Segmentation of aneurysm wall enhancement in evolving unruptured intracranial aneurysms

Yukishige Hashimoto; Toshinori Matsushige; Reo Kawano; Koji Shimonaga; Michitsura Yoshiyama; Hiroki Takahashi; Mayumi Kaneko; Chiaki Ono; Shigeyuki Sakamoto

doi:10.3171/2021.2.JNS2114

Segmentation of aneurysm wall enhancement in evolving unruptured intracranial aneurysms

J Neurosurg. 2021 Aug 13;136(2):449-455. doi: 10.3171/2021.2.JNS2114. Print 2022 Feb 1.

Authors

Yukishige Hashimoto¹, Toshinori Matsushige¹, Reo Kawano², Koji Shimonaga¹, Michitsura Yoshiyama¹, Hiroki Takahashi¹, Mayumi Kaneko³, Chiaki Ono⁴, Shigeyuki Sakamoto⁵

Affiliations

¹ 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital.
² 2Clinical Research Center in Hiroshima, Hiroshima University Hospital.
³ 3Department of Pathology, Hiroshima City Asa Citizens Hospital.
⁴ 4Department of Radiology, Hiroshima City Asa Citizens Hospital; and.
⁵ 5Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

PMID: 34388724
DOI: 10.3171/2021.2.JNS2114

Abstract

Objective: Morphological changes in unruptured intracranial aneurysms (UIAs) are an imaging marker of aneurysm instability. Recent studies have indicated the ability of MR vessel wall imaging (VWI) to stratify unstable UIAs based on a correlation with histopathological aneurysm wall inflammation. In the present study the authors investigated the relationships between aneurysm growth patterns and the segmentation of aneurysm wall enhancement (AWE) in VWI.

Methods: A total of 120 aneurysms with serial angiography from a follow-up period of at least 2 years (mean 65 months, range 24-215 months) were assessed by VWI. Two readers independently evaluated the patterns of morphological changes (stable, whole sac expansion, and secondary aneurysm formation) and the segmentation of AWE (no, focal, and circumferential AWE). The contrast enhancement ratio of the aneurysm wall versus the pituitary stalk (CRstalk) was calculated for the quantitative assessment of AWE. Statistical analyses were performed to investigate the relationships between AWE patterns and patient baseline profiles, aneurysm characteristics, and morphological modifications.

Results: Forty-one of 120 UIAs (34%) exhibited aneurysm growth (whole sac expansion in 19 and secondary aneurysm formation in 22). AWE was detected in 35 of 120 UIAs (focal AWE in 25 and circumferential AWE in 10). The maximum diameter of, irregularities in, and morphological modifications in aneurysms were associated with the segmentation of AWE. Focal AWE correlated with secondary aneurysm formation, and circumferential AWE correlated with whole sac expansion. In focal AWE, CRstalk was significantly higher in secondary aneurysm formation than in stable UIAs. UIAs without AWE (categorized as no AWE) correlated with aneurysm stability.

Conclusions: The segmentation of AWE was associated with aneurysm growth scenarios and may provide a novel insight into the evaluation of unstable UIAs.

Keywords: aneurysm wall enhancement; segmentation; unruptured intracranial aneurysm; vascular disorders; vessel wall imaging.

MeSH terms

Humans
Inflammation
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / pathology
Magnetic Resonance Imaging / methods
Pituitary Gland / pathology