Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccu
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NEURO
Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm Chengcheng Zhu 1 & Xinrui Wang 2,3 & Laura Eisenmenger 4 & Zhang Shi 2 & Andrew Degnan 5 & Bing Tian 2 & Qi Liu 2 & Christopher Hess 1 & David Saloner 1 & Jianping Lu 2 Received: 2 January 2020 / Revised: 19 May 2020 / Accepted: 1 July 2020 # European Society of Radiology 2020
Abstract Objective This study aims to investigate whether aneurysm wall enhancement (AWE) is independently associated with symptomatic status of unruptured intracranial aneurysms (UIAs). Methods One hundred thirty-nine consecutive patients (67 male, mean age 58 ± 11 years) with 79 symptomatic and 87 asymptomatic UIAs were imaged using black-blood MRI pre- and post-gadolinium contrast administration and 3D DSA. Symptoms related to aneurysms were identified including cranial nerve deficits and headache. AWE grade and area were characterized, and aneurysm size was measured on DSA. Multivariate binary logistic regression analysis was used to identify factors associated with symptoms. Further subgroup analysis was performed for aneurysms size < 10 mm. Results Symptomatic UIAs had significantly larger aneurysm size (11.2 ± 6.2 mm vs. 6.4 ± 3.3 mm), enhancement grade (1.3 ± 0.6 vs. 0.4 ± 0.6), enhancement area (2.0 ± 0.9 vs. 0.4 ± 0.7), and higher prevalence of thick enhancement (39% vs. 3%) compared with asymptomatic UIAs, all p < 0.001. In multivariate analysis, only AWE area (odds ratio [OR] 6.9, 95% confidence interval [4.0, 11.7]) was independently associated with symptoms. AWE area had an area under curve (AUC) value of 0.888, with 72.2% sensitivity and 92.0% specificity for symptoms, which was superior to aneurysm size (AUC of 0.771, with 75.9% sensitivity and 65.5% specificity). In the subgroup analysis of aneurysms smaller than 10 mm (n = 118), AWE area (OR, 7.0, p < 0.001) remained the only independent risk factor associated with symptoms. Conclusions Larger AWE area is independently associated with symptomatic UIAs, which may provide additional value to guide UIA management and improve patient outcomes. Key Points • Symptomatic intracranial aneurysms are larger and more often demonstrate significant wall enhancement than asymptomatic aneurysms. • Larger wall enhancement area is independently associated with symptomatic intracranial aneurysm. Keywords Magnetic resonance imaging . Intracranial aneurysm . Gadolinium
Chengcheng Zhu and Xinrui Wang contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07063-6) contains supplementary material, which is available to authorized users. * Jianping Lu [email protected] 1
Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
2
Department of Radiology, Changhai Hospital, Shanghai, China
3
Department of Radiology, General Hospital of Northern Theatre Command, Shenyang, China
4
Department of Radiology, University of Wisconsin, Madison, WI, US
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