Qualitative and Quantitative Wall Enhancement on Magnetic Resonance Imaging Is Associated With Symptoms of Unruptured Intracranial Aneurysms.
Qualitative and Quantitative Wall Enhancement on Magnetic Resonance Imaging Is Associated With Symptoms of Unruptured Intracranial Aneurysms.
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DOI：
10.1161/strokeaha.120.029685
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发表时间：
2021-01
期刊：
影响因子：
8.3
通讯作者：
Zhu C
中科院分区：
文献类型：
--
作者：
Fu Q;Wang Y;Zhang Y;Zhang Y;Guo X;Xu H;Yao Z;Wang M;Levitt MR;Mossa-Basha M;Zhu J;Cheng J;Guan S;Zhu C
血管壁MRI（VW-MRI）上的动脉瘤壁增强（AWE）已被描述为不稳定未破裂颅内动脉瘤（UIA）的新成像生物标志物。由于样本量小和缺乏AWE量化，以前对症状性UIA的研究有限。我们的研究旨在探讨是否定性和定量评估AWE可以区分有症状和无症状的UIA。从2014年10月至2019年10月，前瞻性招募了连续性UIA患者进行3 T VW-MRI。如果出现与动脉瘤直接相关的哨兵头痛或眼神经麻痹，则将UIA归类为症状性。评价室壁强化包括强化模式（0=无，1=局灶性，2=环周性）和定量室壁强化指数（WEI）。单变量和多变量分析用于确定与症状相关的参数。本研究纳入了267例患者的341个未破裂颅内动脉瘤（93个症状性和248个无症状性）。有症状的UIA比无症状的UIA更常显示周向AWE（66.7% vs. 17.3%，P<0.001），以及更高的WEI（中位数（四分位距），1.3（1.0-1.9）vs. 0.3（0.1-0.9），P<0.001）。在多变量分析中，AWE模式和WEI都是与症状相关的独立因素（AWE模式的比值比=2.03 [95%置信区间（CI），1.21至3.39]，P=0.01; WEI的比值比=3.32 [95%置信区间，1.51至7.26]，P=0.003）。AWE模式和WEI相结合的曲线下面积为0.91，识别症状性UIA的敏感性为95.7%，特异性为73.4%。在一个大型队列的UIA与VW-MRI中，AWE模式和WEI都独立地与癫痫相关症状相关。AWE的定性和定量特征可用于识别不稳定的颅内动脉瘤。
Aneurysmal wall enhancement (AWE) on vessel wall MRI (VW-MRI) has been described as a new imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). Previous studies of symptomatic UIAs are limited due to small sample sizes and lack of AWE quantification. Our study aims to investigate whether qualitative and quantitative assessment of AWE can differentiate symptomatic and asymptomatic UIAs. Consecutive patients with UIAs were prospectively recruited for VW-MRI at 3T from October 2014 to October 2019. UIAs were categorized as symptomatic if presenting with sentinel headache or oculomotor nerve palsy directly related to the aneurysm. Evaluation of wall enhancement included enhancement pattern (0=none, 1=focal, 2=circumferential) and quantitative wall enhancement index (WEI). Univariate and multivariate analysis was used to identify the parameters associated with symptoms. 267 patients with 341 unruptured intracranial aneurysms (93 symptomatic and 248 asymptomatic) were included in this study. Symptomatic UIAs more frequently showed circumferential AWE than asymptomatic UIAs (66.7% vs. 17.3%, P<0.001), as well as higher WEI (median (interquartile range), 1.3 (1.0-1.9) vs. 0.3 (0.1-0.9), P<0.001). In multivariate analysis, both AWE pattern and WEI were independent factors associated with symptoms (odds ratio=2.03 across AWE patterns [95% confidence interval (CI), 1.21 to 3.39], P=0.01; odds ratio=3.32 for WEI [95% confidence interval, 1.51 to 7.26], P=0.003). The combination of AWE pattern and WEI had an area under the curve of 0.91 to identify symptomatic UIAs, with a sensitivity of 95.7% and a specificity of 73.4%. In a large cohort of UIAs with VW-MRI, both AWE pattern and WEI were independently associated with aneurysm-related symptoms. The qualitative and quantitative features of AWE can potentially be used to identify unstable intracranial aneurysms.