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High-Resolution MRI Vessel Wall Imaging in Acute Aneurysmal Subarachnoid Hemorrhage

Spatiotemporal Pattern and Clinicoradiologic Implications

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Abstract

Purpose

The spatiotemporal pattern of vessel wall changes was investigated on two time point magnetic resonance images (MRI) in patients with aneurysmal subarachnoid hemorrhages (aSAH) and its association with clinicoradiologic severity score and delayed cerebral ischemia (DCI) was analyzed.

Methods

A total of 32 prospectively enrolled patients with aSAH (mean age 56.94 years; 9 male and 23 female) underwent vessel wall imaging (VWI) MRI. Of the patients 20 completed two time point MRIs early and late during the admission, 10 patients only had early MRI and 2 patients only had late MRI. Timing of early MRI had a mean of 2.5 days (range 1–6 days) and late MRI had a mean of 10.5 days (range 7–16 days) from time of admission. Spatiotemporal pattern of vessel wall enhancement (VWE), vasospasm, diffusion-weighted imaging (DWI) lesion burden (grade 0–III) and infarcts were analyzed against the clinicoradiologic severity score (high-risk: vasograde red and yellow, low-risk: vasograde green) and DCI.

Results

On the early MRI, mild VWE alone was significantly more frequent in the high-risk group (36.7% versus 20.0%; P = 0.024). On the late MRI, vasospasm was significantly more frequent in the high-risk group (27.2% versus 4.5%; P = 0.022). Vasospasm infrequently showed mild VWE (6.67% on early MRI and 9.09% on late MRI). Both mild VWE alone on early MRI and on late MRI were significantly associated with development of DCI during the admission (P = 0.034 and P = 0.035, respectively).

Conclusion

Mild VWE on early MRI and vasospasm on late MRI were significantly more prevalent in high-risk and DCI patients suggesting VWI might enable imaging of early neuroinflammatory changes which are part of the pathomechanism of vasospasm and DCI.

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Funding

SMH AFP Innovation Fund SMH-16-022 and RSNA Research Fellow Grant #RF1614.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Charlie Chia-Tsong Hsu, Suradech Suthiphosuwan, Thien Huynh, Amanda Murphy, Yangmei Li & Aditya Bharatha

  2. Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Southport, Queensland, Australia

    Charlie Chia-Tsong Hsu

  3. Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada

    Thien Huynh

  4. Departments of Medical Imaging and Surgery, University of Toronto, Toronto, Canada

    Aditya Bharatha

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  1. Charlie Chia-Tsong Hsu
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Contributions

Conception and design: A.B., C.C.-T.H., S.S., A.M. Acquisition, analysis, or interpretation of data: C.C.-T.H., S.S., T.H. Drafting of the manuscripts or figures: C.C.-T.H., S.S. Critical revision of the manuscript for important intellectual content: C.C.-T.H., S.S., A.M., T.H., A.B. Statistical analysis: C.C.-T.H., Y.L. Obtained funding: A.B., A.M. Administrative, technical, or material support: C.C.-T.H., Y.L., A.B. Study supervision: A.B.

Corresponding author

Correspondence to Aditya Bharatha.

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Conflict of interest

C.C.-T. Hsu, S. Suthiphosuwan, T. Huynh, A. Murphy, Y. Li and A. Bharatha declare that they have no competing interests.

Ethical standards

This study was approved by the institutional review board of St Michael’s Hospital. REB number: 15-209. All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Hsu, CT., Suthiphosuwan, S., Huynh, T. et al. High-Resolution MRI Vessel Wall Imaging in Acute Aneurysmal Subarachnoid Hemorrhage. Clin Neuroradiol 30, 801–810 (2020). https://doi.org/10.1007/s00062-019-00843-8

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  • DOI: https://doi.org/10.1007/s00062-019-00843-8

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