Circumferential wall enhancement on magnetic resonance imaging is useful to identify rupture site in patients with multiple cerebral aneurysms

Shunsuke Omodaka, Hidenori Endo, Kuniyasu Niizuma, Miki Fujimura, Toshiki Endo, Kenichi Sato, Shin ichiro Sugiyama, Takashi Inoue, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

BACKGROUND: Identification of rupture sites in patients with multiple intracranial aneurysms is largely based on aneurysm size, 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 patients with a total of 62 aneurysms), using MR vessel wall imaging. Three-dimensional T1-weighted fast spin-echo sequences were 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.

Original languageEnglish
Pages (from-to)638-644
Number of pages7
JournalNeurosurgery
Volume82
Issue number5
DOIs
Publication statusPublished - 2018 May 1

Keywords

  • Magnetic resonance imaging
  • Multiple intracranial aneurysms
  • Rupture site
  • Subarachnoid hemorrhage
  • Wall enhancement

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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