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. 2023 Jun 2:14:1108904.
doi: 10.3389/fneur.2023.1108904. eCollection 2023.

Wall enhancement predictive of abnormal hemodynamics and ischemia in vertebrobasilar non-saccular aneurysms: a pilot study

Yeqing Jiang  1 , Liang Ge  1 , Gang Lu  1 , Hailin Wan  1 , Qi Chen  2 , Rong Zou  2 , Xiaochang Leng  2 , Jianping Xiang  2 , Xiaolong Zhang  1
Affiliations

Wall enhancement predictive of abnormal hemodynamics and ischemia in vertebrobasilar non-saccular aneurysms: a pilot study

Yeqing Jiang et al. Front Neurol. .

Abstract

Objective: To analyze how wall enhancement affects hemodynamics and cerebral ischemic risk factors in vertebrobasilar non-saccular intracranial aneurysms (VBNIAs).

Materials and methods: Ten consecutive non-saccular aneurysms were collected, including three transitional vertebrobasilar dolichoectasia (TVBD). A wall enhancement model was quantitatively constructed to analyze how wall enhancement interacts with hemodynamics and cerebral ischemic factors.

Results: Enhanced area revealed low wall shear stress (WSS) and wall shear stress gradient (WSSG), with high oscillatory shear index (OSI), relative residence time (RRT), and gradient oscillatory number (GON) while the vortex and slow flow region in fusiform aneurysms are similar to TVBD fusiform aneurysms. With low OSI, high RRT and similar GON in the dilated segment, the enhanced area still manifests low WSS and WSSG in the slow flow area with no vortex. In fusiform aneurysms, wall enhancement was negatively correlated with WSS (except for case 71, all p values < 0.05, r = -0.52 ~ -0.95), while wall enhancement was positively correlated with OSI (except for case 5, all p values < 0.05, r = 0.50 ~ 0.83). For the 10 fusiform aneurysms, wall enhancement is significantly positively correlated with OSI (p = 0.0002, r = 0.75) and slightly negatively correlated with WSS (p = 0.196, r = -0.30) throughout the dataset. Aneurysm length, width, low wall shear stress area (LSA), high OSI, low flow volume (LFV), RRT, and high aneurysm-to-pituitary stalk contrast ratio (CRstalk) area plus proportion may be predictive of cerebral ischemia.

Conclusion: A wall enhancement quantitative model was established for vertebrobasilar non-saccular aneurysms. Low WSS was negatively correlated with wall enhancement, while high OSI was positively correlated with wall enhancement. Fusiform aneurysm hemodynamics in TVBD are similar to simple fusiform aneurysms. Cerebral ischemia risk appears to be correlated with large size, high OSI, LSA, and RRT, LFV, and wall enhancement.

Keywords: computed fluid dynamics; high-resolution MRI; oscillatory shear index; vertebrobasilar fusiform aneurysm; wall enhancement.

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Conflict of interest statement

QC, RZ, XL, and JX were employed by ArteryFlow Technology Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) The proximal fusiform aneurysm of the basilar artery, (B,C) pre- and post- wall enhancement; (D) one vertebral fusiform aneurysm, (E,F) pre- and post-wall enhancement.
Figure 2
Figure 2
Proximal basilar fusiform aneurysm cloud map, (A): WSS, (B): GON, (C): WWSG, (D): OSI, (E): RRT, (F): Low flow region (isovelocity = 0.042 m/s), (G): aneurysm wall intensity, (H): CRstalk, and (I): eddy current map.
Figure 3
Figure 3
TVBD cloud map, (A): WSS, (B): GON, (C): WWSG, (D): OSI, (E): RRT, (F): Low flow region (isovelocity = 0.039 m/s), (G): aneurysm wall intensity, (H): CRstalk, and (I): eddy current map.
Figure 4
Figure 4
(A): Extraction range of the region of interest enhanced by the aneurysm wall, (B,C): Linear regression analysis of fusiform aneurysm overall data points for wall enhancement, WSS and OSI.
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