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Increased Wall Enhancement Extent Representing Higher Rupture Risk of Unruptured Intracranial Aneurysms

Journal of Korean Neurosurgical Society 2021년 64권 2호 p.189 ~ 197
Jiang Yeqing, Xu Feng, Huang Lei, Lu Gang, Ge Liang, Wan Hailin, Geng Daoying, Zhang Xiaolong,
소속 상세정보
 ( Jiang Yeqing ) - Fudan University Huashan Hospital Department of Radiology
 ( Xu Feng ) - Fudan University Huashan Hospital Department of Neurosurgery
 ( Huang Lei ) - Fudan University Huashan Hospital Department of Radiology
 ( Lu Gang ) - Fudan University Huashan Hospital Department of Radiology
 ( Ge Liang ) - Fudan University Huashan Hospital Department of Radiology
 ( Wan Hailin ) - Fudan University Huashan Hospital Department of Radiology
 ( Geng Daoying ) - Fudan University Huashan Hospital Department of Radiology
 ( Zhang Xiaolong ) - Fudan University Huashan Hospital Department of Radiology

Abstract


Objective : This study aims to investigate the relationship between aneurysm wall enhancement and clinical rupture risks based on the magnetic resonance vessel wall imaging (MR-VWI) quantitative methods.

Methods : One hundred and eight patients with 127 unruptured aneurysms were prospectively enrolled from Feburary 2016 to October 2017. Aneurysms were divided into high risk (≥10) and intermediate-low risk group (<10) according to the PHASES (Population, Hypertension, Age, Size of aneurysm, Earlier SAH history from another aneurysm, Site of aneurysm) scores. Clinical risk factors, aneurysm morphology, and wall enhancement index (WEI) calculated using 3D MR-VWI were analyzed and compared.

Results : In comparison of high-risk and intermediated-low risk groups, univariate analysis showed that neck width (4.5±3.3 mm vs. 3.4±1.7 mm, p=0.002), the presence of wall enhancement (100.0% vs. 62.9%, p<0.001), and WEI (1.6±0.6 vs. 0.8±0.8, p<0.001) were significantly associated with high rupture risk. Multivariate regression analysis revealed that WEI was the most important factor in predicting high rupture risk (odds ratio, 2.6; 95% confidence interval, 1.4?4.9; p=0.002). The receiver operating characteristic (ROC) curve analysis can efficiently differentiate higher risk aneurysms (area under the curve, 0.780; p<0.001) which have a reliable WEI cutoff value (1.04; sensitivity, 0.833; specificity, 0.67) predictive of high rupture risk.

Conclusion : Aneurysms with higher rupture risk based on PHASES score demonstrate increased neck width, wall enhancement, and the enhancement intensity. Higher WEI in unruptured aneurysms has a predictive value for increased rupture risk.

키워드

Intracranial aneurysm, Unruptured; Vessel wall MRI; Natural history; Rupture risk

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