Wall Enhancement, Hemodynamics, and Morphology in Unruptured Intracranial Aneurysms with High Rupture Risk
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ORIGINAL ARTICLE
Wall Enhancement, Hemodynamics, and Morphology in Unruptured Intracranial Aneurysms with High Rupture Risk Nan Lv 1 & Christof Karmonik 2 & Shiyue Chen 3 & Xinrui Wang 3 & Yibin Fang 1 & Qinghai Huang 1
&
Jianmin Liu 1
Received: 13 August 2019 / Revised: 31 December 2019 / Accepted: 9 January 2020 # The Author(s) 2020
Abstract The purpose of this study is to investigate the relationship between morphology, hemodynamics, and aneurysm wall enhancement (AWE) on vessel wall MRI and their potential role in rupture of intracranial aneurysms. Fifty-seven patients (22 males and 35 females; mean age of 58.4) harboring 65 unruptured intracranial aneurysms were retrospectively recruited. Vessel wall MRI images were reviewed and differentiated as no (NAWE), partial (PAWE), and circumferential (CAWE) wall enhancement. Computational geometry and computational fluid dynamics were used to calculate morphological and hemodynamic parameters. The PHASES score was calculated for each case to estimate its rupture risk. Univariate and multivariate logistic regression analysis was performed to investigate the relationship between morphological-hemodynamic pattern and AWE as well as their association with rupture risk. AWE was present in 26 (40.0%) lesions, including 14 (21.5%) PAWE and 12 (18.5%) CAWE. Aneurysm size (odds ratio = 7.46, 95% confidence interval = 1.56–35.77, p = 0.012), size ratio (odds ratio = 12.90, 95% confidence interval = 2.28–72.97, p = 0.004), and normalized wall shear stress (odds ratio = 0.11, 95% confidence interval = 0.02– 0.69, p = 0.018) were independently associated with the presence of AWE. With increasing PHASES score, size-related parameters and the frequency of irregular shape increased significantly, and a hemodynamic pattern of lower and oscillating wall shear stress was observed. Simultaneously, the proportion of NAWE aneurysms decreased, and PAWE and CAWE aneurysms increased significantly (p < 0.001). Unruptured intracranial aneurysms with a higher rupture risk presented with a significantly larger size, lower wall shear stress, and more intense AWE, which might support the interaction between morphology, hemodynamics, and inflammation and their potential role in aneurysm rupture prediction. Keywords Intracranial aneurysms . Hemodynamics . Morphology . Vessel wall imaging
Introduction Unruptured intracranial aneurysms (UIAs) occur in 3 to 5% of the general population, and increasing numbers are detected due to the wider availability of non-invasive imaging techniques [1, 2]. Both of microsurgery and endovascular * Qinghai Huang [email protected] * Jianmin Liu [email protected] 1
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai 200433, China
2
MRI Core, Houston Methodist Research Institute, Houston, TX, USA
3
Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
treatment carry a non-negligible risk of procedural morbidity, which highlights the importance of understanding i
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