Abstract
The incidence of wall enhancement of cerebral aneurysms on vessel wall MR imaging has been described as higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms, but the difference in the degree of enhancement between ruptured and unruptured aneurysms is unknown. We compared the degree of enhancement between ruptured and unruptured intracranial aneurysms by using quantitative MR imaging measures. We performed quantitative analyses of circumferential enhancement along the wall of cerebral aneurysms in 28 ruptured and 76 unruptured consecutive cases by using vessel wall MR imaging. A 3D-T1-weighted fast spin-echo sequence was obtained before and after contrast media injection, and the wall enhancement index was calculated. We then compared characteristics between ruptured and unruptured aneurysms. The wall enhancement index was significantly higher in ruptured than in unruptured aneurysms (1.70 ± 1.06 versus 0.89 ± 0.88, respectively; P = .0001). The receiver operating characteristic curve analysis found that the most reliable cutoff value of the wall enhancement index to differentiate ruptured from unruptured aneurysms was 0.53 (sensitivity, 0.96; specificity, 0.47). The wall enhancement index remained significant in the multivariate logistic regression analysis (P < .0001). Greater circumferential enhancement along the wall of cerebral aneurysms correlates with the ruptured state. A quantitative evaluation of circumferential enhancement by using vessel wall MR imaging could be useful in differentiating ruptured from unruptured intracranial aneurysms.
Highlights
BACKGROUND AND PURPOSEThe incidence of wall enhancement of cerebral aneurysms on vessel wall MR imaging has been described as higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms, but the difference in the degree of enhancement between ruptured and unruptured aneurysms is unknown
Greater circumferential enhancement along the wall of cerebral aneurysms correlates with the ruptured state
A quantitative evaluation of circumferential enhancement by using vessel wall MR imaging could be useful in differentiating ruptured from unruptured intracranial aneurysms
Summary
Study Population and Data Extraction This study was approved by an institutional review board (Kohnan Hospital). We defined the VOI with the highest signal intensity (SI) as follows: First, we set a cubic VOI (volume of 0.125 mm3) on a visible enhanced region along the aneurysm wall on the 3D-T1WI FSE sequence while we checked the aneurysm configuration referencing the volumerendering of 3D-TOF imaging. The highest SI within the VOI on the matched pre- and postcontrast images was measured (SIwall, Figs 1–3). The SI of the stalk (SIstalk) averaged in a volume of 1.0 mm[3] on matched pre- and postcontrast images was measured. Measurement of the Aneurysmal Wall Enhancement were used in further analysis. Multiplanar oblique reconstructions obtained from pre- and ysis was performed to determine factors independently associated postcontrast 3D-T1WI FSE and 3D-TOF were analyzed after with ruptured aneurysms, including variables that reached P valcoregistration with Amira 5.3 (www.amira.com). AJNR Am J Neuroradiol 37:1262– 66 Jul 2016 www.ajnr.org 1263 with JMP Pro 10.2 (SAS Institute, Cary, North Carolina) or SPSS Statistics 19.0 (IBM, Armonk, New York)
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