磁共振成像上的定性和定量壁增强与未破裂颅内动脉瘤的症状有关。
Qualitative and Quantitative Wall Enhancement on Magnetic Resonance Imaging Is Associated With Symptoms of Unruptured Intracranial Aneurysms.
机构信息
Department of Magnetic Resonance (Q.F., Yi Zhang, Yong Zhang, J.C.), The First Affiliated Hospital of Zhengzhou University, Chinar.
Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu (Y.W.).
出版信息
Stroke. 2021 Jan;52(1):213-222. doi: 10.1161/STROKEAHA.120.029685. Epub 2020 Dec 22.
BACKGROUND AND PURPOSE
Aneurysmal wall enhancement (AWE) on vessel wall magnetic resonance imaging (VW-MRI) has been described as a new imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). Previous studies of symptomatic UIAs are limited due to small sample sizes and lack of AWE quantification. Our study aims to investigate whether qualitative and quantitative assessment of AWE can differentiate symptomatic and asymptomatic UIAs.
METHODS
Consecutive patients with UIAs were prospectively recruited for vessel wall magnetic resonance imaging at 3T from October 2014 to October 2019. UIAs were categorized as symptomatic if presenting with sentinel headache or oculomotor nerve palsy directly related to the aneurysm. Evaluation of wall enhancement included enhancement pattern (0=none, 1=focal, and 2=circumferential) and quantitative wall enhancement index (WEI). Univariate and multivariate analyses were used to identify the parameters associated with symptoms.
RESULTS
Two hundred sixty-seven patients with 341 UIAs (93 symptomatic and 248 asymptomatic) were included in this study. Symptomatic UIAs more frequently showed circumferential AWE than asymptomatic UIAs (66.7% versus 17.3%, <0.001), as well as higher WEI (median [interquartile range], 1.3 [1.0-1.9] versus 0.3 [0.1-0.9], <0.001). In multivariate analysis, both AWE pattern and WEI were independent factors associated with symptoms (odds ratio=2.03 across AWE patterns [95% CI, 1.21-3.39], =0.01; odds ratio=3.32 for WEI [95% CI, 1.51-7.26], =0.003). The combination of AWE pattern and WEI had an area under the curve of 0.91 to identify symptomatic UIAs, with a sensitivity of 95.7% and a specificity of 73.4%.
CONCLUSIONS
In a large cohort of UIAs with vessel wall magnetic resonance imaging, both AWE pattern and WEI were independently associated with aneurysm-related symptoms. The qualitative and quantitative features of AWE can potentially be used to identify unstable intracranial aneurysms.
背景与目的
血管壁磁共振成像（VW-MRI）上的动脉瘤壁增强（AWE）已被描述为不稳定未破裂颅内动脉瘤（UIAs）的新成像生物标志物。由于样本量小且缺乏 AWE 定量，以前对有症状的 UIAs 的研究受到限制。我们的研究旨在探讨定性和定量评估 AWE 是否可以区分有症状和无症状的 UIAs。
方法
连续前瞻性地招募了 2014 年 10 月至 2019 年 10 月期间在 3T 上进行血管壁磁共振成像的 UIAs 患者。如果动脉瘤与动脉瘤直接相关的先兆性头痛或动眼神经麻痹，则将 UIAs 分类为有症状。壁增强的评估包括增强模式（0=无，1=局灶性，2=环状）和定量壁增强指数（WEI）。使用单变量和多变量分析来确定与症状相关的参数。
结果
本研究共纳入了 267 例 341 个 UIAs（93 个有症状和 248 个无症状）。与无症状 UIAs 相比，有症状的 UIAs 更常出现环形 AWE（66.7%对 17.3%，<0.001），且 WEI 更高（中位数[四分位数间距]，1.3[1.0-1.9]对 0.3[0.1-0.9]，<0.001）。在多变量分析中，AWE 模式和 WEI 均是与症状相关的独立因素（AWE 模式的比值比=2.03[95%置信区间，1.21-3.39]，<0.001；WEI 的比值比=3.32[95%置信区间，1.51-7.26]，=0.003）。AWE 模式和 WEI 的组合对识别有症状的 UIAs 的曲线下面积为 0.91，其灵敏度为 95.7%，特异性为 73.4%。
结论
在具有血管壁磁共振成像的大量 UIAs 队列中，AWE 模式和 WEI 均与动脉瘤相关症状独立相关。AWE 的定性和定量特征可能有助于识别不稳定的颅内动脉瘤。
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