Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Neurosurgery. 2018 May 1;82(5):638-644. doi: 10.1093/neuros/nyx267.
Identification of rupture sites in patients with multiple intracranial aneurysms is largely based on aneurysm size, location, and shape. Finding circumferential enhancement along the aneurysm wall (CEAW) on magnetic resonance (MR) vessel wall imaging was recently shown to be indicative of ruptured aneurysm.
To investigate the hypothesis that a higher degree of CEAW would identify the site of rupture in patients with multiple aneurysms.
We prospectively performed quantitative analysis of CEAW in consecutive patients with both aneurysmal subarachnoid hemorrhage and multiple aneurysms (26 patients with a total of 62 aneurysms), using MR vessel wall imaging. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast media, and the wall enhancement index (WEI) was calculated. Aneurysm characteristics (size, location, irregular shape, aspect ratio [neck-to-dome length/neck width], and WEI) were compared between ruptured and unruptured aneurysms. Odds ratios with 95% confidence intervals for ruptures were calculated with conditional univariable logistic regression analysis. Analyses were repeated after adjustment for aneurysm size.
Large aneurysm size, high aspect ratio, WEI (above the median values), and irregular shape were significantly associated with aneurysm rupture. After adjustment for aneurysm size, WEI (adjusted odds ratio: 8.8; 95% confidence interval, 1.1-72.6) as well as irregular shape and aspect ratio showed a strong association with rupture.
CEAW is associated with rupture of intracranial aneurysm independent of aneurysm size and patient characteristics. Contrast-enhanced MR vessel wall imaging helps to identify the site of rupture in patients with multiple aneurysms.
在患有多发颅内动脉瘤的患者中，破裂部位的识别主要基于动脉瘤的大小、位置和形状。最近磁共振血管壁成像（MR-VWI）上发现的沿动脉瘤壁的环形强化（CEAW）被证明与破裂的动脉瘤有关。
研究假设在患有多发动脉瘤的患者中，CEAW 的程度越高，越能确定破裂部位。
我们前瞻性地对患有蛛网膜下腔出血伴多发动脉瘤的连续患者（26 例患者共 62 个动脉瘤）进行了 CEAW 的定量分析，使用了 MR-VWI。在注射对比剂前后，我们获得了三维 T1 加权快速自旋回波序列，并计算了壁强化指数（WEI）。比较了破裂和未破裂动脉瘤的动脉瘤特征（大小、位置、不规则形状、长宽比[瘤颈至瘤顶长度/瘤颈宽度]和 WEI）。采用条件单变量逻辑回归分析计算破裂的比值比及其 95%置信区间。在调整动脉瘤大小后，我们重复了分析。
大的动脉瘤大小、高的长宽比、WEI（高于中位数）和不规则形状与动脉瘤破裂显著相关。在调整了动脉瘤大小后，WEI（调整后的比值比：8.8；95%置信区间，1.1-72.6）以及不规则形状和长宽比与破裂有很强的关联。
CEAW 与颅内动脉瘤的破裂独立于动脉瘤的大小和患者特征相关。增强磁共振血管壁成像有助于识别多发动脉瘤患者的破裂部位。
