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.
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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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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.
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