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Choudhary N, Gupta V, Singhi P, Balasubramaniam A, Madaan P, Sharma P. Bifurcation dissecting aneurysm: tips and tricks to differentiate from saccular aneurysm. Neuroradiology 2024:10.1007/s00234-024-03421-z. [PMID: 39009855 DOI: 10.1007/s00234-024-03421-z] [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: 07/17/2023] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
Bifurcations are a common site for saccular aneurysms, but rarely can be a site for dissecting aneurysms. Identification of these aneurysms is extremely important because the management plan depends on it. We describe a rare case of a ruptured dissecting aneurysm at the right ICA bifurcation in a pre-teen child which posed a diagnostic dilemma but ultimately was successfully managed with flow diversion.
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Affiliation(s)
- Neha Choudhary
- Interventional Neuroradiology, First Neuro Hospital, Mangalore, Karnataka, India.
| | - Vivek Gupta
- Interventional Neuroradiology, Fortis Hospitals, Mohali, Punjab, India
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Tan S, Zhou X, Xu X, Lu Y, Zeng X, Wu Q, Wang Y. Diagnostic Performance of High-Resolution Vessel Wall MR Imaging Combined with TOF-MRA in the Follow-up of Intracranial Vertebrobasilar Dissecting Aneurysms after Reconstructive Endovascular Treatment. AJNR Am J Neuroradiol 2023; 44:453-459. [PMID: 36958804 PMCID: PMC10084898 DOI: 10.3174/ajnr.a7838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/14/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND PURPOSE Few studies have reported the utility of high-resolution vessel wall MR imaging in the follow-up of endovascularly treated vertebrobasilar dissecting aneurysms. This study aimed to evaluate the diagnostic performance of high-resolution vessel wall MR imaging combined with TOF-MRA in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment. MATERIALS AND METHODS Patients with intracranial vertebrobasilar dissecting aneurysms with reconstructive endovascular treatment and followed up with TOF-MRA, high-resolution vessel wall MR imaging, and DSA were included. With DSA as the criterion standard, the diagnostic performance of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA in the evaluation of aneurysm occlusion status and parent artery patency was assessed. Visualization of the stented artery on TOF-MRA and high-resolution vessel wall MR imaging was rated on a 5-point scale. RESULTS Twenty-seven patients with 29 aneurysms were included. The sensitivity, specificity, positive predictive value, and negative predictive value of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA for diagnosing aneurysm remnants were 80.0%, 100.0%, 100.0%, and 82.4%; 53.3%, 100.0%, 100.0%, and 66.7%; and 93.3%, 100.0%, 100.0%, and 93.3%, respectively. For the visualization of the stented artery, the mean score of high-resolution vessel wall MR imaging was significantly higher than that of TOF-MRA (4.88 [SD, 0.32] versus 2.53 [SD, 1.25], P < .001). In the evaluation of parent artery patency (normal or pathologic), whereas TOF-MRA had a sensitivity, specificity, positive predictive value, and negative predictive value of 100.0%, 8.0%, 14.8%, and 100.0%, respectively, high-resolution vessel wall MR imaging was completely consistent with the DSA. CONCLUSIONS High-resolution vessel wall MR imaging combined with TOF-MRA at 3T showed good diagnostic performance in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment.
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Affiliation(s)
- S Tan
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Zhou
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Xu
- Department of Neurosurgery (X.X.), The First People's Hospital of Zhaoqing City, Zhaoqing, Guangdong Province, China
| | - Y Lu
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Zeng
- Radiology (X. Zeng, Q.W.), The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Q Wu
- Radiology (X. Zeng, Q.W.), The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Y Wang
- Department of Neurosurgery (Y.W.), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
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Wang Q, Liu M, Zhao K, Xu X, Zhang J, Xu B. Hyperhomocysteinemia increases the risk of vertebrobasilar dissecting aneurysm among the male Han Chinese population: a retrospective case-control study. Int J Neurosci 2023:1-7. [PMID: 36714920 DOI: 10.1080/00207454.2023.2174024] [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: 09/12/2022] [Revised: 10/31/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
OBJECT Vertebrobasilar dissecting aneurysms (VBDAs) are known to have a poor natural history with high rates of re-bleeding and mortality. There is a strong relation between hyperhomocysteinemia (HHcy) and cerebrovascular disease; we perform a retrospective study within the male of Chinese Han population to explore the association between HHcy and VBDAs. METHODS Eighty-eight male patients with VBDA and Eighty-one male control subjects were evaluated for their serum total homocysteine levels. With multiple logistic regression analysis, the association between HHcy and the risk of VBDAs was estimated. Interaction and stratified analyses were conducted according to age, BMI, smoking status, drinking status, and chronic disease histories. The two-piecewise linear regression model examined the threshold effect. RESULTS The multivariate logistic regression analyses revealed a significant association between HHcy and VBDAs (odds ratio (OR) = 2.62; 95% confidence interval (CI), 1.02-6.71) after adjusting for classical vascular risk factors. The relationship was stable in all subgroup analysis. The interactive role was not found in the association between HHcy and VBDAs for the potential risk factor. CONCLUSIONS In summary, our study provides evidence that HHcy can increases the risk of VBDAs in the male Han Chinese population. Further researches with appropriate study designs including sex differences and aneurysm types are needed to verify this association.
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Affiliation(s)
- Qun Wang
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Minghang Liu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Kai Zhao
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Xinghua Xu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - JiaShu Zhang
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - BaiNan Xu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
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Dmytriw AA, Alrashed A, Enriquez-Marulanda A, Medhi G, Mendes Pereira V. Unruptured Intradural Posterior Circulation Dissecting/Fusiform Aneurysms Natural History and Treatment Outcome. Interv Neuroradiol 2023; 29:56-62. [PMID: 34935531 PMCID: PMC9893235 DOI: 10.1177/15910199211068673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The natural history and outcome of unruptured posterior circulation dissecting fusiform aneurysms is not fully understood. These have a high risk of morbidity and mortality, not only due to natural history but also due to the challenging and controversial treatment approaches currently available compared to other types of intracranial aneurysms. METHODS We performed a retrospective study of a prospectively collected aneurysm database at a quaternary neurovascular hospital. We included consecutive patients with unruptured intradural vertebrobasilar dissecting aneurysms between January 2000 and July 2016 who were followed to 2020. Description of baseline, procedural, and outcomes data was performed. Comparisons of patient who had aneurysm rupture on follow-up, increase in 2 or more points of mRS in follow-up and progression of the aneurysm was performed. RESULTS Seventy patients with 78 fusiform posterior circulation aneurysms were identified. Thirty-nine (55.7%) patients were male with a mean age of 51.7 years (SD ± 17.6). When multiple, aneurysms were more likely to be fusiform (60%) than saccular (40.0%). Baseline diameter (measured on CTA/MRA/DSA), length as well as symptomatic presentation were significantly higher in aneurysms which grew over time. Coronary disease, diabetes and growth were associated an >2 increase in mRS. Diabetes as well as initial symptomatic presentation were associated with rupture. CONCLUSIONS Unruptured dissecting/fusiform aneurysm are associated with a considerable rate of rupture during follow-up. Growth is associated with morbidity even in the absence of rupture. Initial large size, coronary disease, diabetes, and to a lesser extent female gender may merit closer follow-up and/or prophylactic treatment.
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Affiliation(s)
- Adam Andrew Dmytriw
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
- Neurosurgical Service, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, USA
| | - Abdullah Alrashed
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
| | - Alejandro Enriquez-Marulanda
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
- Neurosurgical Service, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, USA
| | - Gorky Medhi
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
| | - Vitor Mendes Pereira
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
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Jiang Y, Lu G, Ge L, Zou R, Li G, Wan H, Leng X, Xiang J, Zhang X. Hemodynamic Comparison of Treatment Strategies for Intracranial Vertebral Artery Fusiform Aneurysms. Front Neurol 2022; 13:927135. [PMID: 35873788 PMCID: PMC9296783 DOI: 10.3389/fneur.2022.927135] [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: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study comparatively analyzed the hemodynamic changes resulting from various simulated stent-assisted embolization treatments to explore an optimal treatment strategy for intracranial vertebral artery fusiform aneurysms. An actual vertebral fusiform aneurysm case treated by large coil post-stenting (PLCS) was used as a control. Materials and Methods A single case of an intracranial vertebral artery fusiform aneurysm underwent a preoperative and eight postoperative finite element treatment simulations: PLCS [single and dual Low-profile Visualized Intraluminal Support (LVIS)], Jailing technique (single and dual LVIS both simulated twice, Pipeline Embolization Device (PED) with or without large coils (LCs). Qualitative and quantitative assessments were performed to analyze the most common hemodynamic risk factors for recurrence. Results Jailing technique and PED-only had a high residual flow volume (RFV) and wall shear stress (WSS) on the large curvature of the blood flow impingement region. Quantitative analysis determined that PLSC and PED had a lower RFV compared to preoperative than did the jailing technique [PED+LC 2.46% < PLCS 1.2 (dual LVIS) 4.75% < PLCS 1.1 (single LVIS) 6.34% < PED 6.58% < Jailing 2.2 12.45% < Jailing 1.2 12.71% < Jailing 1.1 14.28% < Jailing 2.1 16.44%]. The sac-averaged flow velocity treated by PLCS, PED and PED+LC compared to preoperatively was significantly lower than the jailing technique [PED+LC = PLCS 1.2 (dual LVIS) 17.5% < PLCS 1.1 (single LVIS) = PED 27.5% < Jailing 1.2 = Jailing 2.2 32.5% < Jailing 1.1 37.5% < Jailing 2.1 40%]. The sac-averaged WSS for the PLCS 1.2 (dual LVIS) model was lower than the PED+LC, while the high WSS area of the Jailing 1 model was larger than for Jailing 2 [PLCS 1.2 38.94% (dual LVIS) < PED+LC 41% < PLCS 1.1 43.36% (single LVIS) < PED 45.23% < Jailing 2.1 47.49% < Jailing 2.2 47.79% < Jailing 1.1 48.97% < Jailing 1.2 49.85%]. Conclusions For fusiform aneurysms, post large coil stenting can provide a uniform coil configuration potentially reducing the hemodynamic risk factors of recurrence. Flow diverters also may reduce the recurrence risk, with long-term follow-up required, especially to monitor branch blood flow to prevent postoperative ischemia.
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Affiliation(s)
- Yeqing Jiang
- Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Lu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Ge
- Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | - Gaohui Li
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | - Hailin Wan
- Huashan Hospital, Fudan University, Shanghai, China
| | | | - Jianping Xiang
- ArteryFlow Technology Co., Ltd, Hangzhou, China
- *Correspondence: Jianping Xiang
| | - Xiaolong Zhang
- Huashan Hospital, Fudan University, Shanghai, China
- Xiaolong Zhang
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Bae H, Suh SI, Yoon WK, Roh H, Kim C, Kwon TH. Correlation of Aneurysmal Wall Enhancement of Unruptured Intracranial Aneurysms on High-Resolution Vessel-Wall Imaging With Clinical Indices and Surgical Findings. Neurosurgery 2021; 89:420-427. [PMID: 34114036 DOI: 10.1093/neuros/nyab178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many physicians consider aneurysmal wall enhancement (AWE) on high resolution-vessel wall imaging (HR-VWI) as an imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). OBJECTIVE To evaluate the clinical value of different AWE signal intensities (SIs) by assessing the correlation between the AWE SIs and surgical findings and rupture risk assessment tools. METHODS Twenty-six patients with 34 aneurysms who underwent surgical clipping were included. The corrected AWE SI was calculated by comparing T1-weighted images with post-gadolinium enhanced T1-weighted images. The correlation of AWE with the population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, site of aneurysm (PHASES) and earlier subarachnoid hemorrhage, location of the aneurysm, age >60 years, population, size of the aneurysm, shape of the aneurysm (ELAPSS) scores was evaluated using correlation and linear regression analysis. To quantify the surgical findings, the average color value of the aneurysms expressed in the CIELCh system was measured. Δh, color difference from yellow, was used for statistical analysis. RESULTS The mean age of the patients and aneurysm size were 64.08 yr and 6.95 mm, respectively. The mean AWE SI, PHASES and ELAPSS scores, and Δh were 22.30, 8.41, 20.32, and 41.36, respectively. The coefficients of correlation of AWE SI with the PHASES and ELAPSS scores and Δh were 0.526, 0.563, and -0.431. We found that the AWE SI affected the PHASES (β = 0.430) and ELAPSS scores (β = 0.514) and Δh (β = -0.427) in simple linear regression analysis. CONCLUSION The AWE on HR-VWI was correlated with the PHASES and ELAPSS scores and the color. The stronger the AWE, the higher were the PHASES and ELAPSS scores and the more abnormal was the color. The AWE might indicate the degree of inflammation.
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Affiliation(s)
- Heejin Bae
- Department of Neurosurgery, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Suh
- Department of Radiology, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Won Ki Yoon
- Department of Neurosurgery, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Haewon Roh
- Department of Neurosurgery, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Chungyeul Kim
- Department of Pathology, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Guro Hospital, Korea University, College of Medicine, Seoul, Republic of Korea
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Sui B, Bai X, Gao P, Lin Y, Zhang Y, Liang J, Yang X. High-resolution vessel wall magnetic resonance imaging for depicting imaging features of unruptured intracranial vertebrobasilar dissecting aneurysms. J Int Med Res 2021; 49:300060520977388. [PMID: 33530789 PMCID: PMC7871068 DOI: 10.1177/0300060520977388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To demonstrate the application value of high-resolution vessel wall magnetic resonance imaging (HR-VW-MRI) for depicting the imaging features of unruptured intracranial vertebrobasilar dissecting aneurysms (VBDAs). Methods HR-VW-MRI data of 49 patients with suspected unruptured VBDAs were retrospectively analyzed. The presence of intramural hematomas (IMH), double lumens, intimal flaps, and outer diameter enlargements were recorded. Specificity and sensitivity were calculated for both two-dimensional (2D) and three-dimensional (3D) sequences. Additionally, IMH volumes were measured and posterior inferior cerebellar artery (PICA) involvement was analyzed. Results Thirty-five VBDAs were confirmed in 34 patients. The overall sensitivity and specificity were 0.889 (95% confidence interval [CI]: 0.730–0.964) and 0.769 (95% CI: 0.460–0.938) for 2D sequences, and 0.917 (95% CI: 0.764–0.978) and 0.846 (95% CI: 0.537–0.973) for 3D sequences, respectively. Intimal flaps were detected in 57.1%, 87.5%, and 71.4% of all cases on 2D pre-contrast T1-weighted, contrast-enhanced T1-weighted, and 3D T1-weighted black-blood (BB) images, respectively. There was no significant difference in IMH volume between 3D T1-weighted BB and magnetization-prepared rapid gradient-echo sequences. PICA involvement was best visualized using 3D T1 sequences. Conclusion 3D T1-weighted BB MRI provided good visualization of VBDA features, with large coverage, and was useful for detecting dissection flaps.
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Affiliation(s)
- Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yan Lin
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia Liang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Black-blood vessel wall magnetic resonance imaging – A new imaging biomarker for regrowth of coiled saccular aneurysms? INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Li M, Liang H, Wang J. Unfavorable Outcomes Related to Endovascular Treatment of Giant Vertebrobasilar Aneurysms. Front Neurol 2020; 11:748. [PMID: 32849210 PMCID: PMC7431816 DOI: 10.3389/fneur.2020.00748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Giant vertebrobasilar aneurysms (GVBAs) have an unfavorable natural history if left untreated and often pose a sizeable challenge to endovascular treatment. The aim of this study was to analyze the angiographic and clinical outcomes of GVBAs treated by various endovascular procedures. Methods: Between January 2010 and September 2018, 27 patients with 27 GVBAs treated endovascularly were enrolled in this consecutive study. The clinical and angiographic features, treatment modalities, and outcomes were analyzed. Results: The patient cohort comprised 21 men (77.8%) and 6 women (22.2%) of mean age 42.7 ± 18.9 years (range, 6-65 years). The most common presenting symptom was compressive symptoms, present in 15 patients (55.6%). None of the GVBAs was ruptured. Of the 27 GVBAs, 23 aneurysms were dissecting aneurysm with intramural hematoma and 4 aneurysms were saccular. Regarding treatment approach, internal trapping was used in 5 aneurysms, stent-assisted coil embolization in 10, sole stenting in 4, and flow diverters in 8. Overall, 12 patients (44.4%) had an unfavorable angiographic or clinical outcome: 3 patients presented with post-operative complications and subsequent death, and 9 with poor prognosis during follow-up. Conclusions: Patients with GVBAs may not benefit from endovascular treatment. Newer-generation devices are necessary to provide more optimal therapy for the management of these complex lesions.
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Affiliation(s)
- Miao Li
- Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Huaxin Liang
- Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jie Wang
- Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, China
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Tian Z, Wang Z, Li W, Zhu W, Liu J, Zhang Y, Yang X, Zhang Y. Dynamic contrast-enhanced MRI analysis for prognosis of intracranial dissecting aneurysm with intramural haematoma after endovascular treatment: an observational registry study. Stroke Vasc Neurol 2020; 6:133-138. [PMID: 32611729 PMCID: PMC8005896 DOI: 10.1136/svn-2020-000326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/07/2020] [Accepted: 05/16/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial dissecting aneurysm (IDA) with intramural haematoma (IMH) is an intractable cerebrovascular disease. The outcome of IDA with IMH after endovascular treatment varies across different individuals: some IMHs stop growing after endovascular treatment, while others continue to grow, even after embolisation of the parent artery. Currently, the mechanism for the continuous growth of IMH after endovascular treatment is still unclear. Continuous haemorrhage of the vasa vasorum in the IMH is considered to be associated with continuous enlargement of the IMH; however, this theory has not been proved by in vivo imaging. METHODS AND ANALYSIS This study will establish a prospective cohort of 80 patients who had an IDA with IMH and received endovascular treatment. Demographic characteristics, IDA morphological characteristics and treatment characteristics will be collected prospectively. All patients will undergo dynamic contrast-enhanced MRI (DCE-MRI) before and 6 months after the endovascular treatment. According to the follow-up results of the MRI, the IDAs will be divided into two groups: a haematoma stabilisation group and a haematoma enlargement group. Then, quantitative analysis of the vasa vasorum in the IMH will be performed, and differences between the two groups will be compared with determine the association between DCE-MRI related parameters and the outcomes of IMH changes. ETHICS AND DISSEMINATION The research was approved by the ethics committee of Beijing Tian Tan Hospital (KY 2019-024-03) and written informed consents would be obtained from all patients included in this study. The results of this study will be disseminated in professional printed media. TRIAL REGISTRATION NUMBER NCT03940859. Registered: 7 May, 2019. https://clinicaltrials.gov/ct2/show/NCT03940859.
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Affiliation(s)
- Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Zhongxiao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
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11
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Samaniego EA, Roa JA, Hasan D. Vessel wall imaging in intracranial aneurysms. J Neurointerv Surg 2019; 11:1105-1112. [PMID: 31337731 DOI: 10.1136/neurintsurg-2019-014938] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 01/06/2023]
Abstract
High-resolution vessel wall imaging (HR-VWI) is becoming a useful tool in the characterization and identification of unstable unruptured brain aneurysms. However, it has not been validated for clinical use. The current evidence on HR-VWI techniques for characterization of brain aneurysms is described in this review. Specific imaging approaches such as aneurysm wall contrast enhancement, MRI-quantitative susceptibility mapping, and 7T MRI are described in detail.
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Affiliation(s)
- Edgar A Samaniego
- Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jorge A Roa
- Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David Hasan
- Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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12
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Chen J, Liu J, Zhang Y, Tian Z, Wang K, Zhang Y, Mu S, Lv M, Jiang P, Duan C, Zhang H, Qu Y, He M, Yang X. China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms. J Transl Med 2018; 16:263. [PMID: 30257699 PMCID: PMC6158879 DOI: 10.1186/s12967-018-1641-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ruptured aneurysms, the commonest cause of nontraumatic subarachnoid hemorrhage, can be catastrophic; the mortality and morbidity of affected patients being very high. Some risk factors, such as smoking, hypertension and female sex have been identified, whereas others, such as hemodynamics, imaging, and genomics, remain unclear. Currently, no accurate model that includes all factors for predicting such rupture is available. We plan to use data from a large cohort of Chinese individuals to set up a multidimensional model for predicting risk of rupture of unruptured intracranial aneurysms (UIAs). METHODS The China Intracranial Aneurysm Project-2 (CIAP-2) will comprise screening of a cohort of 500 patients with UIA (From CIAP-1) and focus on hemodynamic factors, high resolution magnetic resonance imaging (HRMRI) findings, genetic factors, and biomarkers. Possible risk factors for rupture of UIA, including genetic factors, biomarkers, HRMRI, and hemodynamic factors, will be analyzed. The first project of the China Intracranial Aneurysm Project (CIAP-1; chaired by the Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China) will prospectively collect a cohort of 5000 patients with UIA from 20 centers in China, and collect baseline information for each patient. Multidimensional data will be acquired in follow-up assessments. Statistically significant clinical features in the UIA cohort will also be analyzed and integrated into the model for predicting risk of UIA rupture. After the model has been set up, the resultant evidence-based prediction will provide a preliminary theoretical basis for treating aneurysms at high risk of rupture. DISCUSSION This study will explore the risk of rupture of aneurysms and develop a scientific multidimensional model for predicting rupture of unruptured intracranial aneurysms. Clinical Trials registration A Study on a Multidimensional Prediction Model for Rupture Risk of Unruptured Intracranial Aneurysms (CIAP-2), NCT03133624. Registered: 16 April 2017. https://clinicaltrials.gov/ct2/show/NCT03133624.
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Affiliation(s)
- Junfan Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Peng Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - ChuanZhi Duan
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Min He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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Edjlali M, Guédon A, Ben Hassen W, Boulouis G, Benzakoun J, Rodriguez-Régent C, Trystram D, Nataf F, Meder JF, Turski P, Oppenheim C, Naggara O. Circumferential Thick Enhancement at Vessel Wall MRI Has High Specificity for Intracranial Aneurysm Instability. Radiology 2018; 289:181-187. [PMID: 29969070 DOI: 10.1148/radiol.2018172879] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To identify wall enhancement patterns on vessel wall MRI that discriminate between stable and unstable unruptured intracranial aneurysm (UIA). Materials and Methods Patients were included from November 2012 through January 2016. Vessel wall MR images were acquired at 3 T in patients with stable (incidental and nonchanging over 6 months) or unstable (symptomatic or changing over 6 months) UIA. Each aneurysm was evaluated by using a four-grade classification of enhancement: 0, none; 1, focal; 2, thin circumferential; and 3, thick (>1 mm) circumferential. Inter- and intrareader agreement for the presence and the grade of enhancement were assessed by using κ statistics and 95% confidence interval (CI). The sensitivity, specificity, and negative and positive predictive values of each enhancement grade for differentiating stable from unstable aneurysms was compared. Results The study included 263 patients with 333 aneurysms. Inter- and intrareader agreement was excellent for both the presence of enhancement (κ values, 0.82 [95% CI: 0.67, 0.99] and 0.87 [95% CI: 0.7, 1.0], respectively) and enhancement grade (κ = 0.92 [95% CI: 0.87, 0.95]). In unruptured aneurysms (n = 307), grade 3 enhancement exhibited the highest specificity (84.4%; 233 of 276; 95% CI: 80.1%, 88.7%; P = .02) and negative predictive value (94.3%; 233 of 247) for differentiating between stable and unstable lesions. There was a significant association between grade 3 enhancement and aneurysm instability (P < .0001). Conclusion In patients with intracranial aneurysm, a thick (>1 mm) circumferential pattern of wall enhancement demonstrated the highest specificity for differentiating between stable and unstable aneurysms. © RSNA, 2018.
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Affiliation(s)
- Myriam Edjlali
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Alexis Guédon
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Wagih Ben Hassen
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Grégoire Boulouis
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Joseph Benzakoun
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Christine Rodriguez-Régent
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Denis Trystram
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - François Nataf
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Jean-Francois Meder
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Patrick Turski
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Catherine Oppenheim
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
| | - Olivier Naggara
- From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.)
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