Omodaka Shunsuke, Endo Hidenori, Niizuma Kuniyasu, Fujimura Miki, Inoue Takashi, Endo Toshiki, Sato Kenichi, Sugiyama Shin-Ichiro, Tominaga Teiji
Departments of1Neurosurgery.
2Department of Neurosurgery, Tohoku University Graduate School of Medicine; and.
J Neurosurg. 2018 Oct 19;131(4):1262-1268. doi: 10.3171/2018.5.JNS18322. Print 2019 Oct 1.
Recent MR vessel wall imaging studies have indicated intracranial aneurysms in the active state could show circumferential enhancement along the aneurysm wall (CEAW). While ruptured aneurysms frequently show CEAW, CEAW in unruptured aneurysms at the evolving state (i.e., growing or symptomatic) has not been studied in detail. The authors quantitatively assessed the degree of CEAW in evolving unruptured aneurysms by comparing it separately to that in stable unruptured and ruptured aneurysms.
A quantitative analysis of CEAW was performed in 26 consecutive evolving aneurysms using MR vessel wall imaging. Three-dimensional T1-weighted fast spin echo sequences were obtained before and after contrast media injection, and the contrast ratio of the aneurysm wall against the pituitary stalk (CRstalk) was calculated as the indicator of CEAW. Aneurysm characteristics of evolving aneurysms were compared with those of 69 stable unruptured and 67 ruptured aneurysms.
The CRstalk values in evolving aneurysms were significantly higher than those in stable aneurysms (0.54 vs 0.34, p < 0.0001), and lower than those in ruptured aneurysms (0.54 vs 0.83, p < 0.0002). In multivariable analysis, CRstalk remained significant when comparing evolving with stable aneurysms (odds ratio [OR] 12.23, 95% confidence interval [CI] 3.53-42.41), and with ruptured aneurysms (OR 0.083, 95% CI 0.022-0.310).
The CEAW in evolving aneurysms was higher than those in stable aneurysms, and lower than those in ruptured aneurysms. The degree of CEAW may indicate the process leading to rupture of intracranial aneurysms, which can be useful additional information to determine an indication for surgical treatment of unruptured aneurysms.
近期的磁共振血管壁成像研究表明，处于活动状态的颅内动脉瘤可显示沿动脉瘤壁的环形强化（CEAW）。虽然破裂动脉瘤常表现为CEAW，但对于处于演变状态（即生长或有症状）的未破裂动脉瘤中的CEAW尚未进行详细研究。作者通过将演变中的未破裂动脉瘤的CEAW程度分别与稳定的未破裂动脉瘤和破裂动脉瘤的CEAW程度进行比较，对其进行了定量评估。
使用磁共振血管壁成像对26个连续的演变中的动脉瘤进行CEAW定量分析。在注射造影剂前后获取三维T1加权快速自旋回波序列，并计算动脉瘤壁与垂体柄的对比率（CRstalk）作为CEAW的指标。将演变中的动脉瘤的特征与69个稳定的未破裂动脉瘤和67个破裂动脉瘤的特征进行比较。
演变中的动脉瘤的CRstalk值显著高于稳定动脉瘤（0.54对0.34，p<0.0001），且低于破裂动脉瘤（0.54对0.83，p<0.0002）。在多变量分析中，与稳定动脉瘤相比（比值比[OR]12.23，95%置信区间[CI]3.53 - 42.41）以及与破裂动脉瘤相比（OR 0.083，95%CI 0.022 - 0.310）时，CRstalk仍然具有显著性。
演变中的动脉瘤的CEAW高于稳定动脉瘤，低于破裂动脉瘤。CEAW程度可能表明导致颅内动脉瘤破裂的过程，这对于确定未破裂动脉瘤的手术治疗指征可能是有用的额外信息。
