Background Irregular pulsation of aneurysmal wall detected by four-dimensional CT angiography (4D-CTA) has been described as a novel imaging feature of aneurysm vulnerability. Our study aimed to investigate whether irregular pulsation is associated with symptomatic and ruptured intracranial aneurysms (IAs).
Methods This retrospective study included consecutive patients with IAs who underwent 4D-CTA from January 2018 to July 2021. IAs were categorized as asymptomatic, symptomatic or ruptured. The presence of irregular pulsation (defined as a temporary focal protuberance ≥1 mm on more than three successive frames) was identified on 4D-CTA movies. Univariate and multivariate analyses were used to identify the parameters associated with aneurysm symptomatic or ruptured status.
Results Overall, 305 patients with 328 aneurysms (37 ruptured, 60 symptomatic, 231 asymptomatic) were included. Ruptured and symptomatic IAs were significantly larger in size compared with asymptomatic IAs (median (IQR) 6.5 (5.1–8.3) mm, 7.0 (5.5–9.7) mm vs 4.7 (3.8–6.3) mm, p=0.001 and p<0.001, respectively) and had more irregular pulsations (70.3%, 78.3% vs 28.1%, p<0.05). Irregular pulsation (OR 5.03, 95% CI 2.83 to 8.92; p<0.001) was independently associated with aneurysm symptomatic/ruptured status in the whole population. With unruptured IAs, both irregular pulsation (OR 6.31, 95% CI 3.02 to 13.20; p<0.001) and size (OR 1.17, 95% CI 1.03 to 1.32; p=0.015) were independently associated with the symptoms. The combination of irregular pulsation and size increased the accuracy over size alone in identifying symptomatic aneurysms (AUC 0.81 vs 0.77, p=0.007) in unruptured IAs.
Conclusion In a large cohort of patients with IAs detected by 4D-CTA, the presence of irregular pulsation was independently associated with aneurysm symptomatic and ruptured status.
- CT angiography
Data availability statement
Data are available upon reasonable request.
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JZ and XL are joint first authors.
JZ and XL contributed equally.
YZ and HZ contributed equally.
Contributors JZ and XL: study concept and design, acquisition of data, analysis of data, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and manuscript submission. BZ, JZ, BS, LW, JT, JY: acquisition of data, analysis of data, interpretation of data. XL, BZ, BS, HZ and JX handled funding and supervision. MMB, LK, JW, JX: critical revision of the manuscript for important intellectual content. HZ, YZ, and CZ: study concept and design, administrative, technical, or material support, study supervision, critical revision of the manuscript for important intellectual content.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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