Magnetic resonance imaging of saccular intracranial aneurysm wall

Semin KS, Zakharova NE, Eliava ShSh, et al. . Magnetic resonance imaging of saccular intracranial aneurysm wall. Burdenko's Journal of Neurosurgery. 2023;87(5):55‑62. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20238705155

Подписка 2025-2 (Burdenko's Journal of Neurosurgery)

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BACKGROUND

Hemorrhage from intracranial aneurysms is associated with high risk of adverse outcomes. In this regard, surgical treatment of unruptured asymptomatic aneurysms has been actively developed in recent decades. One of the objectives is searching for predictors of aneurysm rupture to clarify the indications for surgery. Non-invasive analysis of vascular wall is actively discussed in last years.

OBJECTIVE

To evaluate the possibilities of MRI of ruptured and unruptured intracranial aneurysm walls and determine clinical significance of certain morphological patterns.

MATERIAL AND METHODS

The study included 111 patients with 158 ruptured and unruptured saccular aneurysms who underwent MRI according to a special protocol between November 2020 and September 2023. We analyzed each aneurysm regarding features of contrast enhancement and changes in SWAN images. After that, we compared these data with ruptures.

RESULTS

Wall of ruptured and unruptured aneurysms can accumulate contrast agent. We found 5 types of contrast enhancement. Thick-layer contrast enhancement was accompanied by 9.6-fold higher risk of aneurysm rupture compared to aneurysms without contrast enhancement. Dark MR signal from intracranial aneurysm wall in SWAN imaging is a significant sign of rupture.

CONCLUSION

MRI of the vascular wall is valuable to verify ruptured aneurysms. Unruptured aneurysms can accumulate contrast agent inside the wall, and pattern of accumulation differs from ruptured aneurysms. Morphological analysis is needed to confirm contrast enhancement as a marker of aneurysm rupture.

Keywords:

aneurysm

magnetic resonance imaging

vascular wall

Authors:

Semin K.S.

FSAI «National Medical Research Center of Neurosurgery named after acad. N.N. Burdenko» Ministry of Health of Russia

ORCID: 0000-0002-1897-9312

Zakharova N.E.

Burdenko Neurosurgical Center

ORCID: 0000-0002-0516-3613

Eliava Sh.Sh.

Burdenko Neurosurgical Center

ORCID: 0000-0001-6103-9329

Konovalov A.N.

Burdenko Neurosurgical Center

ORCID: 0000-0002-0932-4752

Kheireddin A.S.

Burdenko Neurosurgical Center

ORCID: 0000-0002-6395-2055

Kalaeva D.B.

Burdenko Neurosurgical Center

Scopus AuthorID: 57223402054
ORCID: 0000-0001-8719-2225

Batalov A.I.

Burdenko Neurosurgical Center

SPIN RSCI: 1620-1112
Scopus AuthorID: 57223053113
ORCID: 0000-0002-8924-7346

Pronin I.N.

Burdenko Neurosurgical Center

SPIN RSCI: 9223-9217
Scopus AuthorID: 7006011755
ORCID: 0000-0002-4480-0275

Received:

18.01.2023

Accepted:

13.07.2023

List of references:

Lv N, Karmonik C, Chen S, Wang X, Fang Y, Huang Q, Liu J. Relationship between Aneurysm Wall Enhancement in Vessel Wall Magnetic Resonance Imaging and Rupture Risk of Unruptured Intracranial Aneurysms. Clinical Neurosurgery. 2019;84(6):385-391. https://doi.org/10.1093/neuros/nyy310
Etminan N, Chang HS, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, Algra A. Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis. JAMA Neurology. 2019;76(5):588-597. https://doi.org/10.1001/jamaneurol.2019.0006
Rinkel GJE, Djibuti M, Algra A, Van Gijn J. Prevalence and Risk of Rupture of Intracranial Aneurysms A Systematic Review. Stroke. 1998;28(1):251-256.
Krylov VV, Eliava SS, Yakovlev SB, Kheyreddin AS, Belousova OB, Polunina NA. Clinical practice guidelines for the treatment of unruptured asymptomatic brain aneurysms. Burdenko’s Journal of Neurosurgery. 2016;80(5):124-135. (In Russ.). https://doi.org/10.17116/neiro2016805124-135
Zhong W, Su W, Li T, Tan X, Chen C, Wang Q, Wang D, Su W, Wang Y. Aneurysm wall enhancement in unruptured intracranial aneurysms: A histopathological evaluation. Journal of the American Heart Association. 2021;10(2):1-10. https://doi.org/10.1161/JAHA.120.018633
Verma RK, Kottke R, Andereggen L, Weisstanner C, Zubler C, Gralla J, Kiefer C, Slotboom J, Wiest R, Schroth G, Ozdoba C, El-Koussy M. Detecting subarachnoid hemorrhage: Comparison of combined FLAIR/SWI versus CT. European Journal of Radiology. 2013;82(9):1539-1545. https://doi.org/10.1016/j.ejrad.2013.03.021
Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Stroke. 2016;47(3):750-755. https://doi.org/10.1161/STROKEAHA.115.011386
Medvedev YuA, Matsko DE. Aneurysms and malformations of the vessels of the brain. Vol 1. RNHI. 1993. (In Russ.).
Li Y, Wang X, Ren W, Xiao Y, Yu X, Tan X. Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results. BMC Cardiovascular Disorders. 2021;21(1). https://doi.org/10.1186/s12872-021-02085-4
Li Y, Wang X, Ren W, Xiao Y, Yu X. Evaluation of Cardiac Thrombus Stability based on Contrast-Enhanced Echocardiography: Research Protocol and Preliminary Results. Research Square. Published online 2021. https://doi.org/10.21203/rs.3.rs-228409/v1
Larsen N, Flüh C, Saalfeld S, Voß S, Hille G, Trick D, Wodarg F, Synowitz M, Jansen O, Berg P. Multimodal validation of focal enhancement in intracranial aneurysms as a surrogate marker for aneurysm instability. Neuroradiology. 2020;62(12):1627-1635. https://doi.org/10.1007/s00234-020-02498-6/Published
Sato T, Matsushige T, Chen B, Gembruch O, Dammann P, Jabbarli R, Forsting M, Junker A, Maderwald S, Quick HH, Ladd ME, Sure U, Wrede KH. Wall contrast enhancement of thrombosed intracranial aneurysms at 7T MRI. American Journal of Neuroradiology. 2019;40(7):1106-1111. https://doi.org/10.3174/ajnr.A6084
Idbaih A, Boukobza M, Crassard I, Porcher R, Bousser MG, Chabriat H. MRI of clot in cerebral venous thrombosis: High diagnostic value of susceptibility-weighted images. Stroke. 2006;37(4):991-995. https://doi.org/10.1161/01.STR.0000206282.85610.ae
Zhang Y, Fu Q, Wang Y, Cheng J, Ren C, Guan S, Zhu C. Qualitative and Quantitative Wall Enhancement Analyses in Unruptured Aneurysms Are Associated With an Increased Risk of Aneurysm Instability. Frontiers in Neuroscience. 2020;14. https://doi.org/10.3389/fnins.2020.580205
Hu P, Yang Q, Wang DD, Guan SC, Zhang HQ. Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology. 2016;58(10):979-985. https://doi.org/10.1007/s00234-016-1729-3
Shimonaga K, Matsushige T, Ishii D, Sakamoto S, Hosogai M, Kawasumi T, Kaneko M, Ono C, Kurisu K. Clinicopathological Insights From Vessel Wall Imaging of Unruptured Intracranial Aneurysms. Nature Reviews Neurology. 2016;12(12):699-713. https://doi.org/10.1161/STROKEAHA.118.021819
Kadirvel R, Ding YH, Dai D, Zakaria H, Robertson AM, Danielson MA, Lewis DA, Cloft HJ, Kallmes DF. The influence of hemodynamic forces on biomarkers in the walls of elastase-induced aneurysms in rabbits. Neuroradiology. 2007;49(12):1041-1053. https://doi.org/10.1007/s00234-007-0295-0
Hudson JS, Zanaty M, Nakagawa D, Kung DK, Jabbour P, Samaniego EA, Hasan D. Magnetic Resonance Vessel Wall Imaging in Human Intracranial Aneurysms: Histological Analysis. Stroke. 2019;50(1):e1. https://doi.org/10.1161/STROKEAHA.118.023701
Matsushige T, Shimonaga K, Mizoue T, Hosogai M, Hashimoto Y, Takahashi H, Kaneko M, Ono C, Ishii D, Sakamoto S, Kurisu K. Lessons from vessel wall imaging of intracranial aneurysms: New era of aneurysm evaluation beyond morphology. Neurologia Medico-Chirurgica. 2019;59(11):407-414. https://doi.org/10.2176/nmc.ra.2019-0103
Fomenko A, Kaufmann AM. Spontaneous thrombosis of an unruptured saccular aneurysm causing MCA infarction. Canadian Journal of Neurological Sciences. 2016;43(6):856-858. https://doi.org/10.1017/cjn.2016.282

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