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.
- Vessel Wall
Data availability statement
Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.
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Contributors Conception and study design: EAS; acquisition of data: DH, EAS, AR, and CO; analysis and interpretation of results: AR, SC, SS, DI, LW, TRK, JT, and EAS; drafting of the manuscript: AR and EAS; critical revision of the study: all authors; final approval of the version to be published: EAS.
Funding Statistical analysis for this study was supported by a Clinical and Translational Science Award grant funded by the National Institutes of Health (UL1TR002537).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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