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Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm

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Abstract

Objective

This study aims to investigate whether aneurysm wall enhancement (AWE) is independently associated with symptomatic status of unruptured intracranial aneurysms (UIAs).

Methods

One hundred thirty-nine consecutive patients (67 male, mean age 58 ± 11 years) with 79 symptomatic and 87 asymptomatic UIAs were imaged using black-blood MRI pre- and post-gadolinium contrast administration and 3D DSA. Symptoms related to aneurysms were identified including cranial nerve deficits and headache. AWE grade and area were characterized, and aneurysm size was measured on DSA. Multivariate binary logistic regression analysis was used to identify factors associated with symptoms. Further subgroup analysis was performed for aneurysms size < 10 mm.

Results

Symptomatic UIAs had significantly larger aneurysm size (11.2 ± 6.2 mm vs. 6.4 ± 3.3 mm), enhancement grade (1.3 ± 0.6 vs. 0.4 ± 0.6), enhancement area (2.0 ± 0.9 vs. 0.4 ± 0.7), and higher prevalence of thick enhancement (39% vs. 3%) compared with asymptomatic UIAs, all p < 0.001. In multivariate analysis, only AWE area (odds ratio [OR] 6.9, 95% confidence interval [4.0, 11.7]) was independently associated with symptoms. AWE area had an area under curve (AUC) value of 0.888, with 72.2% sensitivity and 92.0% specificity for symptoms, which was superior to aneurysm size (AUC of 0.771, with 75.9% sensitivity and 65.5% specificity). In the subgroup analysis of aneurysms smaller than 10 mm (n = 118), AWE area (OR, 7.0, p < 0.001) remained the only independent risk factor associated with symptoms.

Conclusions

Larger AWE area is independently associated with symptomatic UIAs, which may provide additional value to guide UIA management and improve patient outcomes.

Key Points

• Symptomatic intracranial aneurysms are larger and more often demonstrate significant wall enhancement than asymptomatic aneurysms.

• Larger wall enhancement area is independently associated with symptomatic intracranial aneurysm.

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Abbreviations

AUC:

Area under curve

AWE:

Aneurysm wall enhancement

CV:

Coefficient of variance

DANTE:

Delay alternating with nutation for tailored excitation

ICA:

Internal carotid artery

ICC:

Intra-class correlation coefficient

MSDE:

Motion sensitized driven equilibrium

SD:

Standard deviation

SPACE:

Fast-spin-echo with variable flip angle trains

TOF:

Time of flight

UIA:

Unruptured intracranial aneurysm

VWI:

Vessel-wall imaging

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Funding

This study has received funding by the NIH grant K99HL136883 and Scientific Research Foundation for the Ph.D. of Liaoning Province of China (No. 2019-BS-267).

Author information

Author notes

  1. Chengcheng Zhu and Xinrui Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA

    Chengcheng Zhu, Christopher Hess & David Saloner

  2. Department of Radiology, Changhai Hospital, Shanghai, China

    Xinrui Wang, Zhang Shi, Bing Tian, Qi Liu & Jianping Lu

  3. Department of Radiology, General Hospital of Northern Theatre Command, Shenyang, China

    Xinrui Wang

  4. Department of Radiology, University of Wisconsin, Madison, WI, USA

    Laura Eisenmenger

  5. Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Andrew Degnan

Authors
  1. Chengcheng Zhu
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  2. Xinrui Wang
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  3. Laura Eisenmenger
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  4. Zhang Shi
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  5. Andrew Degnan
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  6. Bing Tian
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  7. Qi Liu
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  8. Christopher Hess
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  9. David Saloner
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  10. Jianping Lu
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Corresponding author

Correspondence to Jianping Lu.

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Guarantor

The scientific guarantor of this publication is Professor Jianping Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

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Zhu, C., Wang, X., Eisenmenger, L. et al. Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm. Eur Radiol 30, 6413–6420 (2020). https://doi.org/10.1007/s00330-020-07063-6

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  • DOI: https://doi.org/10.1007/s00330-020-07063-6

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