Luminal enhancement in intracranial aneurysms: fact or feature?-A quantitative multimodal flow analysis

Purpose Intracranial aneurysm (IA) wall enhancement on post-contrast vessel wall magnetic resonance imaging (VW-MRI) is assumed to be a biomarker for vessel wall inflammation and aneurysm instability. However, the exact factors contributing to enhancement are not yet clarified. This study investigates the relationship between luminal enhancement and intra-aneurysmal flow behaviour to assess the suitability of VW-MRI as a surrogate method for determining quantitative and qualitative flow behaviour in the aneurysm sac. Methods VW-MRI signal is measured in the lumen of three patient-specific IA flow models and compared with the intra-aneurysmal flow fields obtained using phase-contrast magnetic resonance imaging (PC-MRI) and computational fluid dynamics (CFD). The IA flow models were supplied with two different time-varying flow regimes. Results Overall, the velocity fields acquired using PC-MRI or CFD were in good agreement with the VW-MRI enhancement patterns. Generally, the regions with slow-flowing blood show higher VW-MRI signal intensities, whereas high flow leads to a suppression of the signal. For all aneurysm models, a signal value above three was associated with velocity values below three cm/s. Conclusion Regions with lower enhancements have been correlated with the slow and high flow at the same time. Thus, further factors like flow complexity and stability can contribute to flow suppression in addition to the flow magnitude. Nevertheless, VW-MRI can qualitatively assess intra-aneurysmal flow phenomena and estimate the velocity range present in the corresponding region.