Interventional Neuroradiology/Endovascular Neurosurgery Division Department of Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Department of Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
J Neurointerv Surg. 2020 Oct;12(10):1018-1022. doi: 10.1136/neurintsurg-2020-015915. Epub 2020 May 18.
Inflammation of the arterial wall may lead to aneurysm formation. The presence of aneurysm enhancement on high-resolution vessel wall imaging (HR-VWI) is a marker of wall inflammation and instability. We aim to determine if there is any association between increased contrast enhancement in the aneurysmal wall and its parent artery.
Patients with unruptured intracranial aneurysms (UIAs) prospectively underwent 7T HR-VWI. Regions of interest were selected manually and with a semi-automated protocol based on gradient algorithms of intensity patterns. Mean signal intensities in pre- and post-contrast T1-weighted sequences were adjusted to the enhancement of the pituitary stalk and then subtracted to objectively determine: circumferential aneurysmal wall enhancement (CAWE); parent vessel enhancement (PVE); and reference vessel enhancement (RVE). PVE was assessed over regions located 3- and 5 mm from the aneurysm's neck. RVE was assessed in arteries located in a different vascular territory.
Twenty-five UIAs were analyzed. There was a significant moderate correlation between CAWE and 5 mm PVE (Pearson R=0.52, P=0.008), whereas no correlation was found between CAWE and RVE (Pearson R=0.20, P=0.33). A stronger correlation was found between CAWE and 3 mm PVE (Pearson R=0.78, P<0.001). Intra-class correlation analysis demonstrated good reliability between measurements obtained using semi-automated and manual segmentation (ICC coefficient=0.790, 95% CI 0.58 to 0.90).
Parent arteries exhibit higher contrast enhancement in regions closer to the aneurysm's neck, especially in aneurysms≥7 mm. A localized inflammatory/vasculopathic process in the wall of the parent artery may lead to aneurysm formation and growth.
动脉壁的炎症可能导致动脉瘤形成。高分辨率血管壁成像（HR-VWI）上的动脉瘤增强是壁炎症和不稳定性的标志物。我们旨在确定动脉瘤壁的对比增强与其母动脉之间是否存在任何关联。
前瞻性地对未破裂颅内动脉瘤（UIAs）患者进行 7T HR-VWI。手动选择感兴趣区域，并基于强度模式的梯度算法使用半自动协议进行选择。对预对比和对比后 T1 加权序列中的平均信号强度进行调整，以增强垂体柄的强度，然后减去以客观地确定：环形动脉瘤壁增强（CAWE）；母血管增强（PVE）；和参考血管增强（RVE）。PVE 在距动脉瘤颈部 3-5mm 的区域进行评估。RVE 在位于不同血管区域的动脉中进行评估。
分析了 25 个 UIAs。CAWE 与 5mm PVE 之间存在显著中度相关性（Pearson R=0.52，P=0.008），而 CAWE 与 RVE 之间无相关性（Pearson R=0.20，P=0.33）。CAWE 与 3mm PVE 之间存在更强的相关性（Pearson R=0.78，P<0.001）。使用半自动和手动分割获得的测量值之间的组内相关系数分析显示出良好的可靠性（ICC 系数=0.790，95%CI 0.58 至 0.90）。
母动脉在更靠近动脉瘤颈部的区域显示出更高的对比增强，尤其是在≥7mm 的动脉瘤中。母动脉壁中的局部炎症/血管病变过程可能导致动脉瘤的形成和生长。
