Vessel wall enhancement of intracranial aneurysms: fact or artifact?
Vessel wall enhancement of intracranial aneurysms: fact or artifact?
复制标题
DOI：
10.3171/2019.4.focus19236
复制
发表时间：
2019-07-01
影响因子：
4.1
通讯作者：
van den Berg, Rene
中科院分区：
文献类型：
--
作者：
Cornelissen, Bart M. W.;Leemans, Eva L.;van den Berg, Rene
目的对于蛛网膜下腔出血（SAH）合并颅内多发动脉瘤的患者，如何识别破裂的动脉瘤往往是一个挑战。一些研究者声称，血管壁成像（VWI）可用于识别破裂的动脉瘤，因为造影剂注射后的血管壁增强可能与不稳定和破裂的动脉瘤中的炎症有关。本研究的目的是通过评估一系列patients.METHODS患者的影像学数据来确定是否有其他因素有助于动脉瘤壁增强，这些患者在2017年1月至2018年9月期间接受了VWI，有SAH症状，有资格入选研究。使用3-T MRI扫描仪采集具有运动敏感驱动平衡准备脉冲的三维快速自旋回波序列，以可视化动脉瘤壁。根据MRI上的动脉瘤特征和出血分布来识别破裂的动脉瘤。补充成像数据（CT，DSA，MRI）用于评估潜在的潜在增强机制。此外，动脉瘤的MRA上的管腔直径的测量进行了比较，对比增强VWI，以评估动脉瘤enhancement.Results6例患者的14个动脉瘤的管腔内的贡献。平均动脉瘤尺寸为5.8 mm（范围1.1-16.9 mm）。VWI上10个动脉瘤呈强化，5个破裂动脉瘤呈强化，1个未破裂但有症状的动脉瘤呈强化，1天后破裂。4个未破裂动脉瘤增强。在10个增强动脉瘤中，6个（60%）动脉瘤的管腔直径明显变小与多个重叠薄层采集飞行时间上的外观相比，对比增强VWI上的（小>= 0.8 mm）（MOTSA-TOF）MRA和/或增强前VWI，提示增强至少部分在动脉瘤腔本身。结论：除了假设的炎症反应外，有助于动脉瘤壁增强。在本研究中，60%的病例中，增强至少部分是由动脉瘤内血流缓慢引起的，导致动脉瘤壁假性增强。尽管如此，使用VWI区分破裂与未破裂动脉瘤似乎有临床价值，但我们成像动脉瘤壁中炎性细胞浸润的假设尚未得到证实。
OBJECTIVE For patients with subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms, it is often challenging to identify the ruptured aneurysm. Some investigators have asserted that vessel wall imaging (VWI) can be used to identify the ruptured aneurysm since wall enhancement after contrast agent injection is presumably related to inflammation in unstable and ruptured aneurysms. The aim of this study was to determine whether additional factors contribute to aneurysm wall enhancement by assessing imaging data in a series of patients.METHODS Patients with symptoms of SAH who subsequently underwent VWI in the period between January 2017 and September 2018 were eligible for study inclusion. Three-dimensional turbo spin-echo sequences with motion-sensitized driven-equilibrium preparation pulses were acquired using a 3-T MRI scanner to visualize the aneurysm wall. Identification of the ruptured aneurysm was based on aneurysm characteristics and hemorrhage distributions on MRI. Complementary imaging data (CT, DSA, MRI) were used to assess potential underlying enhancement mechanisms. Additionally, aneurysm luminal diameter measurements on MRA were compared with those on contrast-enhanced VWI to assess the intraluminal contribution to aneurysm enhancement.RESULTS Six patients with 14 aneurysms were included in this series. The mean aneurysm size was 5.8 mm (range 1.1-16.9 mm). A total of 10 aneurysms showed enhancement on VWI; 5 ruptured aneurysms showed enhancement, and 1 unruptured but symptomatic aneurysm showed enhancement on VWI and ruptured 1 day later. Four unruptured aneurysms showed enhancement. In 6 (60%) of the 10 enhanced aneurysms, intraluminal diameters appeared notably smaller (>= 0.8 mm smaller) on contrast-enhanced VWI compared to their appearance on multiple overlapping thin slab acquisition time of flight (MOTSA-TOF) MRA and/or precontrast VWI, suggesting that enhancement was at least partially in the aneurysm lumen itself.CONCLUSIONS Several factors other than the hypothesized inflammatory response contribute to aneurysm wall enhancement. In 60% of the cases in this study, enhancement was at least partially caused by slow intraaneurysmal flow, leading to pseudo-enhancement of the aneurysm wall. Notwithstanding, there seems to be clinical value in differentiating ruptured from unruptured aneurysms using VWI, but the hypothesis that we image the inflammatory cell infiltration in the aneurysm wall is not yet confirmed.