Abstract
Objectives
Wall remodeling and inflammation accompany symptomatic unruptured intracranial aneurysms (UIAs). The volume transfer constant (Ktrans) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) reflects UIA wall permeability. Aneurysmal wall enhancement (AWE) on vessel wall MRI (VWI) is associated with inflammation. We hypothesized that Ktrans is related to symptomatic UIAs and AWE.
Methods
Consecutive patients with UIAs were prospectively recruited for 3-T DCE-MRI and VWI from January 2018 to March 2023. UIAs were classified as asymptomatic and symptomatic if associated with sentinel headache or oculomotor nerve palsy. Ktrans and AWE were assessed on DCE-MRI and VWI, respectively. AWE was evaluated using the AWE pattern and wall enhancement index (WEI). Spearman’s correlation coefficient and univariate and multivariate analyses were used to assess correlations between parameters.
Results
We enrolled 82 patients with 100 UIAs (28 symptomatic and 72 asymptomatic). The median Ktrans (2.1 versus 0.4 min−1; p < 0.001) and WEI (1.5 versus 0.4; p < 0.001) were higher for symptomatic aneurysms than for asymptomatic aneurysms. Ktrans (odds ratio [OR]: 1.60, 95% confidence interval [95% CI]: 1.01–2.52; p = 0.04) and WEI (OR: 3.31, 95% CI: 1.05–10.42; p = 0.04) were independent risk factors for symptomatic aneurysms. Ktrans was positively correlated with WEI (Spearman’s coefficient of rank correlation (rs) = 0.41, p < 0.001). The combination of Ktrans and WEI achieved an area under the curve of 0.81 for differentiating symptomatic from asymptomatic aneurysms.
Conclusions
Ktrans may be correlated with symptomatic aneurysms and AWE. Ktrans and WEI may provide an additional value than the PHASES score for risk stratification of UIAs.
Clinical relevance statement
The volume transfer constant (Ktrans) from DCE-MRI perfusion is associated with symptomatic aneurysms and provides additional value above the clinical PHASES score for risk stratification of intracranial aneurysms.
Key Points
• The volume transfer constant is correlated with intracranial aneurysm symptoms and aneurysmal wall enhancement.
• Dynamic contrast-enhanced and vessel wall MRI facilitates understanding of the pathophysiological characteristics of intracranial aneurysm walls.
• The volume transfer constant and wall enhancement index perform better than the traditional PHASES score in differentiating symptomatic aneurysms.
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Abbreviations
- AUC:
-
Area under the curve
- AWE:
-
Aneurysmal wall enhancement
- AWEP:
-
Aneurysmal wall enhancement pattern
- CI:
-
Confidence interval
- DCE-MRI:
-
Dynamic contrast-enhanced magnetic resonance imaging
- FOV:
-
The field of view
- IAs:
-
Intracranial aneurysms
- K trans :
-
The volume transfer constant
- OR:
-
Odds ratio
- ROI:
-
Region of interest
- Rs:
-
Spearman’s coefficient of rank correlation
- SAH:
-
Subarachnoid hemorrhage
- SD:
-
Standard deviation
- SI:
-
Signal intensity
- SPACE:
-
Fast-spin-echo with variable flip angle trains
- TOF MRA:
-
Time-of-flight magnetic resonance angiography
- UIAs:
-
Unruptured intracranial aneurysms
- VFA:
-
Variable flip angle
- VIBE:
-
Volumetric interpolated breathhold
- VIF:
-
Variance inflation factor
- VOI:
-
Volume of interest
- VWI:
-
Vessel wall magnetic resonance imaging
- WEI:
-
Wall enhancement index
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Acknowledgements
We thank Dr. Jinxia Zhu and Feifei Qu of Siemens Healthineers Ltd for supporting MRI sequence debugging, data post-processing, and article polishing.
We sincerely thank all the patients and healthcare workers who participated in this study.
Funding
This study has received funding from the National Natural Science Foundation of China (Grant 82202105) and the Joint construction project in Henan Province (Grant LHGJ20220406). Chengcheng Zhu was supported by grants R01HL162743 and R00HL136883 from the United States National Institute of Health (NIH).
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The scientific guarantor of this publication is Jingliang Cheng.
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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
Chunhua Song (a medical statistician from Zhengzhou University) kindly provided statistical advice for this manuscript.
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Written informed consent was obtained from all subjects (patients) in this study.
Ethical approval
The approval of the ethics committee of the First Affiliated Hospital of Zhengzhou University was obtained (Ethics No. ss-2018–11).
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in “Qualitative and Quantitative Wall Enhancement on Magnetic Resonance Imaging Is Associated With Symptoms of Unruptured Intracranial Aneurysms. Stroke (1970) 52:213–222” and “Evaluation of the Instability of Intracranial Aneurysms Wall by Dynamic Contrast-enhanced Magnetic Resonance Imaging and Vessel Wall Imaging” by the International Society for Medical Magnetic Resonance Annual Meeting (ISMRM 2022).
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• prospective
• case-control study
• performed at one institution
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Fu, Q., Zhang, Y., Zhang, Y. et al. Wall permeability on magnetic resonance imaging is associated with intracranial aneurysm symptoms and wall enhancement. Eur Radiol (2024). https://doi.org/10.1007/s00330-023-10548-9
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DOI: https://doi.org/10.1007/s00330-023-10548-9