Abstract
The increasing number of incidental intracranial aneurysms creates a dilemma of which aneurysms to treat and which to observe. Clinical scoring systems consider risk factors for aneurysm rupture however objective parameters for assessment of aneurysms stability are needed. We retrospectively analysed contrast enhancing behaviour of un-ruptured aneurysms in the black blood magnetic resonance imaging (MRI) in N=71 patients with 90 aneurysms and assessed correlation between aneurysm wall contrast enhancement (AWCE) and aneurysm anatomy and clinical scoring systems. AWCE is associated with aneurysm height and height to width ratio in ICA aneurysms. AWCE is correlated to larger aneurysms in every anatomical location evaluated. However the mean size of the contrast enhancing aneurysms is significantly different between anatomical localizations indicating separate analyses for every artery. Clinical scoring systems like PHASES and UIATS correlate positively with AWCE in black blood MRI. MRI aneurysm wall contrast enhancement is a positive predictor for aneurysm instability and should be routinely assessed in follow up of incidental aneurysms. Aneurysms smaller than 7 mm with AWCE should be followed closely with focus on growth, as they may be prone to growth and rupture.
Highlights
Aneurysms in the adult population are increasingly identified incidentally and have a prevalence of 3%.1,2 Identification of asymptomatic intracranial aneurysms is a neurosurgical dilemma as the treatment risk must be weighed against the natural behaviour of the aneurysms, which is not completely predictable
These processes can be visualized by black blood magnetic resonance imaging (MRI) the remaining question is still the same: Can unstable aneurysms be identified by contrast enhancement behaviour in the black blood MRI? We conducted the present retrospective study to evaluate correlation of aneurysm wall contrast enhancement (AWCE) in the black blood MRI and established risk factors of unstable aneurysms
We retrospectively evaluated N=71 patients with N=90 un-ruptured aneurysms who received black blood MRIs (Figure 1A and C)
Summary
Aneurysms in the adult population are increasingly identified incidentally and have a prevalence of 3%.1,2 Identification of asymptomatic intracranial aneurysms is a neurosurgical dilemma as the treatment risk must be weighed against the natural behaviour of the aneurysms, which is not completely predictable. Identification of asymptomatic intracranial aneurysms is a neurosurgical dilemma as the treatment risk must be weighed against the natural behaviour of the aneurysms, which is not completely predictable. Scoring systems such as the un-ruptured intracranial aneurysm treatment score (UIATS) or PHASES, which estimates the absolute 5year risk of aneurysm rupture based on data pooled from prospective cohort studies attempt to predict aneurysm rupture risk.[3,4] These scoring systems incorporate different factors, which suggested to increase the risk of rupture such as age, hypertension, maximum diameter, morphology, location of the aneurysm, history of previous subarachnoid haemorrhage to name a few. We compared black blood MRI results with UIATS and PHASES scores in order to assess the role of black blood MRI as an objective predictive method of aneurysm rupture
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