Predictors of Vessel Wall Enhancement in Unruptured Intracranial Aneurysms

Aims: It remains unclear whether patients with unruptured intracranial aneurysms should be treated. Large size and associated cranial nerve palsies are considered predictors for rupture among unruptured aneurysms. Vessel wall enhancement (VWE), as determined by high-resolution magnetic resonance vessel wall imaging (MR-VWI), constitutes a robust marker of active aneurysm rupture. We sought to identify

Methods: We conducted a retrospective analysis of a prospective cohort of patients with a prospectively maintained database of unruptured aneurysms imaged with MR-VWI was retrospectively reviewed. Demographic information, medical comorbidities, and aneurysm properties were obtained. Two expert, blinded reviewers evaluated the presence of VWE scored the aneurysms for degree of wall enhancement (no or thin vs thick). A univariate and multivariate logistic regression modelmodelling was utilized and built to identify assess factors associated with VWE>that predicted thick aneurysm wall enhancement.

Results: Of the 94 patients with unruptured aneurysms included in the final analysis, 34 (36%) had VWE and 60 (64%) did not have VWE. Intra- and inter-rater reliability for VWE ascertainment was excellent (kappa 0.86, 95% confidence interval [CI] = 0.75–0.97). Symptomatic presentation with thunderclap headaches (odds ratio [OR] 8.55, p = 0.007) and cranial nerve palsy (OR 219, p = 0.002) was independently associated with aneurysm VWE. Both suspicious headache and cranial nerve palsy were strongly associated with thick aneurysm wall enhancement (suspicious headache OR=8.6, 95% CI=1.9–45.7, p = 0.007; cranial nerve palsy OR=219, 95% CI=13.6–13764, p = 0.002). Larger aneurysm was also size as a continuous variable was also independently associated with thick wall enhancement (OR 1.26/mm, 95% CI 1.11–297, (1.26, p = 0.003).

Conclusions: Known predictors of aneurysm rupture such as thunderclap headache, cranial nerve palsy, and larger aneurysm size were also independent predictors for thick WVE in unruptured aneurysms, as evaluated in MR-VWI. This suggests that WVE on MR-VWI may be a useful tool for identifying high-risk unruptured aneurysms. wall enhancement.