3D aneurysm wall enhancement is associated with symptomatic presentation

被引:13
|
作者
Raghuram, Ashrita [1 ]
Sanchez, Sebastian [1 ]
Wendt, Linder [2 ]
Cochran, Steven [3 ]
Ishii, Daizo [4 ]
Osorno, Carlos [4 ]
Bathla, Girish [5 ]
Koscik, Timothy R. [3 ]
Torner, James [2 ,4 ]
Hasan, David [6 ]
Samaniego, Edgar A. [1 ,4 ,5 ]
机构
[1] Univ Iowa Hosp & Clin, Dept Neurol, Iowa City, IA 52242 USA
[2] Univ Iowa, Inst Clin & Translat Sci, Iowa City, IA USA
[3] Univ Iowa Hosp & Clin, Dept Psychiat, Iowa City, IA 52242 USA
[4] Univ Iowa Hosp & Clin, Dept Neurosurg, Iowa City, IA 52242 USA
[5] Univ Iowa Hosp & Clin, Dept Radiol, Iowa City, IA 52242 USA
[6] Duke Univ, Dept Neurosurg, Durham, NC USA
基金
美国国家卫生研究院;
关键词
Aneurysm; Vessel Wall; Technology; MRI; Stroke; INTRACRANIAL ANEURYSMS; RUPTURE; RISK; PREDICTION; SCORE;
D O I
10.1136/jnis-2022-019125
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
Background Aneurysm wall enhancement (AWE) is a potential surrogate biomarker for aneurysm instability. Previous studies have assessed AWE using 2D multiplanar methods, most of which were conducted qualitatively. Objective To use a new quantitative tool to analyze a large cohort of saccular aneurysms with 3D-AWE maps Methods Saccular aneurysms were imaged prospectively with 3T high resolution MRI. 3D-AWE maps of symptomatic (defined as ruptured or presentation with sentinel headache/cranial nerve neuropathy) and asymptomatic aneurysms were created by extending orthogonal probes from the aneurysm lumen into the wall. Three metrics were used to characterize enhancement: 3D circumferential AWE (3D-CAWE), aneurysm-specific contrast uptake (SAWE), and focal AWE (FAWE). Aneurysms with a circumferential AWE higher than the corpus callosum (3D-CAWE >= 1) were classified as 3D-CAWE+. Symptomatic presentation was analyzed with univariate and multivariate logistic models. Aneurysm size, size ratio, aspect ratio, irregular morphology, and PHASES and ELAPSS scores were compared with the new AWE metrics. Bleb and microhemorrhage analyses were also performed. Results Ninety-three aneurysms were analyzed. 3D-CAWE, SAWE, and FAWE were associated with symptomatic status (OR=1.34, 1.25, and 1.08, respectively). A multivariate model including aneurysm size, 3D-CAWE+, age, female gender, and FAWE detected symptomatic status with 80% specificity and 90% sensitivity (area under the curve=0.914, =0.967). FAWE was also associated with irregular morphology and high-risk location (p=0.043 and p=0.001, respectively). In general, blebs enhanced 56% more than the aneurysm body. Areas of microhemorrhage co-localized with areas of increased SAWE (p=0.047). Conclusions 3D-AWE mapping provides a new set of metrics that could potentially improve the identification of symptomatic aneurysms.
引用
收藏
页码:747 / 752
页数:7
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