Gadolinium Enhancement of the Aneurysm Wall in Unruptured Intracranial Aneurysms Is Associated with an Increased Risk of Aneurysm Instability: A Follow-Up Study
Gadolinium Enhancement of the Aneurysm Wall in Unruptured Intracranial Aneurysms Is Associated with an Increased Risk of Aneurysm Instability: A Follow-Up Study
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DOI：
10.3174/ajnr.a6105
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发表时间：
2019-07-01
影响因子：
3.5
通讯作者：
Rinkel, G. J. E.
中科院分区：
文献类型：
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作者：
Vergouwen, M. D. I.;Backes, D.;Rinkel, G. J. E.
背景与目的：先前的研究表明，未破裂的颅内动脉瘤在MR成像上的钆增强可能反映了动脉瘤壁的不稳定性。然而，之前所有的研究都是横断面的。在这项纵向研究中，我们调查了动脉瘤壁增强是否与动脉瘤不稳定风险增加有关。材料和方法：我们纳入了来自荷兰乌得勒支大学医学中心的所有年龄在18岁及以上的b> = 1未破裂动脉瘤患者，这些患者在之前的2项研究中均采用了3T或7T动脉瘤壁MR成像，并且决定不治疗动脉瘤，而是通过随访成像监测其情况。我们调查了在基线时对动脉瘤壁进行和不进行钆增强的动脉瘤随访期间生长或破裂的风险，并计算了两组之间的风险差异，并给出了相应的95%置信区间。结果：我们纳入了57例65例未破裂颅内动脉瘤。在中位随访27个月（四分位数范围20-31个月）后，19个动脉瘤中有4个（21%;95% CI, 6%-54%）出现生长（n = 2）或破裂（n = 2）， 46个动脉瘤中没有出现生长（0%;95% CI, 0%-8%）（风险差异21%；95% CI, 3%-39%）。结论：磁共振成像上动脉瘤壁钆增强与动脉瘤不稳定风险增加有关。缺乏壁增强使得动脉瘤在短期内不太可能生长或破裂。动脉瘤壁增强是否是动脉瘤不稳定的独立预测因素，还需要更大规模的研究。
BACKGROUND AND PURPOSE: Previous studies have suggested that gadolinium enhancement of the wall of unruptured intracranial aneurysms on MR imaging may reflect aneurysm wall instability. However, all previous studies were cross-sectional. In this longitudinal study, we investigated whether aneurysm wall enhancement is associated with an increased risk of aneurysm instability. MATERIALS AND METHODS: We included all patients 18 years of age or older with >= 1 unruptured aneurysm from the University Medical Center Utrecht, the Netherlands, who were included in 2 previous studies with either 3T or 7T aneurysm wall MR imaging and for whom it was decided not to treat the aneurysm but to monitor it with follow-up imaging. We investigated the risk of growth or rupture during follow-up of aneurysms with and without gadolinium enhancement of the aneurysm wall at baseline and calculated the risk difference between the 2 groups with corresponding 95% confidence intervals. RESULTS: We included 57 patients with 65 unruptured intracranial aneurysms. After a median follow-up of 27 months (interquartile range, 20-31 months), growth (n = 2) or rupture (n = 2) was observed in 4 of 19 aneurysms (21%; 95% CI, 6%-54%) with wall enhancement and in zero of 46 aneurysms (0%; 95% CI, 0%-8%) without enhancement (risk difference, 21%; 95% CI, 3%-39%). CONCLUSIONS: Gadolinium enhancement of the aneurysm wall on MR imaging is associated with an increased risk of aneurysm instability. The absence of wall enhancement makes it unlikely that the aneurysm will grow or rupture in the short term. Larger studies are needed to investigate whether aneurysm wall enhancement is an independent predictor of aneurysm instability.