Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms

OBJECTIVE

To investigate the association between chronic headache outcome and aneurysmal wall enhancement (AWE) on high-resolution vessel wall imaging (HR-VWI) in patients with unruptured intracranial aneurysms (UIAs) who underwent microsurgical clipping.

METHODS

Two hundred seventy-four UIA patients were retrospectively analyzed. Patients were grouped according to presence of AWE. AWE was subclassified as focal or uniform. Clinical and imaging data were recorded. Headache was evaluated using the 10-point numerical rating scale and Headache Impact Test-6 before and 6 months after surgery.

RESULTS

The proportions of patients reporting chronic headache in the no AWE, focal wall enhancement (FWE), and uniform wall enhancement (UWE) groups were 5.7%, 24.8%, and 41.8%, respectively. All patients in the UWE group who reported headache before surgery experienced headache improvement after surgery. Decrease in headache severity was greater in the UWE group than in the FWE group. Multivariate binary logistic regression showed that FWE (odds ratio (OR) 0.490; 95% confidence interval (CI), 0.262-0.917; p = 0.026) and small intraluminal thrombus (OR 0.336; 95% CI, 0.142-0.795; p = 0.013) were independent factors protective against preoperative headache. FWE (OR 0.377; 95% CI, 0.195-0.728; p = 0.004) and small intraluminal thrombus (OR 0.235; 95% CI, 0.088-0.630; p = 0.004) were independent predictors of no headache relief after surgery.

CONCLUSIONS

AWE on HR-VWI is associated with relief of chronic headache after surgical clipping in patients with UIAs. Incidence of chronic headache was highest in patients exhibiting UWE. These patients also experienced the greatest improvement in headache after surgical clipping.

CLINICAL RELEVANCE STATEMENT

This study revealed that high-resolution vessel wall imaging can demonstrate aneurysmal wall plaque and intraluminal thrombus, which may be prognostic imaging markers for chronic headache in patients with unruptured intracranial aneurysms.

KEY POINTS

• Aneurysmal wall enhancement may be associated with chronic headache. • Incidence of chronic headache was highest in patients with aneurysms exhibiting uniform wall enhancement. • Patients with aneurysms exhibiting uniform wall enhancement experienced the greatest improvement in headache after clipping.

Multifocal arterial wall contrast - enhancement in ischemic stroke: A mirror of systemic inflammatory response in acute stroke

PURPOSE

Intracranial plaque gadolinium enhancement revealed by high-resolution MRI imaging (HR MRI) is considered as a marker of plaque inflammation, a contributing factor of plaque unstability. The aim of the present study was to assess the distribution of gadolinium enhancement in intracranial atherosclerosis.

METHODS

Single center analysis of ischemic stroke patients with intracranial atherosclerotic stenosis of M1 or M2 segments of middle cerebral artery, or terminal internal carotid artery (ICA) based on CT-angio or MR-angio. High-resolution MRI imaging (HRMRI) was performed within 6 first weeks following the index event, with 3DT2 BB (black-blood) and 3D T1 BB MR sequences pre and post-contrast administration.

RESULTS

We identified 8 patients with 14 plaques, 4 were deemed non-culprit and 10 culprit. All culprit plaques (10/10 plaques) and 3 out of 4 non-culprit plaques showed a gadolinium enhancement.

CONCLUSION

At the acute/subacute stage of stroke, a gadolinium enhancement may affect multiple asymptomatic intracranial plaques and may reflect a global inflammatory state.

Intimal flap detected by three-dimensional curved multiplanar reconstruction image in isolated posterior inferior cerebellar artery dissection: a report of two cases

BACKGROUND

Spontaneous isolated posterior inferior cerebellar artery (PICA) dissection has been reported more frequently since high-resolution vessel wall magnetic resonance imaging (HR vw-MRI) was introduced to the field. The intimal flap or double lumen, which is commonly reported to be a direct sign of the dissection, is not easily detectable on HR vw-MRI because the size of the PICA is very small and tortuous.

CASE PRESENTATION

Two patients with posterior circulation ischemic stroke due to spontaneous isolated PICA dissection underwent HR vw-MRI. The curved multiplanar reconstruction image reconstructed using three-dimensional (3D) HR vw-MRI (3D curved MPR imaging) is helpful to observe tortuous blood vessels such as the PICA because it can visualize the entire vessel course in a single plane. In this report, routine HR vw-MRI revealed only an intramural hematoma in both patients. However, 3D curved MPR imaging discovered the intimal flap which was not observed on the routine HR vw-MRI. Therefore, these two patients were diagnosed with spontaneous isolated PICA dissection due to the intimal flap that was observed on the 3D curved MPR image.

CONCLUSION

HR vw-MRI is useful for the early diagnosis of isolated PICA dissection. Furthermore, we believe that 3D curved MPR imaging could improve the possibility of diagnosing the dissection early because it can easily confirm direct signs such as an intimal flap or double lumen.