Inflow Angle Impacts Morphology, Hemodynamics, and Inflammation of Side-wall Intracranial Aneurysms

Mingzhu Fu; Fei Peng; Hao Niu; Xiaoxin He; Shuo Chen; Miaoqi Zhang; Jiaxiang Xia; Yishi Wang; Boya Xu; Aihua Liu; Rui Li

doi:10.1002/jmri.28234

Inflow Angle Impacts Morphology, Hemodynamics, and Inflammation of Side-wall Intracranial Aneurysms

J Magn Reson Imaging. 2023 Jan;57(1):113-123. doi: 10.1002/jmri.28234. Epub 2022 Jun 2.

Authors

Mingzhu Fu¹, Fei Peng^{2

3}, Hao Niu^{2

3}, Xiaoxin He^{2

3}, Shuo Chen¹, Miaoqi Zhang¹, Jiaxiang Xia^{2

3}, Yishi Wang⁴, Boya Xu^{2

3}, Aihua Liu^{2

3}, Rui Li¹

Affiliations

¹ Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China.
² Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
³ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
⁴ Philips Healthcare, Beijing, China.

PMID: 35652452
DOI: 10.1002/jmri.28234

Abstract

Background: Aneurysm inflow angle has been shown to be associated with hemodynamic changes by computational fluid dynamics. However, these studies were based on single aneurysm model and were limited to side-wall aneurysms.

Purpose: To investigate the association between inflow angle and morphology, hemodynamic, and inflammation of intracranial side-wall and bifurcation aneurysms.

Study type: Prospective.

Population: A total of 62 patients (aged 58.34 ± 12.39, 44 female) with 59 unruptured side-wall aneurysms and 17 unruptured bifurcation aneurysms were included.

Field strength/sequence: A 3.0 T; 3D fast field echo sequence (TOF-MRA); free-breathing, 3D radio-frequency-spoiled, multi-shot turbo field echo sequence (4D-flow MRI); 3D black-blood T1-weighted volumetric turbo spin echo acquisition sequence (T₁ -VISTA) ASSESSMENT: Two neuroradiologists assessed the inflow angle and size for intracranial aneurysms in 3D space with TOF-MRA images. The average and maximum inflow velocity (V_avg-IA , V_max-IA ), blood flow (Flow_avg-IA , Flow_max-IA ), and average wall shear stress (WSS_avg-IA ) for aneurysms were assessed from 4D-flow MRI in regions of interest drawn by two neuroradiologists. The aneurysmal wall enhancement (AWE) grades between precontrast and postcontrast T₁ -VISTA images were evaluated by three neuroradiologists.

Statistical tests: Kruskal-Wallis H test, χ² test, Pearson's correlation coefficient, scatter plots and regression lines, multivariate logistic regression analysis (partial correlation r) were performed. A P < 0.05 was considered statistically significant.

Results: The WSS_avg-IA (0.52 ± 0.34 vs. 0.27 ± 0.22) and AWE grades (1.38 ± 1.04 vs. 2.02 ± 0.68) between the two inflow angle subgroups of side-wall aneurysms were significantly different. The aneurysm size (r_s = 0.31), WSS_avg-IA (r_s = -0.45), and AWE grades (r_s = 0.45) were significantly correlated with inflow angle in side-wall aneurysms. While in bifurcation aneurysms, there were no significant associations between inflow angle and size (P = 0.901), V_avg-IA (P = 0.699), V_max-IA (P = 0.482), Flow_avg-IA (P = 0.550), Flow_max-IA (P = 0.689), WSS_avg-IA (P = 0.573), and AWE grades (P = 0.872).

Data conclusion: A larger aneurysm size, a lower WSS and a higher AWE grade were correlated with a larger inflow angle in side-wall aneurysms.

Evidence level: 3 TECHNICAL EFFICACY: Stage 2.

Keywords: Inflammation; hemodynamics; inflow angle; intracranial aneurysm; morphology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Hemodynamics / physiology
Humans
Imaging, Three-Dimensional
Inflammation / diagnostic imaging
Intracranial Aneurysm* / diagnostic imaging
Magnetic Resonance Imaging
Prospective Studies