cases of multiple aneurysms. Furthermore, we show that MRI and aneurysm wall enhancement could be a promising option in detecting ruptured aneurysms in cases of multiple aneurysms.
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Affiliation(s)
| | - Saber Zafarshamspour
- Department of NeurosurgeryShiraz University of Medical SciencesShirazFarsIran
- Department of SurgeryRafsanjan University of Medical SciencesRafsanjanKermanIran
| | - Oday Atallah
- Department of NeurosurgeryHannover Medical SchoolHannoverGermany
| | - Alireza Rasekhi
- Department of RadiologyShiraz University of Medical SciencesShirazFarsIran
| | | | - Mohammad Jamali
- Department of NeurosurgeryShiraz University of Medical SciencesShirazFarsIran
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Phi HQ, Alkhatib SG, Raymond SB, Choudhri OA, Song JW. Vessel Wall Imaging in Angiogram-Negative Diffuse Subarachnoid Hemorrhage Reveals a Ruptured Lenticulostriate Aneurysm. Neurointervention 2024; 19:118-122. [PMID: 38835141 PMCID: PMC11222677 DOI: 10.5469/neuroint.2024.00185] [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: 05/01/2024] [Revised: 05/25/2024] [Accepted: 04/27/2024] [Indexed: 06/06/2024] Open
Abstract
A patient presented with acute onset headache and subsequent unconsciousness. The neurologic exam showed left-sided myoclonic jerking and right flaccid hemiparalysis. Noncontrast computed tomography revealed diffuse subarachnoid hemorrhage (SAH) with acute hydrocephalus. Initial digital subtraction angiography (DSA) showed no culprit source for SAH. Repeat DSA on day 7 after initial presentation raised suspicion for left internal carotid artery ophthalmic segment and left lateral lenticulostriate artery (LSA) aneurysms. A magnetic resonance vessel wall imaging (VWI) exam was performed given the presence of multiple potential culprit aneurysms. Vessel wall enhancement around the dome of the left LSA aneurysm suggested rupture, which then facilitated treatment with surgical clipping. LSA aneurysms are exceedingly rare and challenging to treat. Given the associated high degree of morbidity, expedient diagnosis is critical to direct management. VWI could be a valuable tool for detecting ruptured aneurysms in the setting of angiogram-negative SAH.
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Affiliation(s)
- Huy Quang Phi
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Omar Aftab Choudhri
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jae Won Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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Tang Y, Wei H, Zhang Z, Fu M, Feng J, Li Z, Liu X, Wu Y, Zhang J, You W, Xue R, Zhuo Y, Jiang Y, Li Y, Li R, Liu P. Transition of intracranial aneurysmal wall enhancement from high to low wall shear stress mediation with size increase: A hemodynamic study based on 7T magnetic resonance imaging. Heliyon 2024; 10:e30006. [PMID: 38694075 PMCID: PMC11061692 DOI: 10.1016/j.heliyon.2024.e30006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Background Wall shear stress (WSS) has been proved to be related to the formation, development and rupture of intracranial aneurysms. Aneurysm wall enhancement (AWE) on magnetic resonance imaging (MRI) can be caused by inflammation and have confirmed its relationship with low WSS. High WSS can also result in inflammation but the research of its correlation with AWE is lack because of the focus on large aneurysms limited by 3T MRI in most previous studies.This study aimed to assess the potential association between high or low WSS and AWE in different aneuryms. Especially the relationship between high WSS and AWE in small aneurysm. Methods Forty-three unruptured intracranial aneurysms in 42 patients were prospectively included for analysis. 7.0 T MRI was used for imaging. Aneurysm size was measured on three-dimensional time-of-flight (TOF) images. Aneurysm-to-pituitary stalk contrast ratio (CRstalk) was calculated on post-contrast black-blood T1-weighted fast spin echo sequence images. Hemodynamics were assessed by four-dimensional flow MRI. Results The small aneurysms group had more positive WSS-CRstalk correlation coefficient distribution (dome: 78.6 %, p = 0.009; body: 50.0 %, p = 0.025), and large group had more negative coefficient distribution (dome: 44.8 %, p = 0.001; body: 69.0 %, p = 0.002). Aneurysm size was positively correlated with the significant OSI-CRstalk correlation coefficient at the dome (p = 0.012) and body (p = 0.010) but negatively correlated with the significant WSS-CRstalk correlation coefficient at the dome (p < 0.001) and body (p = 0.017). Conclusion AWE can be mediated by both high and low WSS, and translate from high WSS- to low WSS-mediated pathways as size increase. Additionally, AWE may serve as an indicator of the stage of aneurysm development via different correlations with hemodynamic factors.
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Affiliation(s)
- Yudi Tang
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haining Wei
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Medical School, Tsinghua University, Beijing, China
| | - Zihao Zhang
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Medical School, Tsinghua University, Beijing, China
| | - Junqiang Feng
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhixin Li
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xinke Liu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center, Beijing, China
| | - Yue Wu
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jinyuan Zhang
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Wei You
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rong Xue
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yan Zhuo
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yuhua Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center, Beijing, China
| | - Youxiang Li
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Medical School, Tsinghua University, Beijing, China
| | - Peng Liu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center, Beijing, China
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Leber SL, Hassler EM, Michenthaler M, Renner W, Deutschmann H, Reishofer G. Wall Enhancement of Coiled Intracranial Aneurysms Is Associated with Aneurysm Recanalization: A Cross-Sectional Study. AJNR Am J Neuroradiol 2024; 45:599-604. [PMID: 38548301 PMCID: PMC11288544 DOI: 10.3174/ajnr.a8174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/08/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND PURPOSE Wall enhancement of untreated intracranial aneurysms on MR imaging is thought to predict aneurysm instability. Wall enhancement or enhancement of the aneurysm cavity in coiled intracranial aneurysms is discussed controversially in the literature regarding potential healing mechanisms or adverse inflammatory reactions. Our aim was to compare the occurrence of aneurysm wall enhancement and cavity enhancement between completely occluded intracranial aneurysms and recanalized aneurysms after initially complete coil embolization. MATERIALS AND METHODS In this single-center cross-sectional study, we evaluated intracranial aneurysms after successful coil embolization for aneurysm recanalization, wall enhancement, and cavity enhancement with 3T MR imaging. We then compared the incidence of wall enhancement and cavity enhancement of completely occluded aneurysms with aneurysms with recanalization using the χ2 test and performed a multivariate linear regression analysis with recanalization size as an independent variable. RESULTS We evaluated 59 patients (mean age, 54.7 [SD, 12.4] years; 48 women) with 60 intracranial aneurysms and found a significantly higher incidence of wall enhancement in coiled aneurysms with recanalization (n=38) compared with completely occluded aneurysms (n = 22, P = .036). In addition, there was a significantly higher incidence of wall enhancement in aneurysms with recanalization of >3 mm (P = .003). In a multivariate linear regression analysis, wall enhancement (P = .010) and an increase of overall aneurysm size after embolization (P < .001) were significant predictors of recanalization size (corrected R 2= 0.430, CI 95%). CONCLUSIONS The incidence of aneurysm wall enhancement is increased in coiled intracranial aneurysms with recanalization and is associated with recanalization size.
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Affiliation(s)
- Stefan L Leber
- From the Division of Neuroradiology, Vascular and Interventional Radiology (S.L.L., E.M.H., M.M., H.D., G.R.), Department of Radiology, Medical University of Graz, Graz, Austria
| | - Eva M Hassler
- From the Division of Neuroradiology, Vascular and Interventional Radiology (S.L.L., E.M.H., M.M., H.D., G.R.), Department of Radiology, Medical University of Graz, Graz, Austria
| | - Manuela Michenthaler
- From the Division of Neuroradiology, Vascular and Interventional Radiology (S.L.L., E.M.H., M.M., H.D., G.R.), Department of Radiology, Medical University of Graz, Graz, Austria
| | - Wilfried Renner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics (W.R.), Medical University of Graz, Graz, Austria
| | - Hannes Deutschmann
- From the Division of Neuroradiology, Vascular and Interventional Radiology (S.L.L., E.M.H., M.M., H.D., G.R.), Department of Radiology, Medical University of Graz, Graz, Austria
| | - Gernot Reishofer
- From the Division of Neuroradiology, Vascular and Interventional Radiology (S.L.L., E.M.H., M.M., H.D., G.R.), Department of Radiology, Medical University of Graz, Graz, Austria
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Chen Z, Zhang W, Li FL, Lu WB. The relationship between symptomatic status and aneurysm wall enhancement characteristics of single unruptured intracranial aneurysm. RADIOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00117-024-01305-0. [PMID: 38687375 DOI: 10.1007/s00117-024-01305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/01/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE We aimed to analyze the aneurysm wall enhancement (AWE) characteristics of a single unruptured intracranial aneurysm (UIA) and observe the relationship between the symptoms of a single UIA and the aneurysm wall. METHODS In our hospital, 85 patients diagnosed with a single UIA using computed tomography angiography (CTA) were retrospectively analyzed. The patients were divided into symptomatic and asymptomatic groups, including 46 asymptomatic and 39 symptomatic aneurysms. High-resolution magnetic resonance imaging of the vascular wall (HR-MR-VWI) was utilized to ascertain the presence, degree, and extent of AWE and thick-wall enhancement. In addition to AWE characteristics, morphological parameters of aneurysms, such as maximal size, shape, height, neck width, aspect ratio (AR), and size ratio (SR), were scanned using CTA. The differences in the parameters of a single UIA between the two groups were compared. An investigation explored the correlation between the symptom status of a single UIA and AWE. RESULTS We observed a correlation between symptom status and maximal size, height, and neck width for a single UIA, the presence or absence of AWE, and the levels and boundaries of AWE and thick-wall reinforcement. This study found that the AWE range was independently correlated with symptom status in the multivariate regression analysis. CONCLUSION A larger AWE range was an independent risk factor for the onset of symptoms in a single UIA.
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Affiliation(s)
- Zi Chen
- Department of Radiology, Brain Hospital of Hunan Province, the School of Clinical Medicine, Hunan University of Chinese Medicine, No.427, Section 3, Furong Middle Road, Yuhua District, Changsha, Hunan Province, China
| | - Wei Zhang
- Department of Radiology, Brain Hospital of Hunan Province, the School of Clinical Medicine, Hunan University of Chinese Medicine, No.427, Section 3, Furong Middle Road, Yuhua District, Changsha, Hunan Province, China.
| | - Fang-Li Li
- Department of Radiology, Brain Hospital of Hunan Province, the School of Clinical Medicine, Hunan University of Chinese Medicine, No.427, Section 3, Furong Middle Road, Yuhua District, Changsha, Hunan Province, China
| | - Wen-Biao Lu
- Department of Radiology, Hu'nan Prevention and Treatment Institute for Occupational Diseases, Changsha, China
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El Sheikh M, Koh SP, Omer M, Agyemang K, Bhattathiri P, Hassan S, Iqbal A, Izzath W, St George J, Foo SY. Black blood MRI sequences in the acute management of ruptured and unruptured intracranial aneurysms. Br J Neurosurg 2023:1-6. [PMID: 38042989 DOI: 10.1080/02688697.2023.2290668] [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: 10/05/2022] [Accepted: 11/26/2023] [Indexed: 12/04/2023]
Abstract
We present an illustrative case series in which high spatial resolution black blood (BB) MRI sequences were used as an adjunct in the acute management of intracranial aneurysms with diagnostic uncertainty regarding rupture status. Several acute management dilemmas are discussed including the surveillance of previously treated ruptured intracranial aneurysms, identifying culprit lesion(s) amongst multiple ruptured intracranial aneurysms, and risk stratifying incidental unruptured intracranial aneurysms. We present our experience which supports the evaluation of this vessel wall imaging technique in larger multi-centre observational studies. MR imaging was performed on a 3.0 Tesla Siemens Somatom Vida system and sequences used included: Susceptibility Weighted Imaging, Diffusion Weighted Imaging & 3D T1 pre- and post-contrast-enhanced BB sequences.
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Affiliation(s)
- Mustafa El Sheikh
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Shang Peng Koh
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mustafa Omer
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
| | - Kevin Agyemang
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Parameswaran Bhattathiri
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Samih Hassan
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ahmed Iqbal
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Wazim Izzath
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jerome St George
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sin Yee Foo
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
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Dinia L, Vert C, Gramegna LL, Arikan F, Hernández D, Coscojuela P, Martinez-Saez E, Ramón Y Cajal S, Luzi M, Sarria-Estrada S, Salerno A, De Barros A, Gandara D, Quintana M, Rovira A, Tomasello A. Wall enhancement as a biomarker of intracranial aneurysm instability: a histo-radiological study. Acta Neurochir (Wien) 2023; 165:2783-2791. [PMID: 37589724 DOI: 10.1007/s00701-023-05739-8] [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: 01/04/2023] [Accepted: 06/25/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The aim of this is to explore the histological basis of vessel wall enhancement (WE) on magnetic resonance imaging (MRI), which is a strong radiological biomarker of aneurysmal prone to rupture compared to other classical risk predictors (e.g., PHASES score, size, morphology). METHODS A prospective observational study was performed including all consecutive patients presenting with a saccular intracranial aneurysm at Vall d'Hebron University Hospital between October 2017 and May 2019. The patients underwent high-resolution 3 T MRI, and their aneurysms were classified into asymptomatic, symptomatic, and ruptured. A histological and immunohistochemical study was performed in a subgroup of patients (n = 20, of which 15 presented with WE). Multiple regression analyses were performed to identify predictors of rupture and aneurysm symptoms. RESULTS A total of 132 patients were enrolled in the study. WE was present in 36.5% of aneurysms: 22.9% asymptomatic, 76.9% symptomatic, and 100% ruptured. Immunohistochemical markers associated with WE were CD3 T cell receptor (p = 0.05) and CD45 leukocyte common antigen (p = 0.05). Moreover, WE is an independent predictor of symptomatic and ruptured aneurysms (p < 0.001). CONCLUSIONS Aneurysms with WE present multiple histopathological changes that may contribute to wall disruption and represent the pathophysiological basis of radiological WE. Moreover, WE is an independent diagnostic predictor of aneurysm symptoms and rupture.
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Affiliation(s)
- Lavinia Dinia
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Interventional Neuroradiology Section, Department of Radiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Carla Vert
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Vall d'Hebron Institute of Research, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Servicio de Radiología, Unidad de Neurorradiología., Hospital del Mar, Barcelona, Spain
| | - Fuat Arikan
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Hernández
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Pilar Coscojuela
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | | | | | - Michele Luzi
- Interventional Neuroradiology Section, Department of Radiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Torrette University Hospital, UNIVPM, Ancona, Italy
| | - Silvana Sarria-Estrada
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrea De Barros
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dario Gandara
- Neurotraumatology and Neurosurgery Research Unit, Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Quintana
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Neurology Department, Epilepsy Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
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Sache A, Reymond P, Brina O, Jung B, Farhat M, Vargas MI. Near-wall hemodynamic parameters quantification in in vitro intracranial aneurysms with 7 T PC-MRI. MAGMA (NEW YORK, N.Y.) 2023; 36:295-308. [PMID: 37072539 PMCID: PMC10140017 DOI: 10.1007/s10334-023-01082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Wall shear stress (WSS) and its derived spatiotemporal parameters have proven to play a major role on intracranial aneurysms (IAs) growth and rupture. This study aims to demonstrate how ultra-high field (UHF) 7 T phase contrast magnetic resonance imaging (PC-MRI) coupled with advanced image acceleration techniques allows a highly resolved visualization of near-wall hemodynamic parameters patterns in in vitro IAs, paving the way for more robust risk assessment of their growth and rupture. MATERIALS AND METHODS We performed pulsatile flow measurements inside three in vitro models of patient-specific IAs using 7 T PC-MRI. To this end, we built an MRI-compatible test bench, which faithfully reproduced a typical physiological intracranial flow rate in the models. RESULTS The ultra-high field 7 T images revealed WSS patterns with high spatiotemporal resolution. Interestingly, the high oscillatory shear index values were found in the core of low WSS vortical structures and in flow stream intersecting regions. In contrast, maxima of WSS occurred around the impinging jet sites. CONCLUSIONS We showed that the elevated signal-to-noise ratio arising from 7 T PC-MRI enabled to resolve high and low WSS patterns with a high degree of detail.
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Affiliation(s)
- Antoine Sache
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Farhat
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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10
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Ninomiya A, Endo H, Tashiro R, Kanoke A, Tominaga T. The use of vessel wall imaging to detect a de novo microaneurysm on the periventricular anastomoses in moyamoya disease: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE2365. [PMID: 36941196 PMCID: PMC10550681 DOI: 10.3171/case2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Moyamoya disease (MMD) is linked to the formation of intracranial aneurysms. The authors recently observed an effective use of magnetic resonance vessel wall imaging (MR-VWI) to detect de novo unruptured MMD-associated microaneurysms. OBSERVATIONS The authors describe a 57-year-old female who was diagnosed with MMD 6 years ago after suffering a left putaminal hemorrhage. MR-VWI revealed point-like enhancement in the right posterior paraventricular region during the annual follow-up. On the T2-weighted image, this lesion was surrounded by high intensity. Angiography revealed a microaneurysm in the periventricular anastomosis. Right combined revascularization surgery was performed to prevent future hemorrhagic events. Another de novo circumferential enhanced lesion on MR-VWI appeared in the left posterior periventricular region 3 months after surgery. Angiography revealed that the enhanced lesion was a de novo microaneurysm on the periventricular anastomosis. The left combined revascularization surgery went well. The bilateral microaneurysms vanished on follow-up angiography. LESSONS Unruptured MMD-associated microaneurysms on the periventricular anastomosis can be detected using MR-VWI. Revascularization surgery can eliminate microaneurysms by reducing hemodynamic stress on the periventricular anastomosis.
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Affiliation(s)
- Atsuhiko Ninomiya
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
- Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryosuke Tashiro
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and
| | - Atsushi Kanoke
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and
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Diab R, Chang D, Zhu C, Levitt MR, Aksakal M, Zhao HL, Huynh TJ, Romero-Sanchez G, Mossa-Basha M. Advanced cross-sectional imaging of cerebral aneurysms. Br J Radiol 2023; 96:20220686. [PMID: 36400095 PMCID: PMC10997029 DOI: 10.1259/bjr.20220686] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
While the rupture rate of cerebral aneurysms is only 1% per year, ruptured aneurysms are associated with significant morbidity and mortality, while aneurysm treatments have their own associated risk of morbidity and mortality. Conventional markers for aneurysm rupture include patient-specific and aneurysm-specific characteristics, with the development of scoring systems to better assess rupture risk. These scores, however, rely heavily on aneurysm size, and their accuracy in assessing risk in smaller aneurysms is limited. While the individual risk of rupture of small aneurysms is low, due to their sheer number, the largest proportion of ruptured aneurysms are small aneurysms. Conventional imaging techniques are valuable in characterizing aneurysm morphology; however, advanced imaging techniques assessing the presence of inflammatory changes within the aneurysm wall, hemodynamic characteristics of blood flow within aneurysm sacs, and imaging visualization of irregular aneurysm wall motion have been used to further determine aneurysm instability that otherwise cannot be characterized by conventional imaging techniques. The current manuscript reviews conventional imaging techniques and their value and limitations in cerebral aneurysm characterization, and evaluates the applications, value and limitations of advanced aneurysm imaging and post-processing techniques including intracranial vessel wall MRA, 4D-flow, 4D-CTA, and computational fluid dynamic simulations.
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Affiliation(s)
- Rawan Diab
- American University of Beirut School of
Medicine, Beirut, Lebanon
| | - Dandan Chang
- Department of Radiology, University of
Washington, Seattle, United States
| | - Chengcheng Zhu
- Department of Radiology, University of
Washington, Seattle, United States
| | | | - Mehmet Aksakal
- Department of Radiology, University of
Washington, Seattle, United States
| | - Hui-Lin Zhao
- Deparment of Radiology, Renji Hospital,
Shanghai, China
| | - Thien J. Huynh
- Department of Radiology, Mayo
Clinic-Jacksonville, Jacksonville, United States
| | - Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias
Medicas y Nutricion Salvador Zubiran, Mexico City,
Mexico
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12
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A Meta-analysis: Cost Comparison of Flow Diversion and Coil Embolization for Intracranial Aneurysm. DISEASE MARKERS 2022; 2022:2925366. [PMID: 36284988 PMCID: PMC9588347 DOI: 10.1155/2022/2925366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022]
Abstract
Background Intracranial aneurysm serves as a prevalent cerebral disorder leading to the low-quality life and financial burden of the patients. Flow diversion and coil embolization have been confirmed as common therapeutic strategies for intracranial aneurysms. In this work, we identified and compared the cost between the flow diversion and coil embolization in the treatment of intracranial aneurysms in a meta-analysis. Methods We downloaded literatures that are published before Feb 2021 from Cochrane Library, Embase, and Pubmed using terms including “flow diversion”, “pipeline embolization device”, “coil embolization”, “coiling”, “Intracranial aneurysms”, and “Cerebral aneurysms”. The data were analyzed by STATA 15.1. Differences in treatment costs were determined by WMD (95% CI). Results A total of 1332 articles were included in the search of the limited terms, and 8 were selected after eliminating duplicate and unwanted studies. Our data indicated that the total cost of flow diversion for intracranial aneurysms is significantly lower than coil embolization (WMD = −4419.12, 95% CI: -6292.21 to -2546.03, p ≤ 0.001). In addition, we explored the retreatment hospitalization cost of flow diversion and coil embolization for intracranial aneurysms. We found that the retreatment hospitalization cost of flow diversion for intracranial aneurysms is significantly higher than coil embolization (WMD = 3203.85, 95% CI: 1904.60 to 4503.10, p ≤ 0.001). Conclusion We concluded that the total cost was lower, and the retreatment hospitalization costs of flow diversion were higher than coil embolization for the treatment of intracranial aneurysms. Our finding provides valuable insights into the application of flow diversion and coil embolization in intracranial aneurysm therapy. Flow diversion may be applied as a major treatment with the consideration of retreatment.
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13
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Fu M, Peng F, Zhang M, Chen S, Niu H, He X, Xu B, Liu A, Li R. Aneurysmal wall enhancement and hemodynamics: pixel-level correlation between spatial distribution. Quant Imaging Med Surg 2022; 12:3692-3704. [PMID: 35782262 PMCID: PMC9246729 DOI: 10.21037/qims-21-1203] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/29/2022] [Indexed: 03/22/2024]
Abstract
BACKGROUND Inflammation and hemodynamics are interrelated risk factors for intracranial aneurysm rupture. This study aimed to identify the relationship between these risk factors from an individual-patient perspective using biomarkers of aneurysm wall enhancement (AWE) derived from high-resolution magnetic resonance imaging (HR-MRI) and hemodynamic parameters by four-dimensional flow MRI (4D-flow MRI). METHODS A total of 29 patients with 29 unruptured intracranial aneurysms larger than 4 mm were included in this prospective cross-sectional study. A total of 24 aneurysms had AWE and 5 did not have AWE. A three-dimensional (3D) vessel model of each individual aneurysm was generated with 3D time-of-flight magnetic resonance angiography (3D TOF-MRA). Quantification of AWE was sampled with HR-MRI. Time-averaged wall shear stress (WSS) and oscillatory shear index (OSI) were calculated from the 4D-flow MRI. The correlation between spatial distribution of AWE and hemodynamic parameters measured at pixel-level was evaluated for each aneurysm. RESULTS In aneurysms with AWE, the spatial distribution of WSS was negatively correlated with AWE in 100% (24/24) of aneurysms, though 2 had an absolute value of the correlation coefficient <0.1. The OSI was positively correlated with AWE in 91.7% (22/24) of aneurysms; the other 2 aneurysms showed a negative correlation with AWE. In aneurysms with no AWE, there was no correlation between WSS (100%, 5/5), OSI (80%, 4/5), and wall inflammation. CONCLUSIONS The spatial distribution of WSS was negatively correlated with AWE in aneurysms with AWE, and OSI was positively correlated with AWE in most aneurysms with AWE. While aneurysms that did not contain AWE showed no correlation between hemodynamics and wall inflammation.
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Affiliation(s)
- Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Miaoqi Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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14
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Chung CY, Peterson RB, Howard BM, Zygmont ME. Imaging Intracranial Aneurysms in the Endovascular Era: Surveillance and Posttreatment Follow-up. Radiographics 2022; 42:789-805. [PMID: 35333634 DOI: 10.1148/rg.210131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While most intracranial aneurysms (IAs) remain asymptomatic over a patient's lifetime, those that rupture can cause devastating outcomes. The increased usage and quality of neuroimaging has increased detection of unruptured IAs and driven an increase in surveillance and treatment of these lesions. Standard practice is to treat incidentally discovered unruptured IAs that confer high rupture risk as well as ruptured IAs to prevent rehemorrhage. IAs are increasingly treated with coil embolization instead of microsurgical clipping; more recently, flow diversion and intrasaccular flow disruption have further expanded the versatility and utility of endovascular IA treatment. Imaging is increasingly used for posttreatment IA follow-up in the endovascular era. While cerebral angiography remains the standard for IA characterization and treatment planning, advances in CT and CT angiography and MR angiography have improved the diagnostic accuracy of noninvasive imaging for initial diagnosis and surveillance. IA features including size, dome-to-neck ratio, location, and orientation allow rupture risk stratification and determination of optimal treatment strategy and timing. The radiologist should be familiar with the imaging appearance of common IA treatment devices and the expected imaging findings following treatment. In distinction to clipping and coil embolization, flow diversion and intrasaccular flow disruption induce progressive aneurysm obliteration over months to years. Careful assessment of the device; the treated IA; adjacent brain, bone, meninges; and involved extracranial and intracranial vasculature is crucial at posttreatment follow-up imaging to confirm aneurysm obliteration and identify short-term and long-term posttreatment complications. An invited commentary by Chatterjee is available online. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2022.
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Affiliation(s)
- Charlotte Y Chung
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Ryan B Peterson
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Brian M Howard
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Matthew E Zygmont
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
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15
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Elsebaie N, Abdelzaher A, Gamaleldin O. Atypical intracranial aneurysms: spectrum of imaging findings in computed tomography and magnetic resonance imaging. Clin Imaging 2021; 83:1-10. [PMID: 34915276 DOI: 10.1016/j.clinimag.2021.12.003] [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: 08/08/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
We aim to describe demographics, clinical presentation, and spectrum of CT and MRI features suggestive of atypical intracranial aneurysms. The imaging protocols used for the diagnosis of intracranial aneurysms were thoroughly reviewed, including different CT and MRI protocols. We classified atypical aneurysms according to their location, size, clinical presentation, and specific imaging features. Dissecting aneurysms are one of the causes of stroke in young adults that may show intimal flap and double lumen. Traumatic intracranial aneurysms are a rare but serious complication of head injuries. Mycotic aneurysms are small and multiple at distal branch points with a high risk of rupture. Aneurysms with vasculitis are fusiform with a wide neck at a non-branch point that may be associated with vessel wall enhancement. Atherosclerotic aneurysms are usually large fusiform that affect large arteries. Oncotic aneurysms are relatively rare. They were reported to occur in patients with left atrial myxoma. Our study represented a wide spectrum of atypical intracranial aneurysms with their detailed diagnostic imaging findings on MRI and CT including newly introduced MRI sequences, which greatly influenced early diagnosis and timely management.
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Affiliation(s)
- Nermeen Elsebaie
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt.
| | - Ahmed Abdelzaher
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Omneya Gamaleldin
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt
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16
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Morel S, Bijlenga P, Kwak BR. Intracranial aneurysm wall (in)stability-current state of knowledge and clinical perspectives. Neurosurg Rev 2021; 45:1233-1253. [PMID: 34743248 PMCID: PMC8976821 DOI: 10.1007/s10143-021-01672-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
Intracranial aneurysm (IA), a local outpouching of cerebral arteries, is present in 3 to 5% of the population. Once formed, an IA can remain stable, grow, or rupture. Determining the evolution of IAs is almost impossible. Rupture of an IA leads to subarachnoid hemorrhage and affects mostly young people with heavy consequences in terms of death, disabilities, and socioeconomic burden. Even if the large majority of IAs will never rupture, it is critical to determine which IA might be at risk of rupture. IA (in)stability is dependent on the composition of its wall and on its ability to repair. The biology of the IA wall is complex and not completely understood. Nowadays, the risk of rupture of an IA is estimated in clinics by using scores based on the characteristics of the IA itself and on the anamnesis of the patient. Classification and prediction using these scores are not satisfying and decisions whether a patient should be observed or treated need to be better informed by more reliable biomarkers. In the present review, the effects of known risk factors for rupture, as well as the effects of biomechanical forces on the IA wall composition, will be summarized. Moreover, recent advances in high-resolution vessel wall magnetic resonance imaging, which are promising tools to discriminate between stable and unstable IAs, will be described. Common data elements recently defined to improve IA disease knowledge and disease management will be presented. Finally, recent findings in genetics will be introduced and future directions in the field of IA will be exposed.
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Affiliation(s)
- Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, Centre Medical Universitaire, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland. .,Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, Centre Medical Universitaire, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
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17
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Molenberg R, Aalbers MW, Appelman APA, Uyttenboogaart M, van Dijk JMC. Intracranial aneurysm wall enhancement as an indicator of instability: a systematic review and meta-analysis. Eur J Neurol 2021; 28:3837-3848. [PMID: 34424585 PMCID: PMC9292155 DOI: 10.1111/ene.15046] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysm wall enhancement (AWE) of intracranial aneurysms on magnetic resonance imaging has been described in previous studies as a surrogate marker of instability. With this study, an updated literature overview and summary risk estimates of the association between AWE and different specific outcomes (i.e., rupture, growth or symptomatic presentation) for both cross-sectional and longitudinal studies are provided. METHODS The PRISMA guideline was followed and a search was performed of PubMed and Embase to 1 January 2021 for studies that reported on AWE and aneurysm instability. In cross-sectional studies, AWE was compared between patients with stable and unstable aneurysms. In longitudinal studies, AWE of stable aneurysms was assessed at baseline after which patients were followed longitudinally. Risk ratios were calculated for longitudinal studies, prevalence ratios for cross-sectional studies and then the ratios were pooled in a random-effects meta-analysis. Also, the performance of AWE to differentiate between stable and unstable aneurysms was evaluated. RESULTS Twelve studies were included with a total of 1761 aneurysms. In cross-sectional studies, AWE was positively associated with rupture (prevalence ratio 11.47, 95% confidence interval [CI] 4.05-32.46) and growth or symptomatic presentation (prevalence ratio 4.62, 95% CI 2.85-7.49). Longitudinal studies demonstrated a positive association between AWE and growth or rupture (risk ratio 8.00, 95% CI 2.14-29.88). Assessment of the performance of AWE showed high sensitivities, mixed specificities, low positive predictive values and high negative predictive values. CONCLUSIONS Although AWE is positively associated with aneurysm instability, current evidence mostly supports the use of its absence as a surrogate marker of aneurysm stability.
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Affiliation(s)
- Rob Molenberg
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlien W Aalbers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Auke P A Appelman
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten Uyttenboogaart
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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18
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Zhang J, Can A, Lai PMR, Mukundan S, Castro VM, Dligach D, Finan S, Gainer VS, Shadick NA, Savova G, Murphy SN, Cai T, Weiss ST, Du R. Morphological variables associated with ruptured basilar tip aneurysms. Sci Rep 2021; 11:2526. [PMID: 33510194 PMCID: PMC7844275 DOI: 10.1038/s41598-021-81364-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Morphological factors of intracranial aneurysms and the surrounding vasculature could affect aneurysm rupture risk in a location specific manner. Our goal was to identify image-based morphological parameters that correlated with ruptured basilar tip aneurysms. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 200 patients with basilar tip aneurysms diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 were evaluated. We examined aneurysm wall irregularity, the presence of daughter domes, hypoplastic, aplastic or fetal PCoAs, vertebral dominance, maximum height, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. In multivariable analysis, presence of a daughter dome, aspect ratio, and larger flow angle were significantly associated with rupture status. We also introduced two new variables, diameter size ratio and parent-daughter angle ratio, which were both significantly inversely associated with ruptured basilar tip aneurysms. Notably, multivariable analyses also showed that larger diameter size ratio was associated with higher Hunt-Hess score while smaller flow angle was associated with higher Fisher grade. These easily measurable parameters, including a new parameter that is unlikely to be affected by the formation of the aneurysm, could aid in screening strategies in high-risk patients with basilar tip aneurysms. One should note, however, that the changes in parameters related to aneurysm morphology may be secondary to aneurysm rupture rather than causal.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Victor M Castro
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Dmitriy Dligach
- Boston Children's Hospital Informatics Program, Boston, MA, USA
- Department of Computer Science, Loyola University, Chicago, IL, USA
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Vivian S Gainer
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Shawn N Murphy
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tianxi Cai
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott T Weiss
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Stam LB, Aquarius R, de Jong GA, Slump CH, Meijer FJA, Boogaarts HD. A review on imaging techniques and quantitative measurements for dynamic imaging of cerebral aneurysm pulsations. Sci Rep 2021; 11:2175. [PMID: 33500470 PMCID: PMC7838168 DOI: 10.1038/s41598-021-81753-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Measurement of intracranial aneurysm wall motion may refine the current rupture risk estimation. A golden standard for measuring aneurysm pulsation is lacking. The aim is to evaluate magnitudes of aneurysm pulsation as published in current literature. Embase and PubMed were searched for publications containing quantitative measures of cardiac-cycle related cerebral aneurysm pulsation (no date or language restrictions). Eleven studies were included, covering 197 unruptured and untreated cerebral aneurysms. Quantitative pulsation measurements were extracted from the studies. Characteristics of the study population and aneurysms were taken into account, as well as the imaging modality, scanning technique and data processing methods used. A meta-analysis was performed of studies with similar methodologies and individual IA measures and locations. The magnitude of the absolute volume pulsations varied between 14 ± 9 mm3 and 106 ± 123 mm3 and the mean relative volume change varied between 5 and 36%. The meta-analysis revealed a positive correlation between size and absolute volume change. The relative volume change in Basilar artery aneurysms seems smaller. No authors were contacted for original study data and articles only describing visual pulsations were excluded. The variation in methodologies impedes an accurate estimation of the magnitude of IA pulsations. Validation of aneurysm pulsation measurement is crucial prior to clinical studies evaluating IA pulsatility in relation to IA rupture risk. Prerequisite is a reliable and robust imaging method with high spatial and temporal resolution and standardization of the image analysis methods.
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Affiliation(s)
- L B Stam
- Technical Medicine, University of Twente, Enschede, The Netherlands. .,Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-zuid 30, Internal Post Number 633, Nijmegen, The Netherlands.
| | - R Aquarius
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - G A de Jong
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - C H Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - F J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
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20
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Zhong W, Su W, Li T, Tan X, Chen C, Wang Q, Wang D, Su W, Wang Y. Aneurysm Wall Enhancement in Unruptured Intracranial Aneurysms: A Histopathological Evaluation. J Am Heart Assoc 2021; 10:e018633. [PMID: 33410330 PMCID: PMC7955308 DOI: 10.1161/jaha.120.018633] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022]
Abstract
Background Unruptured intracerebral aneurysm wall enhancement (AWE) on vessel wall magnetic resonance imaging scans may be a promising predictor for rupture-prone intracerebral aneurysms. However, the pathophysiology of AWE remains unclear. To this end, the association between AWE and histopathological changes was assessed in this study. Methods and Results A total of 35 patients with 41 unruptured intracerebral aneurysms who underwent surgical clipping were prospectively enrolled. A total of 27 aneurysms were available for histological evaluation. The macroscopic and microscopic features of unruptured intracerebral aneurysms with and without enhancement were assessed. The microscopic features studied included inflammatory cell invasion and vasa vasorum, which were assessed using immunohistochemical staining with CD68, CD3, CD20, and myeloperoxidase for the former and CD34 for the latter. A total of 21 (51.2%) aneurysms showed AWE (partial AWE, n=7; circumferential AWE, n=14). Atherosclerotic and translucent aneurysms were identified in 17 and 14 aneurysms, respectively. Aneurysm size, irregularity, and atherosclerotic and translucent aneurysms were associated with AWE on univariate analysis (P<0.05). Multivariate logistic regression analysis showed that atherosclerosis was the only factor significantly and independently associated with AWE (P=0.027). Histological assessment revealed that inflammatory cell infiltration, intraluminal thrombus, and vasa vasorum were significantly associated with AWE (P<0.05). Conclusions Though AWE on vessel wall magnetic resonance imaging scans may be associated with the presence of atherosclerotic lesions in unruptured intracerebral aneurysms, inflammatory cell infiltration within atherosclerosis, intraluminal thrombus, and vasa vasorum may be the main pathological features associated with AWE. However, the underlying pathological mechanism for AWE still needs to be further studied.
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Affiliation(s)
- Weiying Zhong
- Department of NeurosurgeryQilu Hospital of Shandong University and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanShandong ProvinceChina
- Shandong Key Laboratory of Brain Function RemodelingJinanShandong ProvinceChina
| | - Wenjing Su
- Department of PathologyShandong Provincial Hospital affiliated with Shandong UniversityJinanShandong ProvinceChina
| | - Tao Li
- Department of NeurosurgeryThe No. 4 People's Hospital of JinanJinanShandong ProvinceChina
| | - Xianjun Tan
- Department of NeurosurgeryPeople's Hospital of Chiping CityLiaochengShandong ProvinceChina
| | - Chao Chen
- Department of NeurosurgeryQilu Hospital of Shandong University and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanShandong ProvinceChina
- Shandong Key Laboratory of Brain Function RemodelingJinanShandong ProvinceChina
| | - Qian Wang
- Department of RadiologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Donghai Wang
- Department of NeurosurgeryQilu Hospital of Shandong University and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanShandong ProvinceChina
- Shandong Key Laboratory of Brain Function RemodelingJinanShandong ProvinceChina
| | - Wandong Su
- Department of NeurosurgeryQilu Hospital of Shandong University and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanShandong ProvinceChina
- Shandong Key Laboratory of Brain Function RemodelingJinanShandong ProvinceChina
| | - Yunyan Wang
- Department of NeurosurgeryQilu Hospital of Shandong University and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanShandong ProvinceChina
- Shandong Key Laboratory of Brain Function RemodelingJinanShandong ProvinceChina
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Cord BJ, Renedo D, Santarosa C, Sujijantarat N, Antonios J, Kim JA, Falcone GJ, Sheth KN, Malhotra A, Matouk CC. Vessel wall MRI in ruptured cranial dural arteriovenous fistulas. Interv Neuroradiol 2021; 27:553-557. [PMID: 33430655 DOI: 10.1177/1591019920988205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracranial high-resolution vessel wall MRI (VW-MRI) is an imaging paradigm that is useful in site-of-rupture identification in patients presenting with spontaneous subarachnoid hemorrhage and multiple intracranial aneurysms. Only a handful of case reports describe its potential utility in the evaluation of more complex brain vascular malformations. We report for the first time three patients with ruptured cranial dural arteriovenous fistulas (dAVFs) that were evaluated with high-resolution VW-MRI. The presumed site-of-rupture was identified based on contiguity of a venous ectasia with adjacent blood products and thick, concentric wall enhancement. This preliminary experience suggests a role for high-resolution VW-MRI in the evaluation of ruptured cranial dAVFs, in particular, site-of-rupture identification. It also supports an emerging hypothesis that all spontaneously ruptured, macrovascular lesions demonstrate avid vessel wall enhancement.
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Affiliation(s)
- Branden J Cord
- Department of Neurosurgery, University of California (Davis), Sacramento, USA
| | - Daniela Renedo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, USA
| | | | | | - Joseph Antonios
- Department of Neurosurgery, Yale University School of Medicine, New Haven, USA
| | - Jennifer A Kim
- Department of Neurology, Yale University School of Medicine, New Haven, USA
| | - Guido J Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, USA
| | - Charles C Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven, USA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, USA
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Carotid Blowout Management in the Endovascular Era. World Neurosurg 2020; 141:e1010-e1016. [PMID: 32599207 DOI: 10.1016/j.wneu.2020.06.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is a potential complication of head and neck cancer, and its therapy is associated with high morbidity and mortality. Recent advances in endovascular techniques have improved patient outcomes. In this study, we report outcomes of emergent endovascular intervention for CBS. METHODS We conducted a retrospective analysis of a prospectively maintained neurovascular database and identified 38 consecutive endovascular procedures for CBS from 2008-2019 at our institution. Data collection was performed on patient demographics, type of cancer, previous cancer treatments, type of CBS, location of bleed, diagnostic workup, endovascular treatment, and procedural outcomes and complications. RESULTS A total of 38 consecutive endovascular procedures for CBS were performed from 2008-2019 at our single academic institution. Technical success was achieved in 100% of endovascular procedures. Procedural stroke occurred in 1 (2.6%) procedure, procedural mortality occurred in 1 (2.6%) procedure, recurrent CBS occurred in 4 (10.5%) procedures, and fatal rehemorrhage occurred in 1 (2.6%) procedure. Regarding secondary outcomes, delayed stroke/transient ischemic attack occurred in 1 (2.6%) procedure, whereas there were no cases of delayed infectious complications. CONCLUSIONS The endovascular treatment of CBS is safe and effective with relatively low rates of morbidity and mortality compared with other currently available treatment modalities. However, the overall rate of complications demands attention and sheds light on the need for further improvement in management.
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