Circumferential Wall Enhancement on Magnetic Resonance Imaging is Useful to Identify Rupture Site in Patients with Multiple Cerebral Aneurysms
Circumferential Wall Enhancement on Magnetic Resonance Imaging is Useful to Identify Rupture Site in Patients with Multiple Cerebral Aneurysms
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DOI：
10.1093/neuros/nyx267
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发表时间：
2018-05-01
期刊：
影响因子：
4.8
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Omodaka, Shunsuke;Endo, Hidenori;Tominaga, Teiji
背景：多发性颅内动脉瘤患者破裂部位的识别主要基于动脉瘤的大小、位置和形状。最近，在磁共振 (MR) 血管壁成像中发现沿动脉瘤壁 (CEAW) 的圆周增强表明动脉瘤破裂。 目的：研究较高程度的 CEAW 可以识别多发性动脉瘤患者破裂部位的假设。方法：我们前瞻性地对连续患有动脉瘤性蛛网膜下腔出血和多发性动脉瘤的患者进行 CEAW 定量分析（26例患者共62个动脉瘤），采用MR血管壁成像。注射造影剂前后获得三维T1加权快速自旋回波序列，并计算壁增强指数（WEI）。比较破裂和未破裂动脉瘤的动脉瘤特征（大小、位置、不规则形状、纵横比[颈至圆顶长度/颈宽度]和WEI）。通过条件单变量逻辑回归分析计算破裂的 95% 置信区间的优势比。调整动脉瘤尺寸后重复分析。结果：动脉瘤尺寸大、纵横比高、WEI（高于中值）和不规则形状与动脉瘤破裂显着相关。调整动脉瘤大小后，WEI（调整后的比值比：8.8；95% 置信区间，1.1-72.6）以及不规则形状和纵横比显示与破裂有很强的相关性。结论：CEAW 与颅内动脉瘤破裂相关，与动脉瘤大小和患者特征无关。对比增强磁共振血管壁成像有助于识别多发性动脉瘤患者的破裂部位。
BACKGROUND: Identification of rupture sites in patients with multiple intracranial aneurysms is largely based on aneurysmsize, location, and shape. Finding circumferential enhancement along the aneurysm wall (CEAW) on magnetic resonance (MR) vessel wall imaging was recently shown to be indicative of ruptured aneurysm.OBJECTIVE: To investigate the hypothesis that a higher degree of CEAW would identify the site of rupture in patients with multiple aneurysms.METHODS: We prospectively performed quantitative analysis of CEAW in consecutive patients with both aneurysmal subarachnoid hemorrhage and multiple aneurysms (26 patientswith a total of 62 aneurysms), usingMR vesselwall imaging. Three-dimensional T1-weighted fast spin-echo sequenceswere obtained before and after injection of contrast media, and the wall enhancement index (WEI) was calculated. Aneurysm characteristics (size, location, irregular shape, aspect ratio [neck-to-dome length/neck width], and WEI) were compared between ruptured and unruptured aneurysms. Odds ratios with 95% confidence intervals for ruptures were calculated with conditional univariable logistic regression analysis. Analyses were repeated after adjustment for aneurysm size.RESULTS: Large aneurysm size, high aspect ratio, WEI (above the median values), and irregular shape were significantly associated with aneurysm rupture. After adjustment for aneurysm size, WEI (adjusted odds ratio: 8.8; 95% confidence interval, 1.1-72.6) as well as irregular shape and aspect ratio showed a strong association with rupture.CONCLUSION: CEAW is associated with rupture of intracranial aneurysm independent of aneurysm size and patient characteristics. Contrast-enhanced MR vessel wall imaging helps to identify the site of rupture in patients with multiple aneurysms.