Our group has previously performed a systematic review and meta-analysis regarding the utility of vessel wall imaging with high-resolution magnetic resonance imaging which demonstrated an association between intracranial saccular aneurysm wall enhancement and aneurysm instability. Given the likely increased utilization of vessel wall imaging technology in the time since our previous review, we sought to perform an updated analysis of the association between aneurysm wall enhancement and unstable intracranial aneurysms. This study was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a comprehensive literature review. A meta-analysis was conducted to examine the association between aneurysm wall enhancement and aneurysm instability by using a random-effects model. Seven studies constituting 728 saccular aneurysms in 564 patients were included. Aneurysms that showed vessel wall enhancement had statistically significant higher odds of being unstable (odds ratio [OR]: 10.7; 95% confidence interval [CI]: 6.8–16.8; I²: 64.3%). The sensitivity, specificity, positive predictive value, and negative predictive value of vessel wall imaging in identifying unstable aneurysms were 87.2% (81.8–91.5), 61.1% (56.8–65.3), 46.5% (43.5–49.4) and 92.5% (89.6–94.7), respectively. A statistically significant association between vessel wall enhancement and aneurysm instability is once again demonstrated. The lack of wall enhancement is a strong predictor of aneurysm stability. Vessel wall imaging may represent a useful tool in guiding the management of intracranial aneurysms.

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Abstract E-189 Figure 1

Disclosures A. Larson: None. G. Lanzino: None. W. Brinjikji: None.