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3D aneurysm wall enhancement is associated with symptomatic presentation.

Publication ,  Journal Article
Raghuram, A; Sanchez, S; Wendt, L; Cochran, S; Ishii, D; Osorno, C; Bathla, G; Koscik, TR; Torner, J; Hasan, D; Samaniego, EA
Published in: J Neurointerv Surg
August 2023

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.

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Published In

J Neurointerv Surg

DOI

EISSN

1759-8486

Publication Date

August 2023

Volume

15

Issue

8

Start / End Page

747 / 752

Location

England

Related Subject Headings

  • Risk Factors
  • Magnetic Resonance Imaging
  • Intracranial Aneurysm
  • Humans
  • Headache
  • Female
  • Aneurysm, Ruptured
  • 3209 Neurosciences
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Raghuram, A., Sanchez, S., Wendt, L., Cochran, S., Ishii, D., Osorno, C., … Samaniego, E. A. (2023). 3D aneurysm wall enhancement is associated with symptomatic presentation. J Neurointerv Surg, 15(8), 747–752. https://doi.org/10.1136/jnis-2022-019125
Raghuram, Ashrita, Sebastian Sanchez, Linder Wendt, Steven Cochran, Daizo Ishii, Carlos Osorno, Girish Bathla, et al. “3D aneurysm wall enhancement is associated with symptomatic presentation.J Neurointerv Surg 15, no. 8 (August 2023): 747–52. https://doi.org/10.1136/jnis-2022-019125.
Raghuram A, Sanchez S, Wendt L, Cochran S, Ishii D, Osorno C, et al. 3D aneurysm wall enhancement is associated with symptomatic presentation. J Neurointerv Surg. 2023 Aug;15(8):747–52.
Raghuram, Ashrita, et al. “3D aneurysm wall enhancement is associated with symptomatic presentation.J Neurointerv Surg, vol. 15, no. 8, Aug. 2023, pp. 747–52. Pubmed, doi:10.1136/jnis-2022-019125.
Raghuram A, Sanchez S, Wendt L, Cochran S, Ishii D, Osorno C, Bathla G, Koscik TR, Torner J, Hasan D, Samaniego EA. 3D aneurysm wall enhancement is associated with symptomatic presentation. J Neurointerv Surg. 2023 Aug;15(8):747–752.

Published In

J Neurointerv Surg

DOI

EISSN

1759-8486

Publication Date

August 2023

Volume

15

Issue

8

Start / End Page

747 / 752

Location

England

Related Subject Headings

  • Risk Factors
  • Magnetic Resonance Imaging
  • Intracranial Aneurysm
  • Humans
  • Headache
  • Female
  • Aneurysm, Ruptured
  • 3209 Neurosciences
  • 3202 Clinical sciences