SAD score of intracranial aneurysms for rupture risk assessment based on high-resolution vessel wall imaging

Abstract

ObjectiveWe aimed to develop a comprehensive model that integrates the radiological, morphological, and clinical factors to assess rupture risk for intracranial aneurysms. MethodsWe prospectively enrolled patients with intracranial saccular aneurysms who underwent high-resolution vessel wall imaging (HR-VWI) preoperatively. Clinical characteristics, aneurysm features and aneurysm wall enhancement scale (AWES) were recorded. AWES was categorized into three grades (no/faint/strong enhancement) by comparing AWE to enhancement of the pituitary infundibulum or choroid plexus on HR-VWI. Univariate and multivariate logistic regression analyses were performed to determine risk factors associated with aneurysmal rupture. ResultsA total of 25 ruptured and 116 unruptured aneurysms were included. Multivariate logistic regression analysis revealed that non-ICA site (OR 6.25, 95% CI 1.35–28.30, P = 0.019), AWES (OR 5.99, 95% CI 2.51–14.29, P < 0.001) and daughter sac or lobulated shape (OR 6.22, 95% CI 1.68–23.16, P = 0.006) were independent factors associated with ruptured aneurysms. The “SAD” model was generated and named after the first letters of each of these factors. SAD scores of 0–4 predicted 0, 2%, 12%, 42% and 100% ruptured aneurysms, respectively. The area under the receiver operating characteristic curve for the SAD model was 0.8822. ConclusionThe SAD model aids in distinguishing aneurysm rupture status and in managing unruptured aneurysms. Larger cohort studies are needed to confirm its applicability in predicting the rupture risk of unruptured aneurysms.