Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Department of Neurology, The University of Iowa, Iowa City, Iowa, USA.
J Neurointerv Surg. 2021 Dec;13(12):1180-1186. doi: 10.1136/neurintsurg-2020-017243. Epub 2021 Feb 25.
Intracranial fusiform aneurysms are complex and poorly characterized vascular lesions. High-resolution magnetic resonance imaging (HR-MRI) and computational morphological analysis may be used to characterize cerebral fusiform aneurysms.
To use advanced imaging and computational analysis to understand the unique pathophysiology, and determine possible underlying mechanisms of instability of cerebral fusiform aneurysms.
Patients with unruptured intracranial aneurysms prospectively underwent imaging with 3T HR-MRI at diagnosis. Aneurysmal wall enhancement was objectively quantified using signal intensity after normalization of the contrast ratio (CR) with the pituitary stalk. Enhancement between saccular and fusiform aneurysms was compared, as well as enhancement characteristics of fusiform aneurysms. The presence of microhemorrhages in fusiform aneurysms was determined with quantitative susceptibility mapping (QSM). Three distinct types of fusiform aneurysms were analyzed with computational fluid dynamics (CFD) and finite element analysis (FEA).
A total of 130 patients with 160 aneurysms underwent HR-MRI. 136 aneurysms were saccular and 24 were fusiform. Fusiform aneurysms had a significantly higher CR and diameter than saccular aneurysms. Enhancing fusiform aneurysms exhibited more enhancement of reference vessels than non-enhancing fusiform aneurysms. Ten fusiform aneurysms underwent QSM analysis, and five aneurysms showed microhemorrhages. Microhemorrhage-positive aneurysms had a larger volume, diameter, and greater enhancement than aneurysms without microhemorrhage. Three types of fusiform aneurysms exhibited different CFD and FEA patterns.
Fusiform aneurysms exhibited more contrast enhancement than saccular aneurysms. Enhancing fusiform aneurysms had larger volume and diameter, more enhancement of reference vessels, and more often exhibited microhemorrhage than non-enhancing aneurysms. CFD and FEA suggest that various pathophysiological processes determine the formation and growth of fusiform aneurysms.
颅内梭形动脉瘤是复杂且特征不明显的血管病变。高分辨率磁共振成像（HR-MRI）和计算形态分析可用于对大脑梭形动脉瘤进行特征描述。
使用先进的影像学和计算分析来了解大脑梭形动脉瘤的独特病理生理学，并确定大脑梭形动脉瘤不稳定的可能潜在机制。
前瞻性地对诊断为未破裂颅内动脉瘤的患者进行 3T HR-MRI 成像。使用信号强度对对比率（CR）进行归一化后，客观地量化了动脉瘤壁增强，通过垂体柄进行对比。比较了囊状和梭形动脉瘤之间的增强情况，以及梭形动脉瘤的增强特征。使用定量磁化率映射（QSM）确定梭形动脉瘤中的微出血情况。使用计算流体动力学（CFD）和有限元分析（FEA）分析了 3 种不同类型的梭形动脉瘤。
共有 130 名患者的 160 个动脉瘤接受了 HR-MRI 检查。其中 136 个动脉瘤为囊状，24 个为梭形。梭形动脉瘤的 CR 和直径均明显大于囊状动脉瘤。增强的梭形动脉瘤比非增强的梭形动脉瘤的参考血管增强更多。10 个梭形动脉瘤进行了 QSM 分析，其中 5 个动脉瘤有微出血。微出血阳性的动脉瘤比没有微出血的动脉瘤体积更大、直径更大、增强更多。3 种类型的梭形动脉瘤表现出不同的 CFD 和 FEA 模式。
梭形动脉瘤比囊状动脉瘤有更多的对比增强。与非增强动脉瘤相比，增强的梭形动脉瘤体积更大、直径更大，参考血管的增强更多，且更常出现微出血。CFD 和 FEA 表明，各种病理生理过程决定了梭形动脉瘤的形成和生长。
