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Neuroimaging
Original research
3D aneurysm wall enhancement is associated with symptomatic presentation
  1. Ashrita Raghuram1,
  2. Sebastian Sanchez1,
  3. Linder Wendt2,
  4. Steven Cochran3,
  5. Daizo Ishii4,
  6. Carlos Osorno4,
  7. Girish Bathla5,
  8. Timothy R Koscik3,
  9. James Torner2,4,
  10. David Hasan6,
  11. Edgar A Samaniego1,4,5
  1. 1 Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA
  3. 3 Department of Psychiatry, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  4. 4 Department of Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  5. 5 Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  6. 6 Department of Neurosurgery, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Edgar A Samaniego, Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; edgarsama{at}gmail.com

Abstract

Background Aneurysm wall enhancement (AWE) is a potential surrogate biomarker for aneurysm instability. Previous studies have assessed AWE using 2D multiplanar methods, most of which were conducted qualitatively.

Objective To use a new quantitative tool to analyze a large cohort of saccular aneurysms with 3D-AWE maps

Methods Saccular aneurysms were imaged prospectively with 3T high resolution MRI. 3D-AWE maps of symptomatic (defined as ruptured or presentation with sentinel headache/cranial nerve neuropathy) and asymptomatic aneurysms were created by extending orthogonal probes from the aneurysm lumen into the wall. Three metrics were used to characterize enhancement: 3D circumferential AWE (3D-CAWE), aneurysm-specific contrast uptake (SAWE), and focal AWE (FAWE). Aneurysms with a circumferential AWE higher than the corpus callosum (3D-CAWE ≥1) were classified as 3D-CAWE+. Symptomatic presentation was analyzed with univariate and multivariate logistic models. Aneurysm size, size ratio, aspect ratio, irregular morphology, and PHASES and ELAPSS scores were compared with the new AWE metrics. Bleb and microhemorrhage analyses were also performed.

Results Ninety-three aneurysms were analyzed. 3D-CAWE, SAWE, and FAWE were associated with symptomatic status (OR=1.34, 1.25, and 1.08, respectively). A multivariate model including aneurysm size, 3D-CAWE+, age, female gender, and FAWE detected symptomatic status with 80% specificity and 90% sensitivity (area under the curve=0.914, =0.967). FAWE was also associated with irregular morphology and high-risk location (p=0.043 and p=0.001, respectively). In general, blebs enhanced 56% more than the aneurysm body. Areas of microhemorrhage co-localized with areas of increased SAWE (p=0.047).

Conclusions 3D-AWE mapping provides a new set of metrics that could potentially improve the identification of symptomatic aneurysms.

  • Aneurysm
  • Vessel Wall
  • Technology
  • MRI
  • Stroke

Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/jnis-2022-019125

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    Data availability statement

    Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

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    Footnotes

    • Contributors Conception and study design: EAS; acquisition of data: DH, EAS, AR, and CO; analysis and interpretation of results: AR, SC, SS, DI, LW, TRK, JT, and EAS; drafting of the manuscript: AR and EAS; critical revision of the study: all authors; final approval of the version to be published: EAS.

    • Funding Statistical analysis for this study was supported by a Clinical and Translational Science Award grant funded by the National Institutes of Health (UL1TR002537).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.