Su I-Chang, Willinsky Robert A, Fanning Noel F, Agid Ronit
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, 399 Bathurst St., 3 McLaughlin Wing, Room #425, Toronto, ON, M5T 2S8, Canada.
Neuroradiology. 2014 Jun;56(6):487-95. doi: 10.1007/s00234-014-1355-x. Epub 2014 Mar 28.
Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development.
We performed a retrospective analysis of consecutively treated unruptured aneurysms between January 2000 and December 2011. The presence and evolution of wall enhancement and perianeurysmal edema on MRI after endovascular treatment were analyzed. Variable factors were compared among aneurysms with and without edema.
One hundred thirty-two unruptured aneurysms in 124 patients underwent endovascular treatment. Eighty-five (64.4 %) aneurysms had wall enhancement, and 9 (6.8 %) aneurysms had perianeurysmal brain edema. Wall enhancement tends to persist for years with two patterns identified. Larger aneurysms and brain-embedded aneurysms were significantly associated with wall enhancement. In all edema cases, the aneurysms were embedded within the brain and had wall enhancement. Progressive thickening of wall enhancement was significantly associated with edema. Edema can be symptomatic when in eloquent brain and stabilizes or resolves over the years.
Our study demonstrates the prevalence and some appreciation of the natural history of aneurysmal wall enhancement and perianeurysmal brain edema following endovascular treatment of unruptured aneurysms. Aneurysmal wall enhancement is a common phenomenon while perianeurysmal edema is rare. These phenomena are likely related to the presence of inflammatory reaction near the aneurysmal wall. Both phenomena are usually asymptomatic and self-limited, and prophylactic treatment is not recommended.
动脉瘤周围水肿和动脉瘤壁强化是先前描述的弹簧圈栓塞术后的现象，归因于炎症反应。我们旨在证明这些现象在血管内治疗后未破裂动脉瘤中的发生率和自然病程，并确定促成其发生的因素。
我们对2000年1月至2011年12月连续治疗的未破裂动脉瘤进行了回顾性分析。分析血管内治疗后MRI上动脉瘤壁强化和动脉瘤周围水肿的存在及演变情况。对有水肿和无水肿的动脉瘤之间的可变因素进行比较。
124例患者中的132个未破裂动脉瘤接受了血管内治疗。85个（64.4%）动脉瘤有壁强化，9个（6.8%）动脉瘤有动脉瘤周围脑水肿。壁强化倾向于持续数年，识别出两种模式。较大的动脉瘤和脑内嵌入型动脉瘤与壁强化显著相关。在所有水肿病例中，动脉瘤均嵌入脑内且有壁强化。壁强化的逐渐增厚与水肿显著相关。当水肿位于功能区脑时可出现症状，并在数年内稳定或消退。
我们的研究证明了未破裂动脉瘤血管内治疗后动脉瘤壁强化和动脉瘤周围脑水肿的发生率及对其自然病程的一些认识。动脉瘤壁强化是一种常见现象，而动脉瘤周围水肿罕见。这些现象可能与动脉瘤壁附近炎症反应的存在有关。两种现象通常无症状且为自限性，不建议进行预防性治疗。
