Sex difference in predictors of aneurysmal wall enhancement: a cross-sectional and prospective cohort study

Aneurysm wall enhancement (AWE) is a potential imaging biomarker that can be used to identify intracranial aneurysms with an increased risk of rupture. Factors and mechanisms causing intracranial aneurysms to rupture or progress differ between women and men. Thus, we performed a cross-sectional and prospective cohort study to identify the risk factors predicting AWE in men and women.

Consecutive patients with unruptured intracranial aneurysms were prospectively recruited from September 2022 to September 2024. Baseline characteristics were collected through a standard questionnaire. Multivariate logistic regression was performed to assess the predictors of aneurysmal wall enhancement in men and women.

A total of 332 patients with 435 intracranial aneurysms were included. In the multiple logistic regression analysis, obesity (OR = 2.88, 95% CI 1.06-7.81, P = 0.038), the history of hypertension (OR = 2.76, 95% CI 1.16-6.57, P = 0.022) and younger age (OR = 0.96, 95% CI 0.93-1.00, p = 0.035) were independent risk factors for AWE in men. Meanwhile, drinking habit (OR = 2.64, 95% CI 1.09-6.41, P = 0.032), the family history of intracranial aneurysm (OR = 4.01, 95% CI 1.21-13.36, P = 0.024) and older age (OR = 1.04, 95% CI 1.01-1.07, P = 0.009) were independent risk factors for AWE in women.

This study clearly demonstrates a significant sexual dimorphism in the risk factors associated with AWE. These findings underscore the necessity for sex-specific risk stratification models for intracranial aneurysm management, suggesting that men and women have specific lifestyle interventions to prevent the progression or rupture of intracranial aneurysms.