Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, 450052, Zhengzhou, China.
Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Clin Neuroradiol. 2018 Dec;28(4):509-514. doi: 10.1007/s00062-017-0598-4. Epub 2017 Jun 27.
The estimates on the risk of rupture of intracranial aneurysms remain a controversial topic. Circumferential aneurysmal wall enhancement (CAWE) on vessel wall magnetic resonance imaging (MRI) has been described in unstable aneurysms. Sentinel headaches and third nerve palsy are possible symptoms prior to the rupture of intracranial aneurysms. In this study, we aimed to demonstrate that CAWE could be associated with these symptoms.
We performed a retrospective analysis of consecutive symptomatic or asymptomatic patients with unruptured intracranial aneurysms who were examined by high-resolution MRI from October 2014 to November 2016. Two experienced neurovascular radiologists read the images independently and determined whether there was CAWE of the unruptured intracranial aneurysms. Then, we compared variable factors between patients with and without symptoms through univariate comparison and multivariable logistic regression analyses.
A total of 45 unruptured intracranial aneurysms were detected in 37 patients. The agreement between 2 experienced readers for CAWE was good (kappa = 0.82; 95% confidence interval 0.66-0.99). CAWE of unruptured intracranial aneurysm was more frequently observed in symptomatic than in asymptomatic patients (16/23, 69.6% versus 6/22, 27.3%, respectively, P < 0.05). The CAWE was the only independent factor associated with symptoms in the multivariable logistic regression analysis (odds ratio 5.17; 95% confidence interval 1.30-20.52; P = 0.02).
Our study demonstrates that CAWE correlated with sentinel headaches and third nerve palsy caused by unruptured aneurysms, and this may be an additional clue to distinguish the cause of these symptoms.
颅内动脉瘤破裂风险的评估仍是一个有争议的话题。血管壁磁共振成像（MRI）上的环形动脉瘤壁增强（CAWE）已在不稳定动脉瘤中被描述。先兆性头痛和动眼神经麻痹可能是颅内动脉瘤破裂前的症状。在本研究中，我们旨在证明 CAWE 可能与这些症状相关。
我们对 2014 年 10 月至 2016 年 11 月期间因未破裂颅内动脉瘤而接受高分辨率 MRI 检查的连续有症状或无症状的患者进行了回顾性分析。两位有经验的神经血管放射科医生独立阅读图像，并确定是否存在未破裂颅内动脉瘤的 CAWE。然后，我们通过单变量比较和多变量逻辑回归分析比较了有症状和无症状患者之间的变量因素。
共检测到 37 例患者的 45 个未破裂颅内动脉瘤。两位有经验的读者对 CAWE 的一致性较好（kappa 值为 0.82；95%置信区间为 0.66-0.99）。与无症状患者相比，有症状患者的未破裂颅内动脉瘤更常出现 CAWE（16/23，69.6%比 6/22，27.3%，P<0.05）。在多变量逻辑回归分析中，CAWE 是与症状相关的唯一独立因素（优势比 5.17；95%置信区间 1.30-20.52；P=0.02）。
我们的研究表明，CAWE 与未破裂动脉瘤引起的先兆性头痛和动眼神经麻痹相关，这可能是区分这些症状原因的另一个线索。
