Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr;92(1096):20180950.
doi: 10.1259/bjr.20180950. Epub 2019 Jan 30.

Intracranial aneurysms at higher clinical risk for rupture demonstrate increased wall enhancement and thinning on multicontrast 3D vessel wall MRI

Jason Brett Hartman  1 , Hiroko Watase  2 , Jie Sun  1 , Daniel S Hippe  1 , Louis Kim  1   3 , Michael Levitt  1   3   4 , Laligam Sekhar  3 , Niranjan Balu  1 , Thomas Hatsukami  2 , Chun Yuan  1 , Mahmud Mossa-Basha  1
Affiliations

Intracranial aneurysms at higher clinical risk for rupture demonstrate increased wall enhancement and thinning on multicontrast 3D vessel wall MRI

Jason Brett Hartman et al. Br J Radiol. 2019 Apr.

Abstract

Objective:: Identification of aneurysms at risk for rupture is important and challenging. We sought to evaluate if intracranial vessel wall (IVW) imaging characteristics of unruptured aneurysms correlate with clinical risk factors for rupture.

Methods:: Patients with unruptured intracranial aneurysms were prospectively recruited and underwent a multi contrast 3D IVW protocol between April 6, 2016 and August 29, 2017. Two independent raters, blinded to aneurysm vulnerability, evaluated each aneurysm for wall enhancement, extent of enhancement in terms of the numbers of quadrants enhancing circumferentially, intensity of enhancement, and qualitative wall thinning. PHASES score was calculated for each aneurysm. Univariate logistic regression analysis was used to compare IVW characteristics between aneurysms at higher clinical risk for rupture (PHASES score > 3) and lower clinical risk for rupture (PHASES score ≤ 3).

Results:: 45 patients with 65 unruptured aneurysms were analyzed; 38 aneurysms with PHASES score > 3 (58%) and 27 aneurysms with PHASES score ≤ 3 (42%). Aneurysms with PHASES score > 3 were more likely to demonstrate enhancement (42.1% vs 14.8%, p = 0.022), greater extent of enhancement (mean: 2.9 vs 2.2 quadrants, p = 0.063), and wall thinning (9.2% vs 0%, p = 0.044). Inter-reader agreement was moderate-to-good for the presence (κ = 0.64), extent (κ = 0.64), and intensity of enhancement (κ = 0.60) but relatively low for wall thinning (κ = 0.25).

Conclusion:: Aneurysms at higher risk of rupture by PHASES score are more likely to demonstrate wall enhancement, more diffuse enhancement, and wall thinning on IVW.

Advances in knowledge:: This study prospectively compares IVW-detected wall enhancement and thinning between unruptured aneurysms stratified into high and low risk groups by clinical scores (PHASES) of vulnerability.

PubMed Disclaimer

Conflict of interest statement

Funding: The authors report no conflicts of interest. This work was supported by the Philips Pilot Project Program and National Institutes of Health grant [grant R01NS092207 01A1]. The authors have no additional disclosures. Presented at ASNR 2018, Vancouver, British Columbia, under the title, “Intracranial Aneurysms at Higher Clinical Risk for Rupture Demonstrate Increased Wall Enhancement on Vessel Wall MRI.”

Figures

Figure 1.
Figure 1.
Demonstrates a 12 mm anterior communicating artery aneurysm on pre- and post-contrast 3D T 1 SPACE sequences. The post-contrast image (right) demonstrates enhancement in all four quadrants of the aneurysm wall. PHASES score for this aneurysm was 12. 3D, three-dimensional.
Figure 2.
Figure 2.
Demonstrates an 18 mm paraclinoid segment right internal carotid artery aneurysm on pre- and post-contrast 3D T 1 SPACE sequences. On pre- and post-contrast images there is thinning of the posterior wall. PHASES score for this aneurysm was 7. 3D, three-dimensional.
See this image and copyright information in PMC

References

    1. Etminan N , Rinkel GJ . Unruptured intracranial aneurysms: development, rupture and preventive management . Nat Rev Neurol 2016. ; 12 : 699 – 713 . doi: 10.1038/nrneurol.2016.150 - DOI - PubMed
    1. Rinkel GJ , Djibuti M , Algra A , van Gijn J . Prevalence and risk of rupture of intracranial aneurysms: a systematic review . Stroke 1998. ; 29 : 251 – 6 . - PubMed
    1. Vlak MH , Algra A , Brandenburg R , Rinkel GJ . Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis . Lancet Neurol 2011. ; 10 : 626 – 36 . doi: 10.1016/S1474-4422(11)70109-0 - DOI - PubMed
    1. de Havenon A , Yuan C , Tirschwell D , Hatsukami T , Anzai Y , Becker K , et al. . Nonstenotic culprit plaque: the utility of high-resolution vessel wall MRI of intracranial vessels after ischemic stroke . Case Reports in Radiology 2015. ; 2015 : 1 – 4 . doi: 10.1155/2015/356582 - DOI - PMC - PubMed
    1. Mossa-Basha M , de Havenon A , Becker KJ , Hallam DK , Levitt MR , Cohen WA , et al. . Added value of vessel wall magnetic resonance imaging in the differentiation of moyamoya vasculopathies in a non-Asian cohort . Stroke 2016. ; 47 : 1782 – 8 . doi: 10.1161/STROKEAHA.116.013320 - DOI - PMC - PubMed

MeSH terms