Fu Qichang, Ma Xinmei, Li Linghao, Xia Wanjun, Xie Shanshan, Biekan Jumatay, Wang Mengzhu, Bao Jianfeng, Cheng Junying, Zhang Yong, Guan Sheng, Cheng Jingliang
Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st Construction of E Rd, Two-Seven Districts, Zhengzhou, China.
Circle Cardiovascular Imaging, Calgary, AB, Canada.
Eur J Radiol. 2025 Sep;190:112200. doi: 10.1016/j.ejrad.2025.112200. Epub 2025 May 27.
The wall instability of unruptured intracranial aneurysms (UIAs) is associated with aneurysm growth or rupture. The wall shear stress (WSS) of 4D-flow-MRI can indicate hemodynamic abnormalities on the aneurysm wall. Aneurysm wall enhancement (AWE) of vessel wall MRI (VWI) and volume transfer constant (K) of dynamic contrast-enhanced MRI (DCE-MRI) can indicate inflammation and permeability changes of the unstable aneurysm wall. We hypothesize that the WSS of UIAs is not only associated with AWE and K but also with the risk of growth or rupture derived from the ELAPSS or PHASES scores of the aneurysm.
A cross-sectional retrospective analysis was performed on patients with UIAs who underwent 3.0 T VWI, DCE-MRI, and 4D-flow-MRI in our hospital from January 2018 to October 2023. AWE, K, and WSS were obtained by VWI, DCE-MRI, and 4D-flow MRI, respectively. AWE pattern (AWEP) and wall enhancement index (WEI) were used to evaluate AWE. 3- and 5-year aneurysm growth risk and 5-year rupture risk were predicted based on ELAPSS and PHASES scores, respectively. Correlations between parameters were assessed using Spearman's correlation coefficient or logistic regression.
Ninety-six aneurysms in 78 patients (53 women) were included in the study. WSS differed across AWEP subgroups (p < 0.001). WSS was negatively correlated with AWEP, WEI, and K (rs = -0.35, rs = -0.44, and rs = -0.25; p < 0.001). Multiple logistic regression indicated that decreased WSS was associated with higher odds of AWE (OR: 0.65, 95 % CI: 0.48-0.87). WSS was negatively correlated with the 3- and 5-year growth risk and the 5-year risk of rupture (rs = -0.47, rs = -0.44, and rs = -0.50; p < 0.001).
WSS on 4D-flow-MRI of aneurysms is inversely associated with AWEP, WEI, and K and growth and rupture risk. The decrease in WSS on 4D-flow-MRI may provide valuable information for assessing aneurysm wall instability.
未破裂颅内动脉瘤（UIA）的壁不稳定与动脉瘤生长或破裂相关。4D流MRI的壁面切应力（WSS）可提示动脉瘤壁上的血流动力学异常。血管壁MRI（VWI）的动脉瘤壁强化（AWE）和动态对比增强MRI（DCE-MRI）的容积转移常数（K）可提示不稳定动脉瘤壁的炎症和通透性变化。我们假设UIA的WSS不仅与AWE和K相关，还与动脉瘤的ELAPSS或PHASES评分所衍生的生长或破裂风险相关。
对2018年1月至2023年10月在我院接受3.0T VWI、DCE-MRI和4D流MRI检查的UIA患者进行横断面回顾性分析。分别通过VWI、DCE-MRI和4D流MRI获得AWE、K和WSS。采用AWE模式（AWEP）和壁强化指数（WEI）评估AWE。分别基于ELAPSS和PHASES评分预测3年和5年的动脉瘤生长风险以及5年破裂风险。使用Spearman相关系数或逻辑回归评估参数之间的相关性。
本研究纳入了78例患者（53例女性）的96个动脉瘤。WSS在AWEP亚组间存在差异（p<0.001）。WSS与AWEP、WEI和K呈负相关（rs=-0.35，rs=-0.44，rs=-0.25；p<0.001）。多元逻辑回归表明，WSS降低与AWE的较高比值比相关（OR：0.65，95%CI：0.48-0.87）。WSS与3年和5年生长风险以及5年破裂风险呈负相关（rs=-0.47，rs=-0.44，rs=-0.50；p<0.001）。
动脉瘤4D流MRI上的WSS与AWEP、WEI、K以及生长和破裂风险呈负相关。4D流MRI上WSS的降低可能为评估动脉瘤壁不稳定提供有价值的信息。
