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Vascular neurology
Longitudinal radiological follow-up of individual level non-ischemic cerebral enhancing lesions following endovascular aneurysm treatment
  1. Zakaria Guetarni1,
  2. Remy Bernard2,
  3. Grégoire Boulouis3,
  4. Marc-Antoine Labeyrie4,
  5. Alessandra Biondi5,
  6. Stéphane Velasco6,
  7. Guillaume Saliou7,
  8. Bruno Bartolini7,
  9. Benjamin Daumas-Duport8,
  10. Romain Bourcier8,
  11. Kevin Janot3,
  12. Denis Herbreteau3,
  13. Caterina Michelozzi9,
  14. Kevin Premat1,
  15. Hocine Redjem10,
  16. Simon Escalard10,
  17. Nicolas Bricout11,
  18. Pierre Thouant12,
  19. Charles Arteaga13,
  20. Laurent Pierot14,
  21. Florence Tahon15,
  22. Kamel Boubagra15,
  23. Leon Ikka16,
  24. Emmanuel Chabert17,
  25. Stephanie Lenck1,
  26. Alexis Guédon4,
  27. Arturo Consoli18,
  28. Suzana Saleme19,
  29. Géraud Forestier19,
  30. Federico Di Maria18,
  31. Jean-Christophe Ferré20,
  32. René Anxionnat21,
  33. Francois Eugene20,
  34. Basile Kerleroux22,
  35. Cyril Dargazanli23,
  36. Nader-Antoine Sourour1,
  37. Frédéric Clarençon1,
  38. Eimad Shotar1
  1. 1Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
  2. 2Department of Neurosurgical Anesthesiology and Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
  3. 3Department of Interventional Neuroradiology, CHU de Tours, Tours, France
  4. 4Department of Interventional Neuroradiology, Hopital Lariboisiere, Paris, France
  5. 5Department of Interventional Neuroradiology, Besançon University Hospital, Besancon, France
  6. 6Department of Interventional Neuroradiology, CHU de Poitiers, Poitiers, France
  7. 7Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
  8. 8Department of Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
  9. 9Department of Interventional Neuroradiology, Michallon Hospital, La Tronche, France
  10. 10Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
  11. 11Department of interventional Neuroradiology, Centre Hospitalier Universitaire de Lille, Lille, France
  12. 12Department of Neuroradiology, F Mitterand Hospital, Dijon, France
  13. 13Radiology Department, Hôpital d'Instruction des Armées Sainte-Anne Bibliothèque, Toulon, Provence-Alpes-Côte d'Azu, France
  14. 14Department of Interventional Neuroradiology, University Hospital Reims, Reims, France
  15. 15Department of Neuroradiology, Grenoble Alpes University Hospital, Grenoble, France
  16. 16Department of Interventional Neuroradiology, Bicetre Hospital, Le Kremlin Bicetre, France
  17. 17Department of Neuroradiology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
  18. 18Diagnostic and Therapeutic Neuroradiology Department, Hopital Foch, Suresnes, Île-de-France, France
  19. 19Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
  20. 20Department of Neuroradiology, University Hospital of Rennes, Rennes, France
  21. 21Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
  22. 22Department of Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
  23. 23Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
  1. Correspondence to Dr Eimad Shotar, Department of Interventional Neuroradiology, Hopital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France; eimad.shotar{at}aphp.fr

Abstract

Background Non-ischemic cerebral enhancing (NICE) lesions following aneurysm endovascular therapy are exceptionally rare, with unknown longitudinal evolution.

Objective To evaluate the radiological behavior of individual NICE lesions over time.

Methods Patients included in a retrospective national multicentric inception cohort were analyzed. NICE lesions were defined, using MRI, as delayed onset punctate, nodular, or annular foci enhancements with peri-lesion edema, distributed in the vascular territory of the aneurysm treatment, with no other confounding disease. Lesion burden and the longitudinal behavior of individual lesions were assessed.

Results Twenty-two patients were included, with a median initial lesion burden of 36 (IQR 17–54) on the first MRI scan. Of the 22 patients with at least one follow-up MRI scan, 16 (73%) had new lesions occurring mainly within the first 200 weeks after the date of the procedure. The median number of new lesions per MRI was 6 (IQR 2–16). Among the same 22 patients, 7 (32%) had recurrent lesions. The median persistent enhancement of a NICE lesion was 13 weeks (IQR 6–30). No factor was predictive of early regression of enhancement activity with lesion regression kinetics mainly being patient-dependent.

Conclusions The behavior of individual NICE lesions was found to be highly variable with an overall patient-dependent regression velocity.

  • Aneurysm
  • Complication
  • Inflammatory Response

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-020060

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

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    • Contributors ZG: data collection, data analysis, redaction of the manuscript, approval of final version of manuscript. RB: statistical analysis and figure preparation, critical review of the manuscript, approval of final version of manuscript. GB: study design, critical review of the manuscript, approval of final version of manuscript. N-AS: study design, critical review of the manuscript, approval of final version of manuscript. SNFR NICE lesion collaboration: data collection, critical review of the manuscript, approval of final version of manuscript. FC: study supervision, study design, critical review of the manuscript, approval of final version of manuscript. ES: study guarantor, study design, study supervision, data collection, data analysis, critical review of the manuscript, approval of final version of manuscript. All other authors: data collection, critical review of the manuscript, and approval of the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests FC reports conflict of interest with Medtronic, Guerbet, Balt Extrusion (payment for readings), Codman Neurovascular (core laboratory). N-AS is consultant for Medtronic, Balt Extrusion, Microvention; stock/stock options: Medina. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The manuscript is not supported by industry.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.