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The role of vessel wall imaging in determining the best treatment approach for coexisting aneurysms and subarachnoid hemorrhage

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Abstract

Purpose

The purpose of this study was to investigate the utilization of gadolinium enhancement on vessel wall imaging (VWI) in treatment decision-making for patients with two intracranial aneurysms presenting as a subarachnoid hemorrhage (SAH).

Materials and methods

We prospectively performed VWI using 3.0-Tesla (3T) magnetic resonance imaging (MRI) before treatment with endovascular coiling or surgical clipping in patients with one or two intracranial aneurysms. The VWI protocol includes three different scans: black blood (BB) T1-weighted, BB T2-weighted, TOF axial, and BB contrast-enhanced T1-weighted imaging. We analyzed all aneurysm ruptures both with and without gadolinium enhancement of the aneurysm wall.

Results

Thirty-eight patients with 48 aneurysms were enrolled in this study. Of these patients, 28 had a single aneurysm (15 ruptured and 13 unruptured), and 10 had two aneurysms and SAH (9 patients with two aneurysms and 1 patient with three aneurysms). Of the 15 single ruptured aneurysms, 12 (80.0%) showed positive wall enhancement, whereas 2 of the 13 single unruptured aneurysms (15.4%) demonstrated positive wall enhancement. Ten patients with SAH and two aneurysms showed wall enhancement of a single aneurysm, and these aneurysms were treated first.

Conclusion

Gadolinium enhancement of an aneurysm wall on MRI was associated with aneurysm rupture. In patients with two aneurysms and SAH, this type of imaging can play an important role in determining the order of aneurysm treatment.

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Authors and Affiliations

  1. Jeonbuk National University Medical School, Jeonju, Korea

    Nam Hyeok Kim

  2. Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea

    Gyung Ho Chung, Hyo Sung Kwak & Seung Bae Hwang

  3. Department of Neurosurgery and Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea

    Jong-Myoung Lee & Jung Soo Park

Authors
  1. Nam Hyeok Kim
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  2. Gyung Ho Chung
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  3. Hyo Sung Kwak
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  5. Jong-Myoung Lee
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Corresponding author

Correspondence to Hyo Sung Kwak.

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The authors declare that they have no conflict of interest.

Ethical standards

The retrospective study was performed according to the protocol (JUH 2021-10-01) approved by institutional ethics committee of Jeonbuk National University Hospital and informed consent was waived due to the retrospective nature of this study.

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Kim, N.H., Chung, G.H., Kwak, H.S. et al. The role of vessel wall imaging in determining the best treatment approach for coexisting aneurysms and subarachnoid hemorrhage. Acta Neurol Belg 123, 933–938 (2023). https://doi.org/10.1007/s13760-022-02096-8

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