From the Departments of Neuroradiology (M.E., A.G., W.B.H., G.B., J.B., C.R.R., D.T., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Service Imagerie Morphologique et Fonctionnelle, 1 rue Cabanis, 75674 Paris Cedex 14, France; and Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wis (P.T.).
Radiology. 2018 Oct;289(1):181-187. doi: 10.1148/radiol.2018172879. Epub 2018 Jul 3.
Purpose To identify wall enhancement patterns on vessel wall MRI that discriminate between stable and unstable unruptured intracranial aneurysm (UIA). Materials and Methods Patients were included from November 2012 through January 2016. Vessel wall MR images were acquired at 3 T in patients with stable (incidental and nonchanging over 6 months) or unstable (symptomatic or changing over 6 months) UIA. Each aneurysm was evaluated by using a four-grade classification of enhancement: 0, none; 1, focal; 2, thin circumferential; and 3, thick (>1 mm) circumferential. Inter- and intrareader agreement for the presence and the grade of enhancement were assessed by using κ statistics and 95% confidence interval (CI). The sensitivity, specificity, and negative and positive predictive values of each enhancement grade for differentiating stable from unstable aneurysms was compared. Results The study included 263 patients with 333 aneurysms. Inter- and intrareader agreement was excellent for both the presence of enhancement (κ values, 0.82 [95% CI: 0.67, 0.99] and 0.87 [95% CI: 0.7, 1.0], respectively) and enhancement grade (κ = 0.92 [95% CI: 0.87, 0.95]). In unruptured aneurysms (n = 307), grade 3 enhancement exhibited the highest specificity (84.4%; 233 of 276; 95% CI: 80.1%, 88.7%; P = .02) and negative predictive value (94.3%; 233 of 247) for differentiating between stable and unstable lesions. There was a significant association between grade 3 enhancement and aneurysm instability (P < .0001). Conclusion In patients with intracranial aneurysm, a thick (>1 mm) circumferential pattern of wall enhancement demonstrated the highest specificity for differentiating between stable and unstable aneurysms. © RSNA, 2018.
确定血管壁 MRI 上的壁强化模式，以区分稳定和不稳定的未破裂颅内动脉瘤（UIA）。
本研究纳入了 2012 年 11 月至 2016 年 1 月间的患者。对稳定（偶然发现且 6 个月内无变化）或不稳定（有症状或 6 个月内变化）UIA 的患者进行血管壁 MRI 检查。采用四级强化分类评估每个动脉瘤：0 级，无；1 级，局灶性；2 级，薄环形；3 级，厚（>1mm）环形。采用κ 统计和 95%置信区间（CI）评估强化的存在和程度的观察者间和观察者内一致性。比较每个强化分级对区分稳定和不稳定动脉瘤的敏感性、特异性、阴性预测值和阳性预测值。
研究共纳入 263 例患者的 333 个动脉瘤。强化的存在（κ 值分别为 0.82[95%CI：0.67，0.99]和 0.87[95%CI：0.7，1.0]）和强化程度（κ=0.92[95%CI：0.87，0.95]）的观察者间和观察者内一致性均为极好。在未破裂的动脉瘤（n=307）中，3 级强化的特异性（84.4%，233/276；95%CI：80.1%，88.7%；P=0.02）和阴性预测值（94.3%，233/247）最高，可区分稳定和不稳定病变。3 级强化与动脉瘤不稳定之间存在显著相关性（P<0.0001）。
在颅内动脉瘤患者中，厚（>1mm）环形壁强化模式对区分稳定和不稳定的动脉瘤具有最高的特异性。
