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Updated: May 11, 2026

The Helsinki Rat Microsurgical Sidewall Aneurysm Model
Published on: October 12, 2014
Aneurysm Wall Enhancement Can Predict Rupture Point in Intracranial Aneurysms With Multiple Blebs
Shunsuke Omodaka1, Shin-Ichiro Sugiyama2, Hiroyuki Sakata3
1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai , Miyagi , Japan.
Background And Objectives:
Ruptured aneurysms visualized by vessel wall MRI (VW-MRI) exhibit characteristic aneurysm wall enhancement (AWE). A secondary bulge of the aneurysmal wall, called a bleb, is often the site of rupture in ruptured aneurysms. We hypothesized that a higher degree of AWE would identify the rupture point in aneurysms with multiple blebs.
Methods:
AWE was quantitatively analyzed in consecutive ruptured intracranial aneurysms with multiple blebs (31 aneurysms with a total of 72 blebs) using VW-MRI. A 3-dimensional T1-weighted fast spin-echo sequence was obtained after contrast media injection, and the contrast ratio of the aneurysm wall against the pituitary stalk (CR stalk ) was calculated as the AWE indicator. Bleb characteristics, including CR stalk and wall shear stress (WSS), were compared between ruptured and unruptured blebs. Odds ratios with 95% confidence intervals for ruptures were calculated by conditional logistic regression analysis.
Results:
Ruptured blebs had a higher CR stalk and lower WSS compared with unruptured blebs. CR stalk remained significantly associated with the bleb rupture status in the conditional logistic regression (adjusted odds ratio 3.9, 95% CIs 1.6-9.7).
Conclusion:
AWE is associated with the bleb rupture status independent of WSS. Contrast-enhanced VW-MRI may be a useful noninvasive tool for identifying the rupture point and guiding the treatment strategy.
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