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Does aneurysmal wall enhancement on vessel wall MRI help to distinguish stable from unstable intracranial aneurysms?

Myriam Edjlali1, Jean-Christophe Gentric2, Christine Régent-Rodriguez2

  • 1From the Departments of Radiology (M.E., C.R.-R., D.T., W.B.H., S.L., J.F.M., C.O., O.N.) and Neurosurgery (F.N.), Université Paris Descartes Sorbonne Paris Cité, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; Department of Interventional Neuroradiology, University of Montreal, CHUM Notre-Dame Hospital, Montreal, Quebec, Canada (J.-C.G., J.R.); and the Departments of Medical Physics and Radiology (O.W., P.T.), University of Wisconsin, Madison. m.edjlali@ch-sainte-anne.fr.

Stroke
|October 18, 2014
PubMed
Abstract

Insights

Circumferential aneurysmal wall enhancement (CAWE) on MRI indicates inflammation. This finding was significantly more common in unstable intracranial aneurysms compared to stable ones, serving as a potential marker for aneurysm instability.

Area of Science:

  • Neuroradiology
  • Vascular Imaging
  • Inflammatory Diseases

Background:

  • Vessel wall MRI can detect arterial wall enhancement in intracranial inflammatory arterial disease.
  • Circumferential aneurysmal wall enhancement (CAWE) is a potential indirect marker of inflammation within the aneurysm wall.

Purpose of the Study:

  • To investigate if CAWE is more frequent in unstable intracranial aneurysms (ruptured, symptomatic, or morphologically changing) than in stable ones (incidental, nonevolving).
  • To establish CAWE as a potential imaging biomarker for aneurysm instability and inflammation.

Main Methods:

  • Prospective vessel wall MRI was performed in patients with stable or unstable intracranial aneurysms.
  • Two independent readers assessed the presence of CAWE.
  • Interreader and intrareader agreement for CAWE detection was evaluated.

Main Results:

  • CAWE was significantly more frequent in unstable aneurysms (87%) than in stable aneurysms (28.5%) (P<0.0001).
  • Excellent interreader (κ=0.85) and intrareader (κ=0.90) agreement for CAWE detection was achieved.
  • Multivariate analysis identified CAWE as the sole independent predictor of unstable aneurysm status (OR, 9.20; P=0.0002).

Conclusions:

  • CAWE is a frequently observed finding in unstable intracranial aneurysms.
  • CAWE may serve as a valuable surrogate marker for inflammatory activity within the aneurysmal wall, aiding in the assessment of aneurysm stability.
Keywords:
aneurysminflammationmagnetic resonance imaging

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