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Multicenter Study
. 2024 Jul;34(7):4610-4618.
doi: 10.1007/s00330-023-10388-7. Epub 2023 Dec 18.

Gadolinium-enhanced intracranial aneurysm wall imaging and risk of aneurysm growth and rupture: a multicentre longitudinal cohort study

Laura T van der Kamp  1 , Myriam Edjlali  2 , Olivier Naggara  3 , Toshinori Matsushige  4 , Diederik O Bulters  5 , Ronneil Digpal  5 , Chengcheng Zhu  6 , David Saloner  7 , Peng Hu  8 , Xiaodong Zhai  8 , Mahmud Mossa-Basha  6   9 , Bing Tian  10 , Shigeyuki Sakamoto  11 , Qichang Fu  12 , Ynte M Ruigrok  13 , Huilin Zhao  14 , Huijun Chen  15 , Gabriel J E Rinkel  13 , Irene C van der Schaaf  16 , Mervyn D I Vergouwen  13
Affiliations
Multicenter Study

Gadolinium-enhanced intracranial aneurysm wall imaging and risk of aneurysm growth and rupture: a multicentre longitudinal cohort study

Laura T van der Kamp et al. Eur Radiol. 2024 Jul.

Abstract

Objectives: In patients with an unruptured intracranial aneurysm, gadolinium enhancement of the aneurysm wall is associated with growth and rupture. However, most previous studies did not have a longitudinal design and did not adjust for aneurysm size, which is the main predictor of aneurysm instability and the most important determinant of wall enhancement. We investigated whether aneurysm wall enhancement predicts aneurysm growth and rupture during follow-up and whether the predictive value was independent of aneurysm size.

Materials and methods: In this multicentre longitudinal cohort study, individual patient data were obtained from twelve international cohorts. Inclusion criteria were as follows: 18 years or older with ≥ 1 untreated unruptured intracranial aneurysm < 15 mm; gadolinium-enhanced aneurysm wall imaging and MRA at baseline; and MRA or rupture during follow-up. Patients were included between November 2012 and November 2019. We calculated crude hazard ratios with 95%CI of aneurysm wall enhancement for growth (≥ 1 mm increase) or rupture and adjusted for aneurysm size.

Results: In 455 patients (mean age (SD), 60 (13) years; 323 (71%) women) with 559 aneurysms, growth or rupture occurred in 13/194 (6.7%) aneurysms with wall enhancement and in 9/365 (2.5%) aneurysms without enhancement (crude hazard ratio 3.1 [95%CI: 1.3-7.4], adjusted hazard ratio 1.4 [95%CI: 0.5-3.7]) with a median follow-up duration of 1.2 years.

Conclusions: Gadolinium enhancement of the aneurysm wall predicts aneurysm growth or rupture during short-term follow-up, but not independent of aneurysm size.

Clinical relevance statement: Gadolinium-enhanced aneurysm wall imaging is not recommended for short-term prediction of growth and rupture, since it appears to have no additional value to conventional predictors.

Key points: • Although aneurysm wall enhancement is associated with aneurysm instability in cross-sectional studies, it remains unknown whether it predicts risk of aneurysm growth or rupture in longitudinal studies. • Gadolinium enhancement of the aneurysm wall predicts aneurysm growth or rupture during short-term follow-up, but not when adjusting for aneurysm size. • While gadolinium-enhanced aneurysm wall imaging is not recommended for short-term prediction of growth and rupture, it may hold potential for aneurysms smaller than 7 mm.

Keywords: Brain; Intracranial aneurysm; Magnetic resonance imaging; Risk factors.

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Conflict of interest statement

The authors of this manuscript declare relationships with the following companies: Mervyn D. I. Vergouwen received grant support from Bayer (investigator-initiated research). This company produces GADOVIST®, a contrast agent to perform vessel wall imaging. Bayer had no role in the design and conduct of the study. All other authors had no relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
Risk of growth or rupture in aneurysms with and without wall enhancement. a Hazard function on aneurysm growth or rupture. b Hazard function on aneurysm growth or rupture in a subgroup of aneurysms < 7 mm. Legends: p value represents the outcome of the log-rank test. Abbreviations: AWE aneurysm wall enhancement
See this image and copyright information in PMC

Comment in

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