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  • Irregular pulsation on 4D-CTA and quantitative wall enhancement on VW-MRI are associated with symptoms of unruptured intracranial aneurysms

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Neuroimaging
Original research
Irregular pulsation on 4D-CTA and quantitative wall enhancement on VW-MRI are associated with symptoms of unruptured intracranial aneurysms
  1. Jianjian Zhang1,2,
  2. Xiao Li1,2,
  3. Jin Zhang1,2,
  4. Beibei Sun1,2,
  5. Lingling Wang1,2,
  6. Jiaqi Tian1,2,
  7. Mahmud Mossa-Basha3,
  8. Michael R Levitt4,
  9. Bing Zhao5,
  10. Jianrong Xu1,2,
  11. Yan Zhou1,2,
  12. Huilin Zhao1,2,
  13. Chengcheng Zhu3
  1. 1Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  2. 2College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  3. 3Department of Radiology, University of Washington, Seattle, Washington, USA
  4. 4Department of Neurosurgery, University of Washington, Seattle, Washington, USA
  5. 5Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  1. Correspondence to Dr Huilin Zhao; huilinzhao2013{at}163.com

Abstract

Background Unruptured intracranial aneurysms (IAs) that become symptomatic have been associated with instability.

Objective To investigate the relationship between irregular pulsation on four-dimensional CT angiography (4D-CTA) and aneurysm wall enhancement (AWE) on vessel wall MRI (VW-MRI), and to evaluate their ability to identify symptomatic IAs.

Methods This retrospective study included consecutive patients with IAs who underwent 4D-CTA and VW-MRI between March 2018 and May 2023. IAs were categorized as asymptomatic and symptomatic. The presence of irregular pulsation was identified on 4D-CTA video. Qualitative and quantitative AWE were evaluated. Univariate and multivariate analyses were used to identify the parameters associated with symptoms.

Results 192 patients with 216 aneurysms (167 asymptomatic and 49 symptomatic) were included. IAs with irregular pulsation had significantly higher wall enhancement index (WEI) than IAs without irregular pulsation (median (IQR), 0.5 (0.2–1.1) vs 0.2 (0.0–0.6), P<0.001). Symptomatic IAs had significantly higher WEI than asymptomatic IAs (median (IQR), 0.7 (0.3–1.5) vs 0.2 (0.0–0.5), P<0.001), and more irregular pulsations (79.6% vs 25.1%, P<0.001). Both irregular pulsation (OR=6.86; 95% CI 2.62 to 17.96; P<0.001) and WEI (OR=2.56; 95% CI 1.14 to 5.71; P=0.022) were independently associated with symptoms. Combination of irregular pulsation and WEI achieved the highest area under the curve of 0.86 in identifying symptomatic aneurysms compared with irregular pulsation or WEI alone (P<0.001 and P=0.002, respectively).

Conclusion In a large cohort of patients with unruptured IAs who underwent 4D-CTA and VW-MRI, both irregular pulsation and WEI were independently associated with symptoms. Such measures could identify IAs at higher risk of growth or rupture.

  • Aneurysm
  • CT Angiography
  • MRI
  • Vessel Wall

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2024-022483

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • JZ and XL are joint first authors.

    • X @DrMichaelLevitt

    • JZ and XL contributed equally.

    • Contributors JJZ and XL: study concept and design, acquisition of data, analysis of data, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and manuscript submission. JZ, BS, LW, JT: acquisition of data, analysis of data, interpretation of data. JJZ, XL, BS, HZ, CZ: handling of funding and supervision. BZ, MM-B, MRL: critical revision of the manuscript for important intellectual content. HZ, YZ, and CZ: study concept and design, administrative, technical, or material support, study supervision, critical revision of the manuscript for important intellectual content. HZ is the guarantor of this study.

    • Funding National Natural Science Foundation of China (82302181, 82271942), Fundamental Research Funds for the Central Universities (project number YG2024QNA10), Science and Technology Commission of Shanghai Municipality (Explorer Project 22TS1400600), Shanghai Municipal Public Health Excellent Young Talents Training Program (GWVI-11.2-YQ50), Shanghai Municipal Population and Family Planning Commission(20204Y0091), United States National Institutes of Health (R00HL136883).

    • Competing interests MRL: unrestricted educational grants from Stryker and Medtronic; equity interest in Synchron, Stroke Diagnostics, Proprio, Hyperion Surgical, Fluid Biomed, and Apertur; advisor for Metis Innovative. Consultant for Medtronic, Aeaean Advisors, Stereotaxis, Genomadix, and AIDoc; editorial board of Journal of NeuroInterventional Surgery; Data Safety Monitoring Board of Arsenal Medical.

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