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Neuroimaging
Original research
Irregular pulsation of aneurysmal wall is associated with symptomatic and ruptured intracranial aneurysms
  1. Jianjian Zhang1,
  2. Xiao Li1,
  3. Bing Zhao2,
  4. Jin Zhang1,
  5. Beibei Sun1,
  6. Lingling Wang1,
  7. Jiaqi Tian1,
  8. Mahmud Mossa-Basha3,
  9. Louis J Kim4,
  10. Jing Yan5,
  11. Jieqing Wan2,
  12. Jianrong Xu1,
  13. Yan Zhou1,
  14. Huilin Zhao1,
  15. Chengcheng Zhu3
  1. 1 Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  2. 2 Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  3. 3 Department of Radiology, University of Washington, Seattle, Washington, USA
  4. 4 Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  5. 5 Research Collaboration, Canon Medical Systems (China) Co., LTD, Shanghai, China
  1. Correspondence to Dr Huilin Zhao, Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; huilinzhao2013{at}163.com; Dr Yan Zhou, Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; yaner1475{at}163.com

Abstract

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.

  • aneurysm
  • CT angiography

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-018381

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • 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.

    • 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.