Wall Enhancement, Hemodynamics, and Morphology in Unruptured Intracranial Aneurysms with High Rupture Risk

• Published in: Translational stroke research 2020-10, Vol.11 (5), p.882-889
• Main Authors: Lv, Nan, Karmonik, Christof, Chen, Shiyue, Wang, Xinrui, Fang, Yibin, Huang, Qinghai, Liu, Jianmin
• Format: Article
• Language: English
• Subjects: Aneurysms; Biomedical and Life Sciences; Biomedicine; Cardiology; Contrast agents; Fluid dynamics; Hemodynamics; Hypertension; Magnetic resonance imaging; Medical imaging; Morphology; Neurology; Neurosciences; Neurosurgery; Original; Original Article; Pathogenesis; Patients; Simulation; Vascular Surgery; Veins & arteries
• ISSN: 1868-4483; 1868-601X
• DOI: 10.1007/s12975-020-00782-4

The purpose of this study is to investigate the relationship between morphology, hemodynamics, and aneurysm wall enhancement (AWE) on vessel wall MRI and their potential role in rupture of intracranial aneurysms. Fifty-seven patients (22 males and 35 females; mean age of 58.4) harboring 65 unruptured intracranial aneurysms were retrospectively recruited. Vessel wall MRI images were reviewed and differentiated as no (NAWE), partial (PAWE), and circumferential (CAWE) wall enhancement. Computational geometry and computational fluid dynamics were used to calculate morphological and hemodynamic parameters. The PHASES score was calculated for each case to estimate its rupture risk. Univariate and multivariate logistic regression analysis was performed to investigate the relationship between morphological-hemodynamic pattern and AWE as well as their association with rupture risk. AWE was present in 26 (40.0%) lesions, including 14 (21.5%) PAWE and 12 (18.5%) CAWE. Aneurysm size (odds ratio = 7.46, 95% confidence interval = 1.56–35.77, p  = 0.012), size ratio (odds ratio = 12.90, 95% confidence interval = 2.28–72.97, p  = 0.004), and normalized wall shear stress (odds ratio = 0.11, 95% confidence interval = 0.02–0.69, p  = 0.018) were independently associated with the presence of AWE. With increasing PHASES score, size-related parameters and the frequency of irregular shape increased significantly, and a hemodynamic pattern of lower and oscillating wall shear stress was observed. Simultaneously, the proportion of NAWE aneurysms decreased, and PAWE and CAWE aneurysms increased significantly ( p