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
Meta-Analysis
. 2020 Sep;41(9):1606-1610.
doi: 10.3174/ajnr.A6690. Epub 2020 Aug 20.

Lack of Baseline Intracranial Aneurysm Wall Enhancement Predicts Future Stability: A Systematic Review and Meta-Analysis of Longitudinal Studies

A S Larson  1   2 , V T Lehman  3 , G Lanzino  3   2 , W Brinjikji  1   2
Affiliations
Meta-Analysis

Lack of Baseline Intracranial Aneurysm Wall Enhancement Predicts Future Stability: A Systematic Review and Meta-Analysis of Longitudinal Studies

A S Larson et al. AJNR Am J Neuroradiol. 2020 Sep.

Abstract

Background: The utility of vessel wall MR imaging in identifying unstable intracranial aneurysms has been suggested but remains controversial.

Purpose: Our aim was to provide further insight into the potential relationship between aneurysm wall enhancement on initial vessel wall imaging and aneurysm instability at follow-up.

Data sources: Our sources were PubMed, Scopus, the Web of Science, and the Cochrane Central Register of Controlled Trials.

Study selection: We searched for English language studies that reported the presence of vessel wall enhancement of unruptured intracranial aneurysms on baseline vessel wall imaging studies with longitudinal follow-up of aneurysm status.

Data analysis: Aneurysms were grouped into "stable" and "unstable" groups at follow-up on the basis of growth, symptomatic manifestation, or rupture. The association of each group with aneurysm wall enhancement on initial vessel wall imaging was determined.

Data synthesis: Three studies constituting 407 aneurysms were included. Aneurysms with wall enhancement were at higher risk of being unstable at follow-up (risk ratio = 3.6; 95% confidence interval, 1.7-7.5). The sensitivity of aneurysm wall enhancement on vessel wall imaging was 74.3% (95% CI, 56.7%-87.5%), specificity was 58.3% (95% CI, 53.1%-63.4%), positive predictive value was 14.4% (95% CI, 11.8%-17.4%), negative predictive value was 96.0% (95% CI, 93.2%-97.7%), and the overall accuracy of the test was 59.7% (95% CI, 54.8%-64.5%).

Limitations: Only 3 studies were identified for inclusion in this analysis. More longitudinal studies of vessel wall imaging and aneurysm progression are needed.

Conclusions: The lack of wall enhancement may be a predictor of aneurysm stability. The utility of vessel wall imaging in detecting unstable aneurysms requires more data.

PubMed Disclaimer

Figures

FIGURE.
FIGURE.
Literature review search strategy. SR/MA indicates systematic review/meta-analysis.
See this image and copyright information in PMC

References

    1. Vlak MH, Algra A, Brandenburg R, et al. . 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 10.1016/S1474-4422(11)70109-0 - DOI - PubMed
    1. Backes D, Vergouwen MD, Velthuis BK, et al. . Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms. Stroke 2014;45:1299–1303 10.1161/STROKEAHA.113.004421 - DOI - PubMed
    1. Ujiie H, Tamano Y, Sasaki K, et al. . Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery 2001;48:495–502; discussion 502–03 10.1097/00006123-200103000-00007 - DOI - PubMed
    1. Greving JP, Wermer MJ, Brown RD Jr, et al. . Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 2014;13:59–66 10.1016/S1474-4422(13)70263-1 - DOI - PubMed
    1. Broderick JP, Viscoli CM, Brott T, et al. ; Hemorrhagic Stroke Project Investigators. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke 2003;34:1375–81 10.1161/01.STR.0000074572.91827.F4 - DOI - PubMed