Abstract
(1) Background: The aim of this study was to determine the frequency and the pattern of post-procedural intracranial aneurysm contrast enhancement on high-resolution vessel wall magnetic resonance imaging (HR-VW MRI). We investigated the possible association between this imaging finding and factors such as time elapsed since embolization or aneurysm occlusion grade on baseline and follow-up imaging. (2) Methods: Consecutive patients presenting for follow-up after endovascular treatment of intracranial aneurysms were included. HR-VW MRI was acquired and interpreted independently by two radiologists. (3) Results: This study included 40 aneurysms in 39 patients. Contrast enhancement was detected in 30 (75%) aneurysms. It was peripheral in 12 (30.0%), central in 9 (22.5%), and both peripheral and central in 9 (22.5%) aneurysms. The statistical analysis did not reveal any relationship between follow-up period and the presence of contrast enhancement (p = 0.277). There were no statistically significant differences in the frequency of contrast enhancement between aneurysms with total occlusion and those with remnant flow on follow-up MR angiography (p = 0.850) nor between aneurysms with different interval changes in the aneurysm occlusion grade (p = 0.536). Multivariate analysis did not demonstrate aneurysm size, ruptured aneurysm status, nor initial complete aneurysm occlusion to be a predictor of contrast enhancement (p = 0.080). (4) Conclusions: Post-procedural aneurysm contrast enhancement is a common imaging finding on HR-VW MRI. The clinical utility of this imaging finding, especially in the prediction of aneurysm recurrence, seems limited. The results of our study do not support routine use of HR-VW MRI in the follow-up of patients after endovascular treatment of intracranial aneurysms.
Highlights
Following endovascular intracranial aneurysm repair, patients are routinely followed up with imaging studies as recanalization occurs in as many as 20% of cases [1]
It is presumed to be an imaging marker of aneurysm instability, indicating lesions with higher risk of rupture [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. This hypothesis is consistent with the results of our previous study, in which we have shown a statistically significant association between Aneurysm wall enhancement (AWE) and conventional risk factors for aneurysm rupture [27]
Similar to our previous study, most of the published literature on the use of HR-VW MRI in patients with intracranial aneurysms focuses on unruptured intracranial aneurysms (UIA) and determining whether AWE is an imaging marker of aneurysm instability
Summary
Following endovascular intracranial aneurysm repair, patients are routinely followed up with imaging studies as recanalization occurs in as many as 20% of cases [1]. Similar to our previous study, most of the published literature on the use of HR-VW MRI in patients with intracranial aneurysms focuses on unruptured intracranial aneurysms (UIA) and determining whether AWE is an imaging marker of aneurysm instability. This trend might be explained by the fact that such a marker is highly desirable as the management of UIA remains challenging
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