Multimodal validation of focal enhancement in intracranial aneurysms as a surrogate marker for aneurysm instability.
Multimodal validation of focal enhancement in intracranial aneurysms as a surrogate marker for aneurysm instability.
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DOI：
10.1007/s00234-020-02498-6
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发表时间：
2020-12
期刊：
影响因子：
2.8
通讯作者：
Berg P
中科院分区：
文献类型：
--
作者：
Larsen N;Flüh C;Saalfeld S;Voß S;Hille G;Trick D;Wodarg F;Synowitz M;Jansen O;Berg P
MR血管壁成像的周向增强已被提议作为颅内动脉瘤破裂风险较高的生物标志物。局灶性强化常发生在未破裂的动脉瘤中，但其对风险分层和患者管理的意义尚不清楚。本研究探讨了局灶性室壁增强与血流动力学和形态学危险因素以及室壁炎症和变性的组织学标志物之间的关系。未破裂的大脑中动脉动脉瘤患者接受3D旋转血管造影和3T MR血管壁成像显示局灶性血管壁增强。基于血流模拟计算血流动力学参数，并在增强区域和整个动脉瘤表面之间进行比较。形态学参数被半自动提取，并与室壁增强定量相关。组织学分析包括检测一部分患者的血管、CD34和髓过氧化物酶染色。分析了22个动脉瘤。增强区域与较低的AWSS、较低的maxOSI和增加的LSA显著相关。在多变量分析中，较高的椭圆指数是室壁增强的独立预测因子。炎症和变性的组织学体征以及较高的PHASES评分与局灶性增强显著相关。局灶性壁增强与血流动力学因素共存，这些因素与较高的破裂风险相关。它与破裂风险相关的形态学因素、较高的PHASES评分和壁不稳定的组织学标志物相关。结果支持局灶性增强可作为动脉瘤不稳定性的替代标记的假设。
Circumferential enhancement on MR vessel wall imaging has been proposed as a biomarker of a higher risk of rupture in intracranial aneurysms. Focal enhancement is frequently encountered in unruptured aneurysms, but its implication for risk stratification and patient management remains unclear. This study investigates the association of focal wall enhancement with hemodynamic and morphological risk factors and histologic markers of wall inflammation and degeneration. Patients with an unruptured middle cerebral artery aneurysm who underwent 3D rotational angiography and 3T MR vessel wall imaging showing focal wall enhancement were included. Hemodynamic parameters were calculated based on flow simulations and compared between enhanced regions and the entire aneurysm surface. Morphological parameters were semiautomatically extracted and quantitatively associated with wall enhancement. Histological analysis included detection of vasa vasorum, CD34, and myeloperoxidase staining in a subset of patients. Twenty-two aneurysms were analyzed. Enhanced regions were significantly associated with lower AWSS, lower maxOSI, and increased LSA. In multivariate analysis, higher ellipticity index was an independent predictor of wall enhancement. Histologic signs of inflammation and degeneration and higher PHASES score were significantly associated with focal enhancement. Focal wall enhancement is colocalized with hemodynamic factors that have been related to a higher rupture risk. It is correlated with morphological factors linked to rupture risk, higher PHASES score, and histologic markers of wall destabilization. The results support the hypothesis that focal enhancement could serve as a surrogate marker for aneurysm instability.
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影响因子：
4.1
作者：
Cornelissen, Bart M. W.;Leemans, Eva L.;van den Berg, Rene
通讯作者：
van den Berg, Rene
影响因子：
4.1
作者：
Cornelissen, Bart M. W.;Leemans, Eva L.;Majoie, Charles B. L. M.
通讯作者：
Majoie, Charles B. L. M.
影响因子：
3.5
作者：
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通讯作者：
Hodel, J.
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影响因子：
4.8
作者：
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通讯作者：
Liu, Jianmin
影响因子：
19.7
作者：
Edjlali, Myriam;Guedon, Alexis;Naggara, Olivier
通讯作者：
Naggara, Olivier