Identifying the Symptomatic Aneurysm in Patients With Multiple Intracranial Aneurysms

Identification of the symptomatic aneurysm in patients with multiple intracranial aneurysms (MIAs) represents a challenge. Aneurysm wall enhancement is a potential imaging biomarker to assess symptomatic status among intracranial aneurysms. We aimed to use aneurysm wall enhancement in the identification of symptomatic aneurysms in patients with MIAs.

Patients who underwent high-resolution 3 Tesla magnetic resonance imaging between 2018 and 2024 at 3 institutions-one in the United States and 2 in China-were included in the analysis. Eligible patients had MIAs, with at least 1 aneurysm classified as symptomatic. Morphological measurements were obtained from angiography studies. Three-dimensional circumferential aneurysm wall enhancement (3D-CAWE) was assessed for all aneurysms. Multivariate logistic regression was used to identify variables independently associated with symptomatic status.

Thirty patients with 82 MIAs were included, 30/82 (36.6%) were symptomatic and 52/82 (63.3%) were asymptomatic. Aneurysmal size (adjusted odds ratio [aOR]: 1.5, 95% CI: 0.95-2.8, P = .1) and size ratio (aOR: 2.2, 95% CI: 0.8-3.2, P = .2) were not associated with symptomatic presentation. Symptomatic aneurysms were more likely to have a higher 3D-CAWE (aOR: 1.15, 95% CI: 1.05-1.24, P = .01) when compared with asymptomatic aneurysms. Receiver operating characteristic analysis revealed that a 3D-CAWE cutoff point of 1.02 has a specificity of 88% and negative predictive value of 79% in detecting symptomatic aneurysms among patients with MIAs.

3D-CAWE can be used in the identification of symptomatic aneurysms in patients with MIAs.