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Rangaiah PKB, Pradeep Kumar BP, Augustine R. Histopathology-driven prostate cancer identification: A VBIR approach with CLAHE and GLCM insights. Comput Biol Med 2024; 182:109213. [PMID: 39357133 DOI: 10.1016/j.compbiomed.2024.109213] [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: 05/03/2024] [Revised: 09/23/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024]
Abstract
Efficient extraction and analysis of histopathological images are crucial for accurate medical diagnoses, particularly for prostate cancer. This research enhances histopathological image reclamation by integrating Visual-Based Image Reclamation (VBIR) techniques with contrast-limited adaptive Histogram Equalization (CLAHE) and the Gray-Level Co-occurrence Matrix (GLCM) algorithm. The proposed method leverages CLAHE to improve image contrast and visibility, crucial for regions with varying illumination, and employs a non-linear Support Vector Machine (SVM) to incorporate GLCM features. Our approach achieved a notable success rate of 89.6%, demonstrating significant improvement in image analysis. The average execution time for matched tissues was 41.23 s (standard deviation 36.87 s), and for unmatched tissues, 21.22 s (standard deviation 29.18 s). These results underscore the method's efficiency and reliability in processing histopathological images. The findings from this study highlight the potential of our method to enhance image reclamation processes, paving the way for further research and advancements in medical image analysis. The superior performance of our approach signifies its capability to significantly improve histopathological image analysis, contributing to more accurate and efficient diagnostic practices.
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Affiliation(s)
- Pramod K B Rangaiah
- Microwaves in Medical Engineering Group, Division of Solid State Electronics, Department of Electrical Engineering, Uppsala University, Box 65 SE-751 03, Uppsala, Sweden
| | - B P Pradeep Kumar
- Department of Computer Science and Design, Atria Institute of Technology, Bengaluru 560024, India
| | - Robin Augustine
- Microwaves in Medical Engineering Group, Division of Solid State Electronics, Department of Electrical Engineering, Uppsala University, Box 65 SE-751 03, Uppsala, Sweden.
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Patel A, Abdalla RN, Allaw S, Cantrell DR, Shaibani A, Caprio F, Hasan DM, Alaraj A, Polster SP, Carroll TJ, Ansari SA. Temporal Changes on Postgadolinium MR Vessel Wall Imaging Captures Enhancement Kinetics of Intracranial Atherosclerotic Plaques and Aneurysms. AJNR Am J Neuroradiol 2024; 45:1206-1213. [PMID: 39054289 PMCID: PMC11392371 DOI: 10.3174/ajnr.a8370] [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: 12/05/2023] [Accepted: 03/05/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND PURPOSE Analysis of vessel wall contrast kinetics (ie, wash-in/washout) is a promising method for the diagnosis and risk-stratification of intracranial atherosclerotic disease plaque (ICAD-P) and the intracranial aneurysm walls (IA-W). We used black-blood MR imaging or MR vessel wall imaging to evaluate the temporal relationship of gadolinium contrast uptake kinetics in ICAD-Ps and IA-Ws compared with normal anatomic reference structures. MATERIALS AND METHODS Patients with ICAD-Ps or IAs who underwent MR vessel wall imaging with precontrast, early postcontrast (5-15 minutes), and delayed postcontrast (20-30 minutes) 3D T1-weighted TSE sequences were retrospectively studied. ROIs of a standardized diameter (2 mm) were used to measure the signal intensities of the cavernous sinus, pituitary infundibulum, temporalis muscle, and choroid plexus. Point ROIs were used for ICAD-Ps and IA-Ws. All ROI signal intensities were normalized to white matter signal intensity obtained using ROIs of 10-mm diameter. Measurements were acquired on precontrast, early postcontrast, and delayed postcontrast 3D T1 TSE sequences for each patient.ajnr;45/9/1206/T1T1T1Table 1:MR-VWI parameters for ICAD-Ps and IAsParameterValueSequence3D TSEScan planeAxialFOV (mm)160TR/TE (ms)800/28-32BW (Hx/pixel)370θ120Acceleration2ETL42Matrix acquisition0.5 mm ×0.5 mmMatrix recon0.5 mm ×0.5 mmNo. of slices/thick120/0.5Note:-FOV indicates field of view; TR, the repetition time; TE, the echo time; BW, bandwidth; ETL, echo train length; Matrix recon, matrix reconstruction. RESULTS Ten patients with 17 symptomatic ICAD-Ps and 30 patients with 34 IA-Ws were included and demonstrated persisting contrast uptake (P < .001) of 7.21% and 10.54% beyond the early phase (5-15 minutes postcontrast) and in the delayed phase (20-30 minutes postcontrast) on postcontrast MR vessel wall imaging. However, normal anatomic reference structures including the pituitary infundibulum and cavernous sinus demonstrated a paradoxical contrast washout in the delayed phase. In both ICAD-Ps and IA-Ws, the greatest percentage of quantitative enhancement (>70%-90%) occurred in the early phase of postcontrast imaging, consistent with the rapid contrast uptake kinetics of neurovascular pathology. CONCLUSIONS Using standard MR vessel wall imaging techniques, our results demonstrate the effects of gadolinium contrast uptake kinetics in ICAD-Ps and IA-Ws with extended accumulating enhancement into the delayed phase (> 15 minutes) as opposed to normal anatomic reference structures that conversely exhibit decreasing enhancement. Because these relative differences are used to assess qualitative patterns of ICAD-P and IA-W enhancement, our findings highlight the importance of standardizing acquisition time points and MR vessel wall imaging protocols to interpret pathologic enhancement for the risk stratification of cerebrovascular pathologies.
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Affiliation(s)
- Abhinav Patel
- From the Department of Radiology, (A.P., R.N.A., D.R.C., A.S., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ramez N Abdalla
- From the Department of Radiology, (A.P., R.N.A., D.R.C., A.S., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt
| | - Sammy Allaw
- Department of Radiology (S.A., T.J.C.), University of Chicago, Chicago, Illinois
| | - Donald R Cantrell
- From the Department of Radiology, (A.P., R.N.A., D.R.C., A.S., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Neurology (D.R.C., A.S., F.C., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ali Shaibani
- From the Department of Radiology, (A.P., R.N.A., D.R.C., A.S., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Neurology (D.R.C., A.S., F.C., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Neurological Surgery (A.S., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frances Caprio
- Department of Neurology (D.R.C., A.S., F.C., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David M Hasan
- Department of Neurological Surgery (D.M.H.), Duke University School of Medicine, Durham, North Carolina
| | - Ali Alaraj
- Department of Neurosurgery, College of Medicine (A.A.), University of Illinois at Chicago, Chicago, Illinois
| | - Sean P Polster
- Department of Neurological Surgery (S.P.P.), University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Timothy J Carroll
- Department of Radiology (S.A., T.J.C.), University of Chicago, Chicago, Illinois
| | - Sameer A Ansari
- From the Department of Radiology, (A.P., R.N.A., D.R.C., A.S., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Neurology (D.R.C., A.S., F.C., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Neurological Surgery (A.S., S.A.A.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Fu Q, Zhang Y, Zhang Y, Liu C, Li J, Wang M, Luo H, Zhu J, Qu F, Mossa-Basha M, Guan S, Cheng J, Zhu C. Wall permeability on magnetic resonance imaging is associated with intracranial aneurysm symptoms and wall enhancement. Eur Radiol 2024; 34:5204-5214. [PMID: 38224377 PMCID: PMC11247137 DOI: 10.1007/s00330-023-10548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES Wall remodeling and inflammation accompany symptomatic unruptured intracranial aneurysms (UIAs). The volume transfer constant (Ktrans) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) reflects UIA wall permeability. Aneurysmal wall enhancement (AWE) on vessel wall MRI (VWI) is associated with inflammation. We hypothesized that Ktrans is related to symptomatic UIAs and AWE. METHODS Consecutive patients with UIAs were prospectively recruited for 3-T DCE-MRI and VWI from January 2018 to March 2023. UIAs were classified as asymptomatic and symptomatic if associated with sentinel headache or oculomotor nerve palsy. Ktrans and AWE were assessed on DCE-MRI and VWI, respectively. AWE was evaluated using the AWE pattern and wall enhancement index (WEI). Spearman's correlation coefficient and univariate and multivariate analyses were used to assess correlations between parameters. RESULTS We enrolled 82 patients with 100 UIAs (28 symptomatic and 72 asymptomatic). The median Ktrans (2.1 versus 0.4 min-1; p < 0.001) and WEI (1.5 versus 0.4; p < 0.001) were higher for symptomatic aneurysms than for asymptomatic aneurysms. Ktrans (odds ratio [OR]: 1.60, 95% confidence interval [95% CI]: 1.01-2.52; p = 0.04) and WEI (OR: 3.31, 95% CI: 1.05-10.42; p = 0.04) were independent risk factors for symptomatic aneurysms. Ktrans was positively correlated with WEI (Spearman's coefficient of rank correlation (rs) = 0.41, p < 0.001). The combination of Ktrans and WEI achieved an area under the curve of 0.81 for differentiating symptomatic from asymptomatic aneurysms. CONCLUSIONS Ktrans may be correlated with symptomatic aneurysms and AWE. Ktrans and WEI may provide an additional value than the PHASES score for risk stratification of UIAs. CLINICAL RELEVANCE STATEMENT The volume transfer constant (Ktrans) from DCE-MRI perfusion is associated with symptomatic aneurysms and provides additional value above the clinical PHASES score for risk stratification of intracranial aneurysms. KEY POINTS • The volume transfer constant is correlated with intracranial aneurysm symptoms and aneurysmal wall enhancement. • Dynamic contrast-enhanced and vessel wall MRI facilitates understanding of the pathophysiological characteristics of intracranial aneurysm walls. • The volume transfer constant and wall enhancement index perform better than the traditional PHASES score in differentiating symptomatic aneurysms.
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Affiliation(s)
- Qichang Fu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1St Construction of E Rd, Two-Seven Districts, Zhengzhou, 450052, China
| | - Yi Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1St Construction of E Rd, Two-Seven Districts, Zhengzhou, 450052, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1St Construction of E Rd, Two-Seven Districts, Zhengzhou, 450052, China
| | - Chao Liu
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinyi Li
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyang Luo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd, Beijing, China
| | - Feifei Qu
- MR Collaboration, Siemens Healthineers Ltd, Beijing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sheng Guan
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1St Construction of E Rd, Two-Seven Districts, Zhengzhou, 450052, China.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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Digpal R, Arkill KP, Doherty R, Yates J, Milne LK, Broomes N, Katsamenis OL, Macdonald J, Ditchfield A, Narata AP, Darekar A, Carare RO, Fabian M, Galea I, Bulters D. A Systematic Review and Meta-Analysis of the Pathology Underlying Aneurysm Enhancement on Vessel Wall Imaging. Int J Mol Sci 2024; 25:2700. [PMID: 38473947 DOI: 10.3390/ijms25052700] [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: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
Intracranial aneurysms are common, but only a minority rupture and cause subarachnoid haemorrhage, presenting a dilemma regarding which to treat. Vessel wall imaging (VWI) is a contrast-enhanced magnetic resonance imaging (MRI) technique used to identify unstable aneurysms. The pathological basis of MR enhancement of aneurysms is the subject of debate. This review synthesises the literature to determine the pathological basis of VWI enhancement. PubMed and Embase searches were performed for studies reporting VWI of intracranial aneurysms and their correlated histological analysis. The risk of bias was assessed. Calculations of interdependence, univariate and multivariate analysis were performed. Of 228 publications identified, 7 met the eligibility criteria. Individual aneurysm data were extracted for 72 out of a total of 81 aneurysms. Univariate analysis showed macrophage markers (CD68 and MPO, p = 0.001 and p = 0.002), endothelial cell markers (CD34 and CD31, p = 0.007 and p = 0.003), glycans (Alcian blue, p = 0.003) and wall thickness (p = 0.030) were positively associated with enhancement. Aneurysm enhancement therefore appears to be associated with inflammatory infiltrate and neovascularisation. However, all these markers are correlated with each other, and the literature is limited in terms of the numbers of aneurysms analysed and the parameters considered. The data are therefore insufficient to determine if these associations are independent of each other or of aneurysm size, wall thickness and rupture status. Thus, the cause of aneurysm-wall enhancement currently remains unknown.
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Affiliation(s)
- Ronneil Digpal
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Kenton P Arkill
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
| | - Regan Doherty
- Biomedical Imaging Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Joseph Yates
- Department of Neuropathology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Lorna K Milne
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
| | - Nicole Broomes
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Orestis L Katsamenis
- Faculty of Engineering and Physical Sciences, µ-VIS X-ray Imaging Centre, University of Southampton, Southampton SO16 6YD, UK
| | - Jason Macdonald
- Department of Neuroradiology, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Adam Ditchfield
- Department of Neuroradiology, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ana Paula Narata
- Department of Neuroradiology, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Angela Darekar
- Medical Physics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Roxana O Carare
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Mark Fabian
- Department of Neuropathology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Zamora CA, Mossa-Basha M, Castillo M. Usefulness of Different Imaging Methods in the Diagnosis of Cerebral Vasculopathy. Neuroimaging Clin N Am 2024; 34:39-52. [PMID: 37951704 DOI: 10.1016/j.nic.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Assessment of cerebral vasculopathies is challenging and requires understanding the utility of different imaging methods. Various techniques are available to image the vessel lumen, each with unique advantages and disadvantages. Bolus-based CT and MR angiography requires careful timing of a contrast bolus to provide optimal luminal enhancement. Non-contrast MRA techniques do not require a contrast agent and can provide images with little venous contamination. Digital subtraction angiography remains the gold standard but is invasive, while VW-MRI provides a non-invasive way of assessing vessel wall pathology. Conventional brain MRI has high sensitivity in the diagnosis of vasculitis but findings are nonspecific.
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Affiliation(s)
- Carlos A Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, CB 7510, Old Infirmary Building, 101 Manning Drive, Chapel Hill, NC 27599-7510, USA.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, CB 7510, Old Infirmary Building, 101 Manning Drive, Chapel Hill, NC 27599-7510, USA
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Benndorf G. Advancing vessel wall imaging in intracranial aneurysms: a crucial step towards improved patient management? Acta Neurochir (Wien) 2023; 165:3831-3832. [PMID: 37861925 DOI: 10.1007/s00701-023-05773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 10/21/2023]
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Blaj LA, Cucu AI, Tamba BI, Turliuc MD. The Role of the NF-kB Pathway in Intracranial Aneurysms. Brain Sci 2023; 13:1660. [PMID: 38137108 PMCID: PMC10871091 DOI: 10.3390/brainsci13121660] [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: 10/30/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
The pathophysiology of intracranial aneurysms (IA) has been proven to be closely linked to hemodynamic stress and inflammatory pathways, most notably the NF-kB pathway. Therefore, it is a potential target for therapeutic intervention. In the present review, we investigated alterations in the vascular smooth muscle cells (VSMCs), extracellular matrix, and endothelial cells by the mediators implicated in the NF-kB pathway that lead to the formation, growth, and rupture of IAs. We also present an overview of the NF-kB pathway, focusing on stimuli and transcriptional targets specific to IAs, as well as a summary of the current strategies for inhibiting NF-kB activation in IAs. Our report adds to previously reported data and future research directions for treating IAs using compounds that can suppress inflammation in the vascular wall.
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Affiliation(s)
- Laurentiu Andrei Blaj
- Department of Neurosurgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.A.B.); (M.D.T.)
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Andrei Ionut Cucu
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
- Faculty of Medicine and Biological Sciences, University Stefan cel Mare of Suceava, 720229 Suceava, Romania
| | - Bogdan Ionel Tamba
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Department of Pharmacology, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Dana Turliuc
- Department of Neurosurgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.A.B.); (M.D.T.)
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
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Wang B, Shen C, Su Z, Nie X, Zhao J, Qiu S, Li Y. Correlation between the rate of morphological changes and rupture of intracranial aneurysms during one cardiac cycle analyzed by 4D-CTA. Front Neurol 2023; 14:1235312. [PMID: 37849835 PMCID: PMC10577209 DOI: 10.3389/fneur.2023.1235312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Objective This study aimed to analyze the relationship between the rate of morphological changes and intracranial aneurysm rupture during the cardiac cycle. Methods Eighty-four patients with intracranial aneurysms were retrospectively analyzed and divided into the rupture (42 cases) and unruptured (42 cases) groups. Four-dimensional computed tomography angiography (4D-CTA) was performed to collect quantitative parameters of aneurysm morphology and calculate the morphological change rate. The potential factors associated with aneurysm rupture were determined by comparing the general clinical data and rate of change in the location and morphology of the aneurysm between the two groups. Results Each morphological change rate in the rupture group was generally higher than that of the unruptured group. The rate of dome height change and aneurysm volume change were independent factors associated with aneurysm rupture. ROC curve analysis revealed that the diagnostic accuracy of the aneurysm volume change rate was higher. When the volume change rate was 12.33%, the sensitivity and specificity of rupture were 90.5 and 55.8%, respectively. Conclusion The rate of change in dome height and volume of intracranial aneurysms during one cardiac cycle were independent factors associated with aneurysm rupture.
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Affiliation(s)
- Binghao Wang
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Neurosurgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chengen Shen
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Zhongzhou Su
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Xiaohu Nie
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Jingjing Zhao
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Hospital Infection Control, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Sheng Qiu
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Yuntao Li
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
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Pravdivtseva MS, Berg P, Hövener JB, Jansen O, Larsen N. Reply to the Letter to the Editor: Pseudo-Enhancement in Intracranial Aneurysms on Black-Blood MRI: Effects of Flow Rate, Spatial Resolution, and Additional Flow Suppression. J Magn Reson Imaging 2023; 57:965. [PMID: 35716093 DOI: 10.1002/jmri.28290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mariya S Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Philipp Berg
- Laboratory of Fluid Dynamics and Technical Flows, Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Aneurysm wall enhancement, atherosclerotic proteins, and aneurysm size may be related in unruptured intracranial fusiform aneurysms. Eur Radiol 2023:10.1007/s00330-023-09456-9. [PMID: 36840766 DOI: 10.1007/s00330-023-09456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/25/2022] [Accepted: 01/20/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE This cross-sectional study aimed to investigate the associations between aneurysm wall enhancement (AWE), atherosclerotic protein levels, and aneurysm size in unruptured intracranial fusiform aneurysms (IFAs). METHODS Patients with IFAs underwent high-resolution magnetic resonance imaging (HR-MRI) and atherosclerotic protein examinations from May 2015 to December 2021 were collected. A CRstalk (signal intensity [SI] of IFA wall/SI of pituitary stalk) > 0.60 was considered to indicate AWE. Atherosclerotic protein data was obtained from the peripheral blood. Aneurysmal characteristics included the maximal diameter of the cross-section (Dmax), location, type of IFA, presence of mural thrombus, and mural clots. Statistical analyses were performed with univariate analysis, logistic regression analysis, and Spearman's correlation coefficient. RESULTS Seventy-one IFAs from 71 patients were included in the study. Multivariate analysis revealed statin use (OR = 0.189, p = 0.026) and apolipoprotein B (Apo-B) level (OR = 6.019, p = 0.026) were the independent predictors of AWE in IFAs. In addition, statin use (OR = 0.813, p = 0.036) and Apo-B level (OR = 1.610, p = 0.003) were also the independent predictors of CRstalk. Additionally, we found that CRstalk and AWE were significantly positively associated with Dmax (rs = 0.409 and 0.349, respectively; p < 0.001 and p = 0.003, respectively). CONCLUSIONS There may be correlations between AWE, atherosclerotic protein levels, and aneurysm size in patients with IFAs. Apo-B and statin use were independent predictors of AWE in IFAs, which have the potential to be new therapeutic targets for IFAs. KEY POINTS • There may be correlations between aneurysm wall enhancement, atherosclerotic protein levels in the peripheral blood, and aneurysm size in patients with intracranial fusiform aneurysms. • Apolipoprotein B and statin use were independent predictors of aneurysm wall enhancement in intracranial fusiform aneurysms.
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11
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Wang Y, Liu X, Wang Y, Qi H, Liu X, Kong X, Zhang Q, Dou J, Wang J, Chen H. Optimization of the Contrast Agent Injection Protocol for Carotid Artery Dynamic Contrast-Enhanced Magnetic Resonance Imaging. J Magn Reson Imaging 2022; 56:1372-1381. [PMID: 35324034 DOI: 10.1002/jmri.28175] [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: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The injection protocol used in previous carotid artery dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies varied. PURPOSE To investigate the effect of contrast injection protocol and optimize this protocol for carotid artery DCE-MRI. STUDY TYPE Prospective. SUBJECTS Digital phantom and seven patients with carotid atherosclerosis. FIELD STRENGTH/SEQUENCE 3 T, spoiled gradient recalled echo sequence. ASSESSMENT Different injection doses (0.01-0.3 mmol/kg) and effective injection rates (0.01-1 mmol/sec) were tested using a digital carotid plaque phantom considering the contrast pharmacokinetics, DCE-MRI imaging, contrast variation and flow-related imaging artifacts, random time delay between the contrast injection and image acquisition, and pharmacokinetic analysis process. For each injection protocol, combining the root mean square relative error (RMSRE) of the measured K trans and v P maps within the adventitial vasa vasorum from 10 tested time delays by the root mean square produced RMSREoverall-vv which was used to measure the overall accuracy of the pharmacokinetic parameters. In vivo validation was performed on seven patients with carotid atherosclerosis by imaging them twice using the traditional commonly used protocol and the recommended protocol found by simulation. STATISTICAL TEST Student's t-test, chi-square test, and paired t-test, P < 0.05 was considered statistically significant. RESULTS A low region of RMSREoverall-vv with the combination of medium injection dose and low effective injection rate was found. The protocol with injection dose of 0.07 mmol/kg and effective injection rate of 0.06 mmol/sec achieved the minimal RMSREoverall-vv (4.29%), thus was recommended, which showed more accurate arterial input function. Coinciding with the simulation results, this recommended protocol in in vivo experiments produced significantly fewer image artifacts, lower K trans and v P (P all <0.05) than traditional protocol which overestimated these parameters in simulation. DATA CONCLUSION The contrast injection protocol influenced the accuracy of the pharmacokinetics parameter estimation in carotid artery DCE-MRI. The injection protocol with injection dose of 0.07 mmol/kg and effective injection rate of 0.06 mmol/sec was recommended. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | | | - Haikun Qi
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Xian Liu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jiaqi Dou
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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12
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Sunderland K, Jiang J, Zhao F. Disturbed flow's impact on cellular changes indicative of vascular aneurysm initiation, expansion, and rupture: A pathological and methodological review. J Cell Physiol 2022; 237:278-300. [PMID: 34486114 PMCID: PMC8810685 DOI: 10.1002/jcp.30569] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
Aneurysms are malformations within the arterial vasculature brought on by the structural breakdown of the microarchitecture of the vessel wall, with aneurysms posing serious health risks in the event of their rupture. Blood flow within vessels is generally laminar with high, unidirectional wall shear stressors that modulate vascular endothelial cell functionality and regulate vascular smooth muscle cells. However, altered vascular geometry induced by bifurcations, significant curvature, stenosis, or clinical interventions can alter the flow, generating low stressor disturbed flow patterns. Disturbed flow is associated with altered cellular morphology, upregulated expression of proteins modulating inflammation, decreased regulation of vascular permeability, degraded extracellular matrix, and heightened cellular apoptosis. The understanding of the effects disturbed flow has on the cellular cascades which initiate aneurysms and promote their subsequent growth can further elucidate the nature of this complex pathology. This review summarizes the current knowledge about the disturbed flow and its relation to aneurysm pathology, the methods used to investigate these relations, as well as how such knowledge has impacted clinical treatment methodologies. This information can contribute to the understanding of the development, growth, and rupture of aneurysms and help develop novel research and aneurysmal treatment techniques.
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Affiliation(s)
- Kevin Sunderland
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
| | - Feng Zhao
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
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13
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Wang Y, Sun J, Li R, Liu P, Liu X, Ji J, Chen C, Chen Y, Qi H, Li Y, Zhang L, Jia L, Peng F, Fu M, Wang Y, Xu M, Kong C, Xia S, Wang X, He L, Zhang Q, Chen Z, Liu A, Li Y, Lv M, Chen H. Increased aneurysm wall permeability colocalized with low wall shear stress in unruptured saccular intracranial aneurysm. J Neurol 2021; 269:2715-2719. [PMID: 34731309 DOI: 10.1007/s00415-021-10869-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022]
Abstract
Aneurysm wall permeability has recently emerged as an in vivo marker of aneurysm wall remodeling. We sought to study the spatial relationship between hemodynamic forces derived from 4D-flow MRI and aneurysm wall permeability by DCE-MRI in a region-based analysis of unruptured saccular intracranial aneurysms (IAs). We performed 4D-flow MRI and DCE-MRI on patients with unruptured IAs of ≥ 5 mm to measure hemodynamic parameters, including wall shear stress (WSS), oscillatory shear index (OSI), WSS temporal (WSSGt) and spatial (WSSGs) gradient, and aneurysm wall permeability (Ktrans) in different sectors of aneurysm wall defined by evenly distributed radial lines emitted from the aneurysm center. The spatial association between Ktrans and hemodynamic parameters measured at the sector level was evaluated. Thirty-one patients were scanned. Ktrans not only varied between aneurysms but also demonstrated spatial heterogeneity within an aneurysm. Among all 159 sectors, higher Ktrans was associated with lower WSS, which was seen in both Spearman's correlation analysis (rho = - 0.18, p = 0.025) and linear regression analysis using generalized estimating equation to account for correlations between multiple sectors of the same aneurysm (regression coefficient = - 0.33, p = 0.006). Aneurysm wall permeability by DCE-MRI was shown to be spatially heterogenous in unruptured saccular IAs and associated with local WSS by 4D-flow MRI.
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Affiliation(s)
- Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xian Liu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Chunmiao Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Yu Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Haikun Qi
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Yunduo Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | | | - Min Xu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Chunli Kong
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Shuiwei Xia
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Xiaole Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Zhensen Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Huijun Chen
- 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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Liu X, Feng J, Li Z, Zhang Z, Zhang Q, Jiang Y, Huo X, Chai X, Wu Y, Kong Q, Liu P, Ge H, Jin H, An J, Jiang P, Saloner DA, Li Y, Zhu C. Quantitative analysis of unruptured intracranial aneurysm wall thickness and enhancement using 7T high resolution, black blood magnetic resonance imaging. J Neurointerv Surg 2021; 14:723-728. [PMID: 34452988 DOI: 10.1136/neurintsurg-2021-017688] [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: 04/21/2021] [Accepted: 08/03/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study was performed to quantify intracranial aneurysm wall thickness (AWT) and enhancement using 7T MRI, and their relationship with aneurysm size and type. METHODS 27 patients with 29 intracranial aneurysms were included. Three-dimensional T1 weighted pre- and post-contrast fast spin echo with 0.4 mm isotropic resolution was used. AWT was defined as the full width at half maximum on profiles of signal intensity across the aneurysm wall on pre-contrast images. Enhancement ratio (ER) was defined as the signal intensity of the aneurysm wall over that of the brain parenchyma. The relationships between AWT, ER, and aneurysm size and type were investigated. RESULTS 7T MRI revealed large variations in AWT (range 0.11-1.24 mm). Large aneurysms (>7 mm) had thicker walls than small aneurysms (≤7 mm) (0.49±0.05 vs 0.41±0.05 mm, p<0.001). AWT was similar between saccular and fusiform aneurysms (p=0.546). Within each aneurysm, a thicker aneurysm wall was associated with increased enhancement in 28 of 29 aneurysms (average r=0.65, p<0.05). Thicker walls were observed in enhanced segments (ER >1) than in non-enhanced segments (0.53±0.09 vs 0.38±0.07 mm, p<0.001). CONCLUSION Improved image quality at 7T allowed quantification of intracranial AWT and enhancement. A thicker aneurysm wall was observed in larger aneurysms and was associated with stronger enhancement.
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Affiliation(s)
- Xinke Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junqiang Feng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhixin Li
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zihao Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Beijing 100101, China .,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xubin Chai
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yue Wu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qingle Kong
- MR Collaboration, Siemens Healthcare China, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd, Siemens Healthcare China, Shenzhen, China
| | - Peng Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - David A Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
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15
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Sang C, Kallmes DF, Kadirvel R, Durka MJ, Ding YH, Dai D, Watkins SC, Robertson AM. Adaptive Remodeling in the Elastase-induced Rabbit Aneurysms. EXPERIMENTAL MECHANICS 2021; 61:263-283. [PMID: 33814553 PMCID: PMC8011419 DOI: 10.1007/s11340-020-00671-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/29/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Rupture of brain aneurysms is associated with high fatality and morbidity rates. Through remodeling of the collagen matrix, many aneurysms can remain unruptured for decades, despite an enlarging and evolving geometry. OBJECTIVE Our objective was to explore this adaptive remodeling for the first time in an elastase induced aneurysm model in rabbits. METHODS Saccular aneurysms were created in 22 New Zealand white rabbits and remodeling was assessed in tissue harvested 2, 4, 8 and 12 weeks after creation. RESULTS The intramural principal stress ratio doubled after aneurysm creation due to increased longitudinal loads, triggering a remodeling response. A distinct wall layer with multi-directional collagen fibers developed between the media and adventitia as early as 2 weeks, and in all cases by 4 weeks with an average thickness of 50.6 ± 14.3 μm. Collagen fibers in this layer were multi-directional (AI = 0.56 ± 0.15) with low tortuosity (1.08 ± 0.02) compared with adjacent circumferentially aligned medial fibers (AI = 0.78 ± 0.12) and highly tortuous adventitial fibers (1.22 ± 0.03). A second phase of remodeling replaced circumferentially aligned fibers in the inner media with longitudinal fibers. A structurally motivated constitutive model with both remodeling modes was introduced along with methodology for determining material parameters from mechanical testing and multiphoton imaging. CONCLUSIONS A new mechanism was identified by which aneurysm walls can rapidly adapt to changes in load, ensuring the structural integrity of the aneurysm until a slower process of medial reorganization occurs. The rabbit model can be used to evaluate therapies to increase aneurysm wall stability.
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Affiliation(s)
- C Sang
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
| | - D F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - R Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - M J Durka
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
| | - Y-H Ding
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - D Dai
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - S C Watkins
- Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA
| | - A M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
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16
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Youn SW, Lee J. From 2D to 4D Phase-Contrast MRI in the Neurovascular System: Will It Be a Quantum Jump or a Fancy Decoration? J Magn Reson Imaging 2020; 55:347-372. [PMID: 33236488 DOI: 10.1002/jmri.27430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Considering the crosstalk between the flow and vessel wall, hemodynamic assessment of the neurovascular system may offer a well-integrated solution for both diagnosis and management by adding prognostic significance to the standard CT/MR angiography. 4D flow MRI or time-resolved 3D velocity-encoded phase-contrast MRI has long been promising for the hemodynamic evaluation of the great vessels, but challenged in clinical studies for assessing intracranial vessels with small diameter due to long scan times and low spatiotemporal resolution. Current accelerated MRI techniques, including parallel imaging with compressed sensing and radial k-space undersampling acquisitions, have decreased scan times dramatically while preserving spatial resolution. 4D flow MRI visualized and measured 3D complex flow of neurovascular diseases such as aneurysm, arteriovenous shunts, and atherosclerotic stenosis using parameters including flow volume, velocity vector, pressure gradients, and wall shear stress. In addition to the noninvasiveness of the phase contrast technique and retrospective flow measurement through the wanted windows of the analysis plane, 4D flow MRI has shown several advantages over Doppler ultrasound or computational fluid dynamics. The evaluation of the flow status and vessel wall can be performed simultaneously in the same imaging modality. This article is an overview of the recent advances in neurovascular 4D flow MRI techniques and their potential clinical applications in neurovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sung Won Youn
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology and Biomedical Engineering, Kyungpook National University School of Medicine, Daegu, Korea
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17
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Castle-Kirszbaum M, Maingard J, Lim RP, Barras CD, Kok HK, Chandra RV, Chong W, Asadi H. Four-Dimensional Magnetic Resonance Imaging Assessment of Intracranial Aneurysms: A State-of-the-Art Review. Neurosurgery 2020; 87:453-465. [PMID: 32140714 DOI: 10.1093/neuros/nyaa021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/15/2019] [Indexed: 11/14/2022] Open
Abstract
Treatment of unruptured intracranial aneurysms can reduce the risk of subarachnoid hemorrhage and its associated morbidity and mortality. However, current methods to predict the risk of rupture and optimize treatment strategies for intracranial aneurysms are limited. Assessment of intra-aneurysmal flow using 4-dimensional magnetic resonance imaging (4D MRI) is a novel tool that could be used to guide therapy. A systematic search of the literature was performed to provide a state-of-the-art review on 4D MRI assessment of unruptured intracranial aneurysms. A total of 18 studies were available for review. Eccentric flow on 4D MRI is associated with a greater aspect ratio and peak wall shear stress (WSS). WSS, vorticity, and peak velocity are greater in saccular than fusiform aneurysms. Unstable aneurysms are associated with greater WSS, peak wall stress, and flow jet angle and may exhibit wall enhancement. In comparison to computational fluid dynamics (CFD), 4D MRI has a lower spatial resolution and reports lower WSS and velocity magnitudes, but these parameters equalize when spatial resolution is matched. 4D MRI demonstrates the intra-aneurysmal hemodynamic changes associated with flow diversion, including significantly decreased flow velocity. Thus, 4D MRI is a novel, noninvasive imaging tool used for the evaluation of hemodynamics within intracranial aneurysms. Hemodynamic indices derived from 4D MRI appear to correlate well with the simulated (CFD) values and may be used to measure the success of endovascular therapies and risk factors for aneurysm growth and rupture.
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Affiliation(s)
- Mendel Castle-Kirszbaum
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Julian Maingard
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,School of Medicine, Deakin University, Victoria, Australia
| | - Ruth P Lim
- Austin Health, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Christen D Barras
- Department of Radiology, Royal Adelaide Hospital, The University of Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Hong Kuan Kok
- School of Medicine, Deakin University, Victoria, Australia.,Department of Radiology Northern Health, Melbourne, Australia
| | - Ronil V Chandra
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Winston Chong
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,School of Medicine, Deakin University, Victoria, Australia.,Austin Health, Melbourne, Australia
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18
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Soldozy S, Norat P, Elsarrag M, Chatrath A, Costello JS, Sokolowski JD, Tvrdik P, Kalani MYS, Park MS. The biophysical role of hemodynamics in the pathogenesis of cerebral aneurysm formation and rupture. Neurosurg Focus 2020; 47:E11. [PMID: 31261115 DOI: 10.3171/2019.4.focus19232] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022]
Abstract
The pathogenesis of intracranial aneurysms remains complex and multifactorial. While vascular, genetic, and epidemiological factors play a role, nascent aneurysm formation is believed to be induced by hemodynamic forces. Hemodynamic stresses and vascular insults lead to additional aneurysm and vessel remodeling. Advanced imaging techniques allow us to better define the roles of aneurysm and vessel morphology and hemodynamic parameters, such as wall shear stress, oscillatory shear index, and patterns of flow on aneurysm formation, growth, and rupture. While a complete understanding of the interplay between these hemodynamic variables remains elusive, the authors review the efforts that have been made over the past several decades in an attempt to elucidate the physical and biological interactions that govern aneurysm pathophysiology. Furthermore, the current clinical utility of hemodynamics in predicting aneurysm rupture is discussed.
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19
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Abstract
BACKGROUND The radiographic appearance of infectious intracranial aneurysms (IIAs) of infective endocarditis (IE) on magnetic resonance imaging (MRI) of brain is varied. We aimed to describe the IIA-specific MRI features in a series of patients with IIAs. METHODS Records of patients with active IE who had digital subtraction angiography (DSA) at a tertiary medical center from January 2011 to December 2016 were reviewed. MRIs performed prior to IIA treatment were reviewed for findings on susceptibility-weighted imaging (SWI), diffusion-weighted imaging, and T1 with and without contrast. RESULTS Of the 732 patients with IE, 53 (7%) had IIAs. Of these, 28 patients had an evaluable pre-treatment MRI, in whom 33 IIAs were imaged. MRI to DSA median time was 1 day (interquartile range = 1-5). On MRI, 12 (36%) IIAs had SWI lesion with contrast enhancement, 7 (21%) had cerebral microbleeds, 3 (11%) had sulcal SWI lesion, 2 (6%) IIAs had abscesses, 3 (9%) had intraparenchymal hemorrhage, 3 (9%) had subarachnoid hemorrhage, and 6 (18%) had ischemic stroke at the anatomical locations of IIAs. Four IIAs (12%) had no correlating MRI findings, though those patients had MRI without contrast. CONCLUSION The MRI features such as SWI lesion and contrast enhancement were the commonest MRI presentations associated with the presence of IIA.
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20
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Santarosa C, Cord B, Koo A, Bhogal P, Malhotra A, Payabvash S, Minja FJ, Matouk CC. Vessel wall magnetic resonance imaging in intracranial aneurysms: Principles and emerging clinical applications. Interv Neuroradiol 2019; 26:135-146. [PMID: 31818175 DOI: 10.1177/1591019919891297] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intracranial high-resolution vessel wall magnetic resonance imaging is an imaging paradigm that complements conventional imaging modalities used in the evaluation of neurovascular pathology. This review focuses on the emerging utility of vessel wall magnetic resonance imaging in the characterization of intracranial aneurysms. We first discuss the technical principles of vessel wall magnetic resonance imaging highlighting methods to determine aneurysm wall enhancement and how to avoid common interpretive pitfalls. We then review its clinical application in the characterization of ruptured and unruptured intracranial aneurysms, in particular, the emergence of aneurysm wall enhancement as a biomarker of aneurysm instability. We offer our perspective from a high-volume neurovascular center where vessel wall magnetic resonance imaging is in routine clinical use.
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Affiliation(s)
| | - Branden Cord
- Department of Neurosurgery, Yale University, New Haven, USA
| | - Andrew Koo
- Department of Neurosurgery, Yale University, New Haven, USA
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | - Ajay Malhotra
- Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
| | - Sam Payabvash
- Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
| | - Frank J Minja
- Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
| | - Charles C Matouk
- Department of Neurosurgery, Yale University, New Haven, USA.,Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
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21
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Wang GX, Xia C, Liu J, Cui C, Lei S, Gong MF, Wen L, Zhang D. The Relationship of Arterial Wall Enhancement Ratio on MRI with the Degree of Inflammation in a Rabbit Aneurysm Model: A Pilot Study. Acad Radiol 2019; 26:e292-e297. [PMID: 30567638 DOI: 10.1016/j.acra.2018.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To identify the relationship between enhancement ratio (ER) of aneurysm walls and degrees of inflammation. MATERIALS AND METHODS Twenty-five white rabbits were used in this study; all underwent surgery to isolate the right common carotid artery (RCCA). Twenty rabbits underwent an aneurysm creation procedure, and 5 underwent a control procedure. In the aneurysm creation procedure, there was surgical exposure of the origin of RCCA and temporary occlusion with an aneurysm clip. The distal RCCA was ligated, and the trapped segment was infused with elastase for 20 minutes, after which the clip was removed. In the control procedure, the trapped segment was infused with saline. High-resolution magnetic resonance imaging was performed at weeks 2, 3, 4, and 5 after the procedure, and wall ER was calculated. After MRI, aneurysms were harvested and stained with hematoxylin-eosin. Pearson correlation analysis and scatter plots were used to evaluate the relationship between wall ER and the degree of inflammation. The relationships between the wall ER, the number of inflammatory cells and time were analyzed by linear graphs. RESULTS Wall ER positively correlated with inflammatory cell count of the aneurysm wall (r = 0.877, p < 0.001). The relationships between wall ER, the number of inflammatory cells, and time increased and then decreased according linear graphs. CONCLUSION In this study, the aneurysm wall ER was confirmed to be associated with the degree of inflammation on the rabbit aneurysm model.
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Lehman VT, Brinjikji W. Vessel Wall Imaging of Unruptured Intracranial Aneurysms: Ready for Prime Time? Not so Fast! AJNR Am J Neuroradiol 2019; 40:E26-E29. [PMID: 31048296 DOI: 10.3174/ajnr.a6048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - W Brinjikji
- Departments of Radiology and Neurosurgery Mayo Clinic College of Graduate Medical Education Rochester, Minnesota
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Qi H, Liu X, Liu P, Yuan W, Liu A, Jiang Y, Li Y, Sun J, Chen H. Complementary Roles of Dynamic Contrast-Enhanced MR Imaging and Postcontrast Vessel Wall Imaging in Detecting High-Risk Intracranial Aneurysms. AJNR Am J Neuroradiol 2019; 40:490-496. [PMID: 30792252 DOI: 10.3174/ajnr.a5983] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/02/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Individual assessment of the absolute risk of intracranial aneurysm rupture remains challenging. Emerging imaging techniques such as dynamic contrast-enhanced MR imaging and postcontrast vessel wall MR imaging may improve risk estimation by providing new information on aneurysm wall properties. The purpose of this study was to investigate the relationship between aneurysm wall permeability on dynamic contrast-enhanced MR imaging and aneurysm wall enhancement on postcontrast vessel wall MR imaging in unruptured intracranial aneurysms. MATERIALS AND METHODS Patients with unruptured saccular intracranial aneurysms were imaged with vessel wall MR imaging before and after gadolinium contrast administration. Dynamic contrast-enhanced MR imaging was performed coincident with contrast injection using 3D T1-weighted spoiled gradient-echo imaging. The transfer constant (K trans) was measured adjacent to intracranial aneurysm and adjacent to the normal intracranial artery. RESULTS Twenty-nine subjects were analyzed (mean age, 53.9 ± 13.5 years; 24% men; PHASES score: median, 8; interquartile range, 4.75-10). K trans was higher in intracranial aneurysms compared with the normal intracranial artery (median, 0.0110; interquartile range, 0.0060-0.0390 versus median, 0.0032; interquartile range, 0.0018-0.0048 min-1; P < .001), which correlated with intracranial aneurysm size (Spearman ρ = 0.54, P = .002) and PHASES score (ρ = 0.40, P = .30). Aneurysm wall enhancement, detected in 19 (66%) aneurysms, was associated with intracranial aneurysm size and the PHASES score but not significantly with K trans (P = .30). Aneurysms of 2 of the 9 patients undergoing conservative treatment ruptured during 1-year follow-up. Both ruptured aneurysms had increased K trans, whereas only 1 had aneurysm wall enhancement at baseline. CONCLUSIONS Dynamic contrast-enhanced MR imaging showed increased K trans adjacent to intracranial aneurysms, which was independent of aneurysm wall enhancement on postcontrast vessel wall MR imaging. Increased aneurysm wall permeability on dynamic contrast-enhanced MR imaging provides new information that may be useful in intracranial aneurysm risk assessment.
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Affiliation(s)
- H Qi
- From the Department of Biomedical Engineering (H.Q., X.L., H.C.), Tsinghua University, Beijing, China
| | - X Liu
- From the Department of Biomedical Engineering (H.Q., X.L., H.C.), Tsinghua University, Beijing, China
| | - P Liu
- Department of Interventional Neuroradiology (P.L., A.L.,Y.J., Y.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - W Yuan
- Department of Radiology (W.Y.), Navy Qingdao No. 1 Sanatorium of People's Liberation Army, Qingdao, China
| | - A Liu
- Department of Interventional Neuroradiology (P.L., A.L.,Y.J., Y.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Y Jiang
- Department of Interventional Neuroradiology (P.L., A.L.,Y.J., Y.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Y Li
- Department of Interventional Neuroradiology (P.L., A.L.,Y.J., Y.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J Sun
- Department of Radiology (J.S.), University of Washington, Seattle, Washington
| | - H Chen
- From the Department of Biomedical Engineering (H.Q., X.L., H.C.), Tsinghua University, Beijing, China
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24
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Wall enhancement ratio determined by vessel wall MRI associated with symptomatic intracranial aneurysms. Eur J Radiol 2019; 112:88-92. [PMID: 30777225 DOI: 10.1016/j.ejrad.2019.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/05/2018] [Accepted: 01/14/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE To study the association of the enhancement ratio (ER) of aneurysmal wall enhancement (AWE) with symptomatic intracranial aneurysms (IAs), we hypothesized that the ER of AWE would be stronger in symptomatic IAs than in asymptomatic IAs, as assessed by high-resolution magnetic resonance imaging (HRMRI). MATERIALS AND METHODS Between February 2016 and February 2018, 80 consecutive patients with 89 unruptured IAs were reviewed. Patients and IAs were divided into symptomatic and asymptomatic groups. In addition to the clinical characteristics, the IA features (e.g., size, shape) were evaluated via computed tomography angiography, while the ER and enhanced patterns were evaluated by HRMRI. Multiple logistic regression analysis was performed to determine the independent risk factors for symptomatic IAs. Receiver operating characteristic curve analysis was used for the final model to obtain the optimal thresholds. RESULTS Multiple logistic regression analysis indicated that only the ER was associated with symptomatic IAs. The threshold value of the ER was 60.5%. CONCLUSIONS A higher ER was more frequently identified in symptomatic IAs. More attention should be paid to this factor in the management of IAs.
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25
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Xu J, Zhang Y, Chu L, Chen W, Du Y, Gu J. Long non-coding RNA HIF1A-AS1 is upregulated in intracranial aneurysms and participates in the regulation of proliferation of vascular smooth muscle cells by upregulating TGF-β1. Exp Ther Med 2018; 17:1797-1801. [PMID: 30867687 PMCID: PMC6395997 DOI: 10.3892/etm.2018.7144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/05/2018] [Indexed: 12/29/2022] Open
Abstract
Long non-coding (lnc)RNA hypoxia inducible factor 1α-antisense RNA 1 (HIF1A-AS1) not only participates in different types of malignancies, but also serves pivotal roles in thoracic aortic aneurysms, which suggests its possible involvement in intracranial aneurysms. Therefore, the present study aimed to investigate its involvement in intracranial aneurysms. Expression levels of HIF1A-AS1 and transforming growth factor (TGF)-β1 in the blood of patients with intracranial aneurysms and healthy controls were detected using reverse transcription-quantitative polymerase chain reaction. The diagnostic value of blood HIF1A-AS1 for intracranial aneurysms was analyzed using receiver operating characteristic curve analysis. A HIF1A-AS1 expression vector was constructed and transfected into human vascular smooth muscle cells (VSMCs) and the effects on cell proliferation and TGF-β1 expression were explored using the Cell Counting kit-8 assay and western blot analysis, respectively. Upregulated HIF1A-AS1 expression levels in blood were observed in patients with intracranial aneurysms when compared with controls. Notably, upregulated HIF1A-AS1 expression effectively distinguished patients with intracranial aneurysms from healthy controls. Furthermore, HIF1A-AS1 and TGF-β1 expression levels were positively correlated with intracranial aneurysms. HIF1A-AS1 overexpression also upregulated TGF-β1 expression and inhibited VSMC proliferation. Although TGF-β1 treatment had no significant effect on HIF1A-AS1 expression, TGF-β inhibitor significantly reduced the effects of HIF1A-AS1 overexpression on cell proliferation. It was therefore concluded that HIF1A-AS1 may participate in intracranial aneurysms by regulating VSMC proliferation through the upregulation of TGF-β1.
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Affiliation(s)
- Jiaming Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
| | - Yang Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
| | - Lisheng Chu
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
| | - Weiyan Chen
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
| | - Yueguang Du
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
| | - Jingjing Gu
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
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Computed Tomography Angiography Evaluation of Risk Factors for Unstable Intracranial Aneurysms. World Neurosurg 2018; 115:e27-e32. [DOI: 10.1016/j.wneu.2018.03.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 01/03/2023]
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27
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Signorelli F, Sela S, Gesualdo L, Chevrel S, Tollet F, Pailler-Mattei C, Tacconi L, Turjman F, Vacca A, Schul DB. Hemodynamic Stress, Inflammation, and Intracranial Aneurysm Development and Rupture: A Systematic Review. World Neurosurg 2018; 115:234-244. [DOI: 10.1016/j.wneu.2018.04.143] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
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Evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage according to the PHASES score. Neurosurg Rev 2018; 42:489-492. [PMID: 29948496 DOI: 10.1007/s10143-018-0989-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/16/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
The PHASES score was developed to determine the risk of rupture of un-ruptured intracranial aneurysms (UIAs). The purposes of the current study were to apply this score on patients with actually ruptured intracranial aneurysms and to analyze the hypothetically prediction of the risk in this particularly patient group. We extracted the data of 100 recently treated patients (23 male, 77 female, mean age 56.4 years, range 17-93 years) with ruptured saccular intracranial aneurysms from our prospectively maintained neurovascular database according to the parameters used in the PHASES score (population, hypertension, age, earlier SAH, size and site of the aneurysm). Descriptive statistical analysis was performed using SPSS for Windows version 18.0 (SPSS Inc., Chicago, Illinois, USA). Ninety-nine percent of the patients were European and 1% Japanese in our series. Pre-existing arterial hypertension was found in 59%. Fifteen percent of the patients were > 75 years. Earlier SAH was found in 1%. The site of the aneurysms were the internal carotid artery (ICA) in 10%, the middle cerebral artery (MCA) in 14%, and arteries of the anterior and posterior circulation (PC) including the posterior communicating artery (PCOM) in 76%. Sixty-six percent of the aneurysms were smaller than 7 mm, 18% ranged between 7 and 9.9 mm, 14% were between 10 and 19.9 mm, and 2% were larger than 20 mm. European population, aneurysm size < 7 mm, and age < 75 years scored with 0 point in the PHASES study occurred most frequently in our series. The distribution of the aneurysm site to the anterior and posterior circulation scored with 4 points occurred most frequently. Considering the 5-year risk of rupture, 70% of our patient collective would have an estimated risk of < 2%. Interestingly, 70% of the patients with aneurysmal SAH had a low risk profile and would have a low risk of rupture according to the PHASES score in our series. This observation underlines the discrepancy of the estimated low risk of rupture for UIAs in young and healthy patients and the obvious fact the majority of the SAH patients are actually young with low risk factors. Parameters beyond the features of the PHASES score are needed to determine the risk of rupture of intracranial aneurysms.
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Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review. World Neurosurg 2018; 113:280-292. [PMID: 29360591 DOI: 10.1016/j.wneu.2018.01.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are pathologic dilatations of cerebral arteries. This systematic review summarizes and compares imaging techniques for assessing unruptured IAs (UIAs). This review also addresses their uses in different scopes of practice. Pathophysiologic mechanisms are reviewed to better understand the clinical usefulness of each imaging modality. METHODS A literature review was performed using PubMed with these search terms: "intracranial aneurysm," "cerebral aneurysm," "magnetic resonance angiography (MRA)," computed tomography angiography (CTA)," "catheter angiography," "digital subtraction angiography," "molecular imaging," "ferumoxytol," and "myeloperoxidase". Only studies in English were cited. RESULTS Since the development and improvement of noninvasive diagnostic imaging (computed tomography angiography and magnetic resonance angiography), many prospective studies and meta-analyses have compared these tests with gold standard digital subtraction angiography (DSA). Although computed tomography angiography and magnetic resonance angiography have lower detection rates for UIAs, they are vital in the treatment and follow-up of UIAs. The reduction in ionizing radiation and lack of endovascular instrumentation with these modalities provide benefits compared with DSA. Novel molecular imaging techniques to detect inflammation within the aneurysmal wall with the goal of stratifying risk based on level of inflammation are under investigation. CONCLUSIONS DSA remains the gold standard for preoperative planning and follow-up for patients with IA. Newer imaging modalities such as ferumoxytol-enhanced magnetic resonance imaging are emerging techniques that provide critical in vivo information about the inflammatory milieu within aneurysm walls. With further study, these techniques may provide aneurysm rupture risk and prediction models for individualized patient care.
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30
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High-resolution magnetic resonance imaging of intracranial aneurysms treated by flow diversion. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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31
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Wang GX, Wen L, Lei S, Ran Q, Yin JB, Gong ZL, Zhang D. Wall enhancement ratio and partial wall enhancement on MRI associated with the rupture of intracranial aneurysms. J Neurointerv Surg 2017; 10:566-570. [PMID: 28918385 PMCID: PMC5969388 DOI: 10.1136/neurintsurg-2017-013308] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Abstract
Objectives To evaluate the risk factors for rupture of intracranial aneurysms (IAs) using high resolution MRI (HRMRI). Methods 91 consecutive patients with 106 IAs were reviewed from February 2016 to April 2017. Patients and IAs were divided into ruptured and unruptured groups. In addition to the clinical characteristics of the patients, the features of IAs (eg, shape) were evaluated by CT angiography, whereas wall thickness, enhanced patterns, and enhancement ratio (ER) were evaluated by MRI. Multiple logistic regression analysis was used to identify independent risk factors associated with the rupture of IAs. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained. Results ER (OR 6.638) and partial wall enhancement (PWE) (OR 6.710) were not markers of aneurysms more prone to rupture, but simply were more commonly found in the ruptured aneurysm cohort. The threshold value for ER was 61.5%. Conclusions ER (≥61.5%) and IAs with PWE are better predictors of rupture. Increased attentions should be paid to these factors during assessment of IA rupture.
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Affiliation(s)
- Guang-Xian Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Wen
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Sheng Lei
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qian Ran
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jin-Bo Yin
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zi-Li Gong
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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32
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Maslehaty H, Capone C, Frantsev R, Fischer I, Jabbarli R, Cornelius JF, Kamp MA, Cappabianca P, Sure U, Steiger HJ, Petridis AK. Predictive anatomical factors for rupture in middle cerebral artery mirror bifurcation aneurysms. J Neurosurg 2017; 128:1799-1807. [PMID: 28841119 DOI: 10.3171/2017.2.jns162705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to define predictive factors for rupture of middle cerebral artery (MCA) mirror bifurcation aneurysms. METHODS The authors retrospectively analyzed the data in patients with ruptured MCA bifurcation aneurysms with simultaneous presence of an unruptured MCA bifurcation mirror aneurysm treated in two neurosurgical centers. The following parameters were measured and analyzed with the statistical software R: neck, dome, and width of both MCA aneurysms-including neck/dome and width/neck ratios, shape of the aneurysms (regular vs irregular), inflow angle of both MCA aneurysms, and the diameters of the bilateral A1 and M1 segments and the frontal and temporal M2 trunks, as well as the bilateral diameter of the internal carotid artery (ICA). RESULTS The authors analyzed the data of 44 patients (15 male and 29 female, mean age 50.1 years). Starting from the usual significance level of 0.05, the Sidak-corrected significance level is 0.0039. The diameter of the measured vessels was statistically not significant, nor was the inflow angle. The size of the dome was highly significant (p = 0.0000069). The size of the neck (p = 0.0047940) and the width of the aneurysms (p = 0.0056902) were slightly nonsignificant at the stated significance level of 0.0039. The shape of the aneurysms was bilaterally identical in 22 cases (50%). In cases of asymmetrical presentation of the aneurysm shape, 19 (86.4%) ruptured aneurysms were irregular and 3 (13.6%) had a regular shape (p = 0.001). CONCLUSIONS In this study the authors show that the extraaneurysmal flow dynamics in mirror aneurysms are nonsignificant, and the aneurysmal geometry also does not seem to play a role as a predictor for rupture. The only predictors for rupture were size and shape of the aneurysms. It seems as though under the same conditions, one of the two aneurysms suffers changes in its wall and starts growing in a more or less stochastic manner. Newer imaging methods should enable practitioners to see which aneurysm has an unstable wall, to predict the rupture risk. At the moment one can only conclude that in cases of MCA mirror aneurysms the larger one, with or without shape irregularities, is the unstable aneurysm and that this is the one that needs to be treated.
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Affiliation(s)
| | - Crescenzo Capone
- 2Department of Neurosurgery, University Hospital Düsseldorf.,3Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | | | - Igor Fischer
- 4Department of Neurosurgery, Statistical Analysis Office, Bio-Statistics, University Hospital Düsseldorf, Germany; and
| | | | | | - Marcel A Kamp
- 2Department of Neurosurgery, University Hospital Düsseldorf
| | - Paolo Cappabianca
- 3Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Ulrich Sure
- 1Department of Neurosurgery, University Hospital Essen
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Fu Q, Guan S, Liu C, Wang K, Cheng J. Clinical Significance of Circumferential Aneurysmal Wall Enhancement in Symptomatic Patients with Unruptured Intracranial Aneurysms: a High-resolution MRI Study. Clin Neuroradiol 2017; 28:509-514. [PMID: 28656370 DOI: 10.1007/s00062-017-0598-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The estimates on the risk of rupture of intracranial aneurysms remain a controversial topic. Circumferential aneurysmal wall enhancement (CAWE) on vessel wall magnetic resonance imaging (MRI) has been described in unstable aneurysms. Sentinel headaches and third nerve palsy are possible symptoms prior to the rupture of intracranial aneurysms. In this study, we aimed to demonstrate that CAWE could be associated with these symptoms. METHODS We performed a retrospective analysis of consecutive symptomatic or asymptomatic patients with unruptured intracranial aneurysms who were examined by high-resolution MRI from October 2014 to November 2016. Two experienced neurovascular radiologists read the images independently and determined whether there was CAWE of the unruptured intracranial aneurysms. Then, we compared variable factors between patients with and without symptoms through univariate comparison and multivariable logistic regression analyses. RESULTS A total of 45 unruptured intracranial aneurysms were detected in 37 patients. The agreement between 2 experienced readers for CAWE was good (kappa = 0.82; 95% confidence interval 0.66-0.99). CAWE of unruptured intracranial aneurysm was more frequently observed in symptomatic than in asymptomatic patients (16/23, 69.6% versus 6/22, 27.3%, respectively, P < 0.05). The CAWE was the only independent factor associated with symptoms in the multivariable logistic regression analysis (odds ratio 5.17; 95% confidence interval 1.30-20.52; P = 0.02). CONCLUSIONS Our study demonstrates that CAWE correlated with sentinel headaches and third nerve palsy caused by unruptured aneurysms, and this may be an additional clue to distinguish the cause of these symptoms.
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Affiliation(s)
- Qichang Fu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, 450052, Zhengzhou, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Liu
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Keyan Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, 450052, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, 450052, Zhengzhou, China.
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Cantrell CG, Vakil P, Jeong Y, Ansari SA, Carroll TJ. Diffusion-compensated tofts model suggests contrast leakage through aneurysm wall. Magn Reson Med 2017; 78:2388-2398. [PMID: 28112862 DOI: 10.1002/mrm.26607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to investigate the diffusional transport of contrast agent and its effects on kinetic modeling of dynamic contrast enhanced (DCE) images. METHODS We performed simulations of our diffusion-compensated model and compared these results to human intracranial aneurysms (IAs). We derive an easy-to-use parameterization of diffusional effects that can provide an accurate estimate of diffusion corrected contrast agent leakage rates (ktrans ). Finally, we performed re-ansalysis of an existing data set to determine whether diffusion-corrected kinetic parameters improve the identification of high-risk IAs, thereby providing a new MRI-based imaging metric of IA stability based on wall integrity. RESULTS Probability distributions of simulated versus measured data show contrast leakage away from the aneurysm wall. Parameterization of diffusional effects on ktrans showed high correlation with long-chain methods in both surrounding tissue and near the aneurysm wall (r2 = 0.91 and r2 = 0.90, respectively). Finally, size, ktrans , and ( ktrans-kDCtrans) showed significant univariate relationships with rupture risk (P < 0.05). CONCLUSIONS We report the first evidence of diffusion-compensated permeability modeling in intracranial aneurysms and propose a parameterization of diffusional effects on ktrans . Furthermore, a comparison of measured versus simulated data suggests that contrast leakage occurs across the aneurysm wall. Magn Reson Med 78:2388-2398, 2017. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Charles G Cantrell
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois, USA.,University of Chicago, Department of Radiology, Chicago, Illinois, USA
| | - Parmede Vakil
- University of Illinois, College of Medicine, Chicago, Illinois, USA.,Northwestern University, Department of Radiology, Evanston, Illinois, USA
| | - Yong Jeong
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois, USA
| | - Sameer A Ansari
- Northwestern University, Department of Radiology, Evanston, Illinois, USA.,Northwestern University, Departments of Neurology and Neurological Surgery, Evanston, Illinois, USA
| | - Timothy J Carroll
- University of Chicago, Department of Radiology, Chicago, Illinois, USA
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35
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Vakil P, Elmokadem AH, Syed FH, Cantrell CG, Dehkordi FH, Carroll TJ, Ansari SA. Quantifying Intracranial Plaque Permeability with Dynamic Contrast-Enhanced MRI: A Pilot Study. AJNR Am J Neuroradiol 2016; 38:243-249. [PMID: 27856437 DOI: 10.3174/ajnr.a4998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic disease plaque hyperintensity and/or gadolinium contrast enhancement have been studied as imaging biomarkers of acutely symptomatic ischemic presentations using single static MR imaging measurements. However, the value in modeling the dynamics of intracranial plaque permeability has yet to be evaluated. The purpose of this study was to use dynamic contrast-enhanced MR imaging to quantify the contrast permeability of intracranial atherosclerotic disease plaques in symptomatic patients and to compare these parameters against existing markers of plaque volatility using black-blood MR imaging pulse sequences. MATERIALS AND METHODS We performed a prospective study of contrast uptake dynamics in the major intracranial vessels proximal and immediately distal to the circle of Willis using dynamic contrast-enhanced MR imaging, specifically in patients with symptomatic intracranial atherosclerotic disease. Using the Modified Tofts model, we extracted the volume transfer constant (Ktrans) and fractional plasma volume (Vp) parameters from plaque-enhancement curves. Using regression analyses, we compared these parameters against time from symptom onset as well as intraplaque hyperintensity and postcontrast enhancement derived from T1 SPACE, a black-blood MR vessel wall imaging sequence. RESULTS We completed analysis in 10 patients presenting with symptomatic intracranial atherosclerotic disease. Ktrans and Vp measurements were higher in plaques versus healthy white matter and similar or less than values in the choroid plexus. Only Ktrans correlated significantly with time from symptom onset (P = .02). Dynamic contrast-enhanced MR imaging parameters were not found to correlate significantly with intraplaque enhancement or intraplaque hyperintensity (P = .4 and P = .17, respectively). CONCLUSIONS Elevated Ktrans and Vp values found in intracranial atherosclerotic disease plaques versus healthy white matter suggest that dynamic contrast-enhanced MR imaging is a feasible technique for studying vessel wall and plaque characteristics in the proximal intracranial vasculature. Significant correlations between Ktrans and symptom onset, which were not observed on T1 SPACE-derived metrics, suggest that Ktrans may be an independent imaging biomarker of acute and symptom-associated pathologic changes in intracranial atherosclerotic disease plaques.
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Affiliation(s)
- P Vakil
- From the College of Medicine (P.V.), University of Illinois, Chicago, Illinois.,Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - A H Elmokadem
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.)
| | - F H Syed
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.)
| | - C G Cantrell
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - F H Dehkordi
- Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois
| | - T J Carroll
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - S A Ansari
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.) .,Neurology and Neurological Surgery (S.A.A.), Northwestern University, Chicago, Illinois
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Schnell S, Wu C, Ansari SA. Four-dimensional MRI flow examinations in cerebral and extracerebral vessels - ready for clinical routine? Curr Opin Neurol 2016; 29:419-28. [PMID: 27262148 PMCID: PMC4939804 DOI: 10.1097/wco.0000000000000341] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To evaluate the feasibility of 4-dimensional (4D) flow MRI for the clinical assessment of cerebral and extracerebral vascular hemodynamics in patients with neurovascular disease. RECENT FINDINGS 4D flow MRI has been applied in multiple studies to qualitatively and quantitatively study intracranial aneurysm blood flow for potential risk stratification and to assess treatment efficacy of various neurovascular lesions, including intraaneurysmal and parent artery blood flow after flow diverter stent placement and staged embolizations of arteriovenous malformations and vein of Galen aneurysmal malformations. Recently, the technique has been utilized to characterize age-related changes of normal cerebral hemodynamics in healthy individuals over a broad age range. SUMMARY 4D flow MRI is a useful tool for the noninvasive, volumetric and quantitative hemodynamic assessment of neurovascular disease without the need for gadolinium contrast agents. Further improvements are warranted to overcome technical limitations before broader clinical implementation. Current developments, such as advanced acceleration techniques (parallel imaging and compressed sensing) for faster data acquisition, dual or multiple velocity encoding strategies for more accurate arterial and venous flow quantification, ultrahigh-field strengths to achieve higher spatial resolution and streamlined postprocessing workflow for more efficient and standardized flow analysis, are promising advancements in 4D flow MRI.
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Affiliation(s)
- Susanne Schnell
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Can Wu
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Sameer A. Ansari
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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de Havenon A, Chung L, Park M, Mossa-Basha M. Intracranial vessel wall MRI: a review of current indications and future applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0021-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Matouk CC, Cord BJ, Yeung J, Malhotra A, Johnson MH, Minja FJ. High-resolution Vessel Wall Magnetic Resonance Imaging in Intracranial Aneurysms and Brain Arteriovenous Malformations. Top Magn Reson Imaging 2016; 25:49-55. [PMID: 27049241 DOI: 10.1097/rmr.0000000000000084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Over the last several years, the advent of intracranial high-resolution vessel wall magnetic resonance imaging (VW-MRI) has provided a new lens with which to view cerebrovascular disease that has not previously been available with conventional imaging. It has already fundamentally changed the way that steno-occlusive diseases are evaluated at many academic centers. This review focuses on current and emerging applications of intracranial high-resolution VW-MRI in the clinical evaluation of intracranial aneurysms and brain arteriovenous malformations. Examples are provided from our clinical practice.
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Affiliation(s)
- Charles C Matouk
- *Department of Neurosurgery †Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
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Yoon NK, McNally S, Taussky P, Park MS. Imaging of cerebral aneurysms: a clinical perspective. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0016-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Yu J, Xu B, Liu Y, Xu B, Xu K. Progress in treating ruptured infundibular dilatation at the origin of the intracranial posterior communicating artery. Int J Clin Exp Med 2015; 8:17080-17087. [PMID: 26770300 PMCID: PMC4694200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
Infundibular dilatation (ID) can occur at the origin of the intracranial posterior communicating artery. When this type of widening is less than 3 mm in diameter and the ID reaches the posterior communicating artery, it can be called posterior communicating artery infundibular dilatation (Pcom-ID). Currently, Pcom-ID is considered a normal anatomic variation, and the majority of Pcom-IDs are stable. However, in some cases, rupture occurs in a Pcom-ID; furthermore, Pcom-IDs can evolve into aneurysms. There are not many studies on Pcom-ID rupture hemorrhage; therefore, we performed a retrospective evaluation of published studies on Pcom-ID rupture hemorrhage and conducted a classification analysis for this condition. It is reasonable to classify Pcom-ID into three types: Type 1, direct rupture of the Pcom-ID; Type 2, bleb rupture of Pcom-ID; and Type 3, Pcom-ID rupture caused by an aneurysm. This type of classification can provide meaningful guidance for treating ruptured Pcom-ID. In addition, the present study also included a systematic review and summarization of the literature on each type. This investigation was aimed to improve the understanding of Pcom-ID rupture hemorrhage.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin UniversityChangchun 130021, China
| | - Baofeng Xu
- Department of Neurosurgery, First Hospital of Jilin UniversityChangchun 130021, China
| | - Yang Liu
- Department of Radiology, First Hospital of Jilin UniversityChangchun 130021, China
| | - Bing Xu
- Department of Radiology, First Hospital of Jilin UniversityChangchun 130021, China
| | - Kan Xu
- Department of Neurosurgery, First Hospital of Jilin UniversityChangchun 130021, China
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