Deparment of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany.
Deparment of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Neurosurgery. 2021 Sep 15;89(4):664-671. doi: 10.1093/neuros/nyab249.
High-resolution vessel wall imaging plays an increasingly important role in assessing the risk of aneurysm rupture.
To introduce an approach toward the validation of the wall enhancement as a direct surrogate parameter for aneurysm stability.
A total of 19 patients harboring 22 incidental intracranial aneurysms were enrolled in this study. The aneurysms were dichotomized according to their aneurysm-to-pituitary stalk contrast ratio using a cutoff value of 0.5 (nonenhancing < 0.5; enhancing ≥ 0.5). We evaluated the association of aneurysm wall enhancement with morphological characteristics, hemodynamic features, and inflammatory chemokines directly measured inside the aneurysm.
Differences in plasma concentration of chemokines and inflammatory molecules, morphological, and hemodynamic parameters were analyzed using the Welch test or Mann-Whitney U test. The concentration ΔIL-10 in the lumen of intracranial aneurysms with low wall enhancement was significantly increased compared to aneurysms with strong aneurysm wall enhancement (P = .014). The analysis of morphological and hemodynamic parameters showed significantly increased values for aneurysm volume (P = .03), aneurysm area (P = .044), maximal diameter (P = .049), and nonsphericity index (P = .021) for intracranial aneurysms with strong aneurysm wall enhancement. None of the hemodynamic parameters reached statistical significance; however, the total viscous shear force computed over the region of low wall shear stress showed a strong tendency toward significance (P = .053).
Aneurysmal wall enhancement shows strong associations with decreased intrasaccular IL-10 and established morphological indicators of aneurysm instability.
高分辨率血管壁成像在评估动脉瘤破裂风险方面发挥着越来越重要的作用。
介绍一种验证管壁增强作为动脉瘤稳定性直接替代参数的方法。
本研究共纳入 19 例 22 个偶然发现的颅内动脉瘤患者。根据动脉瘤与垂体柄的对比度比值（截断值为 0.5）将动脉瘤分为非增强组（<0.5）和增强组（≥0.5）。我们评估了动脉瘤壁增强与直接在动脉瘤内测量的形态特征、血流动力学特征和炎症趋化因子之间的相关性。
使用 Welch 检验或 Mann-Whitney U 检验分析趋化因子和炎症分子、形态和血流动力学参数的差异。低壁增强颅内动脉瘤腔内ΔIL-10 浓度明显高于强壁增强动脉瘤（P=0.014）。形态和血流动力学参数分析显示，强壁增强组的动脉瘤体积（P=0.03）、动脉瘤面积（P=0.044）、最大直径（P=0.049）和非球性指数（P=0.021）显著增加。尽管没有任何血流动力学参数具有统计学意义，但低壁切应力区域计算的总粘性剪切力具有显著趋势（P=0.053）。
动脉瘤壁增强与囊内 IL-10 减少和动脉瘤不稳定的已建立形态学指标密切相关。
