Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland.
Neurol Neurochir Pol. 2020;54(6):518-523. doi: 10.5603/PJNNS.a2020.0087. Epub 2020 Oct 22.
The prevalence of intracranial aneurysms is estimated to be around 3% in the general population. Although these are often incidental findings, they potentially carry the risk of rupture, with all of the devastating consequences of SAH.
Several risk factors of aneurysm rupture have been identified, including aneurysm size, irregular shape, and location. Although it is widely accepted that the risk of rupture increases with size, small aneurysms remain the cause of a significant percentage of aneurysmal SAH. Up to 30% of patients with acute aneurysmal SAH have multiple aneurysms. Determining the site of rupture in these patients can be challenging, given that the results of imaging studies and clinical symptoms are sometimes inconclusive. It would be extremely useful to identify new imaging biomarkers of aneurysm instability which could have an impact on patient management and qualification for treatment. High-resolution vessel wall magnetic resonance imaging (HR-VW MRI) opens up new possibilities for improved characterisation of intracranial vasculature. One of the most promising clinical applications of this new imaging tool is the evaluation of intracranial aneurysms.
Aneurysm wall enhancement (AWE) on HR-VW MRI is believed to be a marker for wall inflammation and, potentially, for aneurysm instability. In this article, we summarise the published literature on AWE with special emphasis on its use in determining the site of rupture in the setting of acute SAH in patients with multiple aneurysms, as well as its role in identifying unruptured aneurysms which are at the greatest risk of rupture.
More and larger studies are needed to definitively establish the role of AWE on HR-VW MRI in the diagnostic workup of patients with intracranial aneurysms.
颅内动脉瘤的患病率在普通人群中估计约为 3%。尽管这些通常是偶然发现的，但它们有可能破裂，导致蛛网膜下腔出血的所有灾难性后果。
已经确定了动脉瘤破裂的几个危险因素，包括动脉瘤的大小、形状不规则和位置。尽管普遍认为破裂的风险随着大小的增加而增加，但小动脉瘤仍然是动脉瘤性蛛网膜下腔出血的一个重要原因。多达 30%的急性动脉瘤性蛛网膜下腔出血患者有多个动脉瘤。由于影像学研究和临床症状的结果有时并不明确，确定这些患者的破裂部位具有挑战性。确定动脉瘤不稳定的新影像学标志物将非常有用，这可能会对患者的管理和治疗资格产生影响。高分辨率血管壁磁共振成像（HR-VW MRI）为改善颅内血管的特征提供了新的可能性。这种新的成像工具最有前途的临床应用之一是评估颅内动脉瘤。
HR-VW MRI 上的动脉瘤壁增强（AWE）被认为是血管壁炎症的标志物，并且可能是动脉瘤不稳定的标志物。在本文中，我们总结了关于 AWE 的已发表文献，特别强调了其在确定急性蛛网膜下腔出血患者多发性动脉瘤破裂部位中的作用，以及其在识别最有可能破裂的未破裂动脉瘤中的作用。
需要更多和更大的研究来明确 HR-VW MRI 上的 AWE 在颅内动脉瘤患者的诊断中的作用。
