Liu Peng, Qi Haikun, Liu Aihua, Lv Xianli, Jiang Yuhua, Zhao Xihai, Li Rui, Lu Bing, Lv Ming, Chen Huijun, Li Youxiang
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, China.
Interv Neuroradiol. 2016 Oct;22(5):501-5. doi: 10.1177/1591019916653252. Epub 2016 Jun 24.
Aneurysmal wall enhancement (AWE) has emerged as a new possible biomarker for depicting inflammation of the intracranial aneurysm (IA). However, the relationships of AWE with other risk factors are still unclear for unruptured IA. The purpose of this study was to investigate the association between AWE and other risk metrics.
Forty-eight patients with unruptured saccular IAs diagnosed by digital subtraction angiography were recruited to undergo magnetic resonance (MR) black-blood imaging. AWE was evaluated using the pre- and post-contrast black-blood MR images. Univariate and multivariate logistic regression analysis was performed to investigate the association of AWE with other risk factors, including size, maximal neck width, parent vessel diameter, location, multiplicity, daughter sacs and other clinical factors. The prevalence of AWE in each ISUIA grade was reported and compared by Wilcoxon rank sum test.
In total, 61 aneurysms were detected in 48 patients. Aneurysm size was found to be an independent risk factor associated with AWE (OR 2.46 per mm increase, 95% CI 1.34-4.51; p = 0.004). Patient age was independently and inversely associated with AWE (OR 0.898 per year increase, 95% CI 0.812-0.994; p = 0.037). Higher prevalence of AWE was observed in larger aneurysms (12%, 71.4%, 100%, and 100% of ISUIA grade 1-4 IAs have AWE, respectively). Notably, 12% of small IAs (size <7 mm) exhibited AWE. The IAs with AWE had significant higher ISUIA grade than the IAs without (p < 0.001, Wilcoxon rank sum test).
The wall enhancement in contrast-enhanced black-blood MR images was independently associated with aneurysm size in unruptured IAs. However, some small unruptured aneurysms did exhibit wall enhancement, suggesting that AWE may provide additional aneurysm instability information to improve current size-based rupture risk evaluation metrics.
动脉瘤壁强化（AWE）已成为一种描绘颅内动脉瘤（IA）炎症的新的潜在生物标志物。然而，对于未破裂IA，AWE与其他危险因素之间的关系仍不明确。本研究的目的是探讨AWE与其他风险指标之间的关联。
招募48例经数字减影血管造影诊断为未破裂囊状IA的患者，进行磁共振（MR）黑血成像。使用对比剂前和对比剂后的黑血MR图像评估AWE。进行单因素和多因素逻辑回归分析，以研究AWE与其他危险因素的关联，包括大小、最大颈部宽度、母血管直径、位置、多发性、子囊和其他临床因素。报告并通过Wilcoxon秩和检验比较各ISUIA分级中AWE的患病率。
48例患者共检测到61个动脉瘤。发现动脉瘤大小是与AWE相关的独立危险因素（每增加1mm，OR为2.46，95%CI为1.34 - 4.51；p = 0.004）。患者年龄与AWE独立且呈负相关（每年增加，OR为0.898，95%CI为0.812 - 0.994；p = 0.037）。在较大的动脉瘤中观察到更高的AWE患病率（ISUIA 1 - 4级IA中分别有12%、71.4%、100%和100%有AWE）。值得注意的是，12%的小IA（大小<7mm）表现出AWE。有AWE的IA的ISUIA分级显著高于无AWE的IA（p < 0.001，Wilcoxon秩和检验）。
对比增强黑血MR图像中的壁强化与未破裂IA的动脉瘤大小独立相关。然而，一些小的未破裂动脉瘤确实表现出壁强化，这表明AWE可能提供额外的动脉瘤不稳定性信息，以改善当前基于大小的破裂风险评估指标。
