Abstract
Purpose
To evaluate and compare wall enhancement patterns in saccular and fusiform intracranial aneurysms using high-resolution black-blood MRI at 7 T.
Methods
Thirty-one patients with 32 unruptured intracranial aneurysms (21 saccular and 11 fusiform) underwent 7-T black-blood MRI. Aneurysm wall enhancement (AWE) was categorized as follows: no wall enhancement (NWE), focal wall enhancement (FWE), and uniform wall enhancement (UWE). The degree of enhancement was scored as follows: 0 (no enhancement), 1 (signal intensity (SI) of the aneurysm wall less than that of the pituitary infundibulum), and 2 (equal to that of the pituitary infundibulum). The chi-squared test was used to compare the AWE pattern and degree between saccular and fusiform aneurysms.
Results
In saccular aneurysms, 12/21 (57%) enhanced. Of these, 9 showed FWE (5 grade 1 and 4 grade 2), and 3 showed UWE (2 grade 1 and 1 grade 2). In fusiform aneurysms, 11/11 (100%) enhanced. Of these, 1 showed FWE and 10 showed UWE. All fusiform aneurysms had grade-2 enhancement. Fusiform aneurysms had more extensive and higher SI AWE than saccular aneurysms (p < 0.01) despite having a similar size (6.9 ± 3.0 mm vs. 8.0 ± 2.9, p = 0.23). For saccular aneurysm, larger aneurysm size was correlated with higher degree of enhancement with Pearson’s r = 0.64 (p = 0.002).
Conclusion
Intracranial fusiform aneurysms had enhancement of higher SI and that covered a more extensive area than saccular aneurysms, which might indicate differences in vessel wall pathology.
Key Points
• Intracranial aneurysm wall enhancement can be reliably characterized by 7-T black-blood MRI.
• AWE in intracranial fusiform aneurysms presents over a larger surface area and with greater signal intensity as compared with that in saccular aneurysms, which might indicate differences in pathology.
• Stronger signal intensity of AWE correlates with the aneurysm size in saccular aneurysms.
Similar content being viewed by others
Abbreviations
- AWE:
-
Aneurysm wall enhancement
- DANTE:
-
Delay alternating with nutation for tailored excitation
- ER:
-
Enhancement ratio
- FEW:
-
Focal wall enhancement
- iMSDE:
-
Improved motion-sensitized driven-equilibrium
- MPR:
-
Multiplanar reconstruction
- NEW:
-
No wall enhancement
- SI:
-
Signal intensity
- SPACE:
-
Fast spin echo with variable flip angle trains
- UWE:
-
Uniform wall enhancement
References
Vlak MH, Algra A, Brandenburg R, Rinkel GJ (2011) Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 10:626–636
Molyneux AJ, Kerr RSC, Birks J et al (2009) Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 8:427–433
Korja M, Kivisaari R, Rezai Jahromi B, Lehto H (2017) Natural history of ruptured but untreated intracranial aneurysms. Stroke 48:1081–1084
Wiebers DO, Whisnant JP, Huston J 3rd et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110
Edjlali M, Guédon A, Hassen WB et al (2018) Circumferential thick enhancement at vessel wall MRI has high specificity for intracranial aneurysm instability. Radiology 289:181–187
Matouk CC, Mandell DM, Gunel M, Bulsara KR, Malhotra A, Hebert R (2013) Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle. Neurosurgery 72
Edjlali M, Gentric JC, Regent-Rodriguez C et al (2014) Does aneurysmal wall enhancement on vessel wall MRI help to distinguish stable from unstable intracranial aneurysms? Stroke 45:3704–3706
Shimonaga K, Matsushige T, Ishii D et al (2018) Clinicopathological insights from vessel wall imaging of unruptured intracranial aneurysms. Stroke 49:2516–2519
Larsen N, von der Brelie C, Trick D et al (2018) Vessel wall enhancement in unruptured intracranial aneurysms: an indicator for higher risk of rupture? High-resolution MR imaging and correlated histologic findings. AJNR Am J Neuroradiol 39:1617–1621
Biondi A (2006) Trunkal intracranial aneurysms: dissecting and fusiform aneurysms. Neuroimaging Clin N Am 16:453–465 viii
Anson JA, Lawton MT, Spetzler RF (1996) Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193
Burleson AC, Strother CM, Turitto VT (1995) Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics. Neurosurgery 37:774–782 discussion 782-774
Kondo S, Hashimoto N, Kikuchi H, Hazama F, Nagata I, Kataoka H (1997) Cerebral aneurysms arising at nonbranching sites. An experimental study. Stroke 28:398–403 discussion 403-394
Strother CM, Graves VB, Rappe A (1992) Aneurysm hemodynamics: an experimental study. AJNR Am J Neuroradiol 13:1089–1095
Nakatomi H, Segawa H, Kurata A et al (2000) Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896–900
Govaert JC, Walker AE (1968) The pathology of intracranial aneurysms. Prog Brain Res 30:283–288
Kleinloog R, Korkmaz E, Zwanenburg JJ et al (2014) Visualization of the aneurysm wall: a 7.0-tesla magnetic resonance imaging study. Neurosurgery 75:614–622 discussion 622
Zhu C, Haraldsson H, Tian B et al (2016) High resolution imaging of the intracranial vessel wall at 3 and 7 T using 3D fast spin echo MRI. Magma 29:559–570
Blankena R, Kleinloog R, Verweij BH et al (2016) Thinner regions of intracranial aneurysm wall correlate with regions of higher wall shear stress: a 7T MRI study. AJNR Am J Neuroradiol. https://doi.org/10.3174/ajnr.A4734
Hu P, Yang Q, Wang DD, Guan SC, Zhang HQ (2016) Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology. https://doi.org/10.1007/s00234-016-1729-3
Wang GX, Wen L, Lei S et al (2017) Wall enhancement ratio and partial wall enhancement on MRI associated with the rupture of intracranial aneurysms. J Neurointerv Surg. https://doi.org/10.1136/neurintsurg-2017-013308
Nagahata S, Nagahata M, Obara M et al (2014) Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm? Clin Neuroradiol. https://doi.org/10.1007/s00062-014-0353-z
Cianfoni A, Pravata E, De Blasi R, Tschuor CS, Bonaldi G (2013) Clinical presentation of cerebral aneurysms. Eur J Radiol 82:1618–1622
Griessenauer CJ, Foreman P, Shoja MM et al (2015) Carotid and vertebral injury study (CAVIS) technique for characterization of blunt traumatic aneurysms with reliability assessment. Interv Neuroradiol 21:255–262
Zhu C, Wang X, Degnan AJ et al (2018) Wall enhancement of intracranial unruptured aneurysm is associated with increased rupture risk and traditional risk factors. Eur Radiol. https://doi.org/10.1007/s00330-018-5522-z
Zhang Y, Tian Z, Sui B et al (2017) Endovascular treatment of spontaneous intracranial fusiform and dissecting aneurysms: outcomes related to imaging classification of 309 cases. World Neurosurg 98:444–455
Mizutani T, Miki Y, Kojima H, Suzuki H (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259 discussion 259-260
Scanarini M, Mingrino S, Giordano R, Baroni A (1978) Histological and ultrastructural study of intracranial saccular aneurysmal wall. Acta Neurochir (Wien) 43:171–182
Serrone JC, Gozal YM, Grossman AW et al (2014) Vertebrobasilar fusiform aneurysms. Neurosurg Clin N Am 25:471–484
Nasr DM, Flemming KD, Lanzino G et al (2018) Natural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis. Cerebrovasc Dis 45:68–77
Juvela S, Porras M, Poussa K (2000) Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 93:379–387
Hasan D, Chalouhi N, Jabbour P et al (2012) Early change in ferumoxytol-enhanced magnetic resonance imaging signal suggests unstable human cerebral aneurysm: a pilot study. Stroke 43:3258–3265
Dieleman N, van der Kolk AG, Zwanenburg JJM et al (2014) Imaging intracranial vessel wall pathology with magnetic resonance imaging: current prospects and future directions. Circulation 130:192–201
Liu P, Qi H, Liu A et al (2016) Relationship between aneurysm wall enhancement and conventional risk factors in patients with unruptured intracranial aneurysms: a black-blood MRI study. Interv Neuroradiol. https://doi.org/10.1177/1591019916653252
Backes D, Hendrikse J, van der Schaaf I et al (2017) Determinants of gadolinium-enhancement of the aneurysm wall in unruptured intracranial aneurysms. Neurosurgery. https://doi.org/10.1093/neuros/nyx487
Kalsoum E, Chabernaud Negrier A, Tuilier T et al (2018) Blood flow mimicking aneurysmal wall enhancement: a diagnostic pitfall of vessel wall MRI using the postcontrast 3D turbo spin-echo MR imaging sequence. AJNR Am J Neuroradiol 39:1065–1067
Li L, Miller KL, Jezzard P (2012) DANTE-prepared pulse trains: a novel approach to motion-sensitized and motion-suppressed quantitative magnetic resonance imaging. Magn Reson Med. 68:1423–1438
Zhu C, Graves MJ, Yuan J, Sadat U, Gillard JH, Patterson AJ (2014) Optimization of improved motion-sensitized driven-equilibrium (iMSDE) blood suppression for carotid artery wall imaging. J Cardiovasc Magn Reson 16:61
Thomas BP, Welch EB, Niederhauser BD et al (2008) High-resolution 7T MRI of the human hippocampus in vivo. J Magn Reson Imaging 28:1266–1272
von Morze C, Xu D, Purcell DD et al (2007) Intracranial time-of-flight MR angiography at 7T with comparison to 3T. J Magn Reson Imaging 26:900–904
Acknowledgments
We sincerely thank all the patients and health care workers who participated in this study.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: “National Key R&D Program of China,” grant no. Z161100002616002; “Scientific and Technological Projects of Science and Technology Commission of Beijing,” grant no. 2017YFB1304400.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Guarantor
The scientific guarantor of this publication is Youxiang Li.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Informed consent
Written informed consent was obtained from all subjects (patients) in this study.
Ethical approval
Institutional Review Board approval was obtained.
Methodology
• Prospective
• Observational
• Performed at one institution
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Liu, X., Zhang, Z., Zhu, C. et al. Wall enhancement of intracranial saccular and fusiform aneurysms may differ in intensity and extension: a pilot study using 7-T high-resolution black-blood MRI. Eur Radiol 30, 301–307 (2020). https://doi.org/10.1007/s00330-019-06275-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-019-06275-9