Systemic immune-inflammation index is associated with aneurysmal wall enhancement in unruptured intracranial fusiform aneurysms

Fei Peng; Jiaxiang Xia; Hao Niu; Xin Feng; Tianheng Zheng; Xiaoxin He; Boya Xu; Xuge Chen; Peng Xu; Hong Zhang; Jigang Chen; Xin Tong; Xiaoyan Bai; Zhiye Li; Yonghong Duan; Binbin Sui; Xingquan Zhao; Aihua Liu

doi:10.3389/fimmu.2023.1106459

Systemic immune-inflammation index is associated with aneurysmal wall enhancement in unruptured intracranial fusiform aneurysms

Front Immunol. 2023 Jan 27:14:1106459. doi: 10.3389/fimmu.2023.1106459. eCollection 2023.

Authors

Fei Peng¹, Jiaxiang Xia¹, Hao Niu¹, Xin Feng², Tianheng Zheng³, Xiaoxin He¹, Boya Xu¹, Xuge Chen¹, Peng Xu⁴, Hong Zhang⁵, Jigang Chen¹, Xin Tong¹, Xiaoyan Bai⁶, Zhiye Li⁶, Yonghong Duan⁴, Binbin Sui⁶, Xingquan Zhao⁷, Aihua Liu¹

Affiliations

¹ Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
³ College of Integrated Chinese and Western Medicine, Jining Medical University, Jining, China.
⁴ Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
⁵ Operating Room, Heze Municipal Hospital, Heze, Shandong, China.
⁶ Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China.
⁷ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Abstract

Introduction: Inflammation plays a key role in the progression of intracranial aneurysms. Aneurysmal wall enhancement (AWE) correlates well with inflammatory processes in the aneurysmal wall. Understanding the potential associations between blood inflammatory indices and AWE may aid in the further understanding of intracranial aneurysm pathophysiology.

Methods: We retrospectively reviewed 122 patients with intracranial fusiform aneurysms (IFAs) who underwent both high-resolution magnetic resonance imaging and blood laboratory tests. AWE was defined as a contrast ratio of the signal intensity of the aneurysmal wall to that of the pituitary stalk ≥ 0.90. The systemic immune-inflammation (SII) index (neutrophils × platelets/lymphocytes) was calculated from laboratory data and dichotomized based on whether or not the IFA had AWE. Aneurysmal symptoms were defined as sentinel headache or oculomotor nerve palsy. Multivariable logistic regression and receiver operating characteristic curve analyses were performed to determine how well the SII index was able to predict AWE and aneurysmal symptoms. Spearman's correlation coefficients were used to explore the potential associations between variables.

Results: This study included 95 patients, of whom 24 (25.3%) presented with AWE. After adjusting for baseline differences in neutrophil to lymphocyte ratios, leukocytes, and neutrophils in the multivariable logistic regression analysis, smoking history (P = 0.002), aneurysmal symptoms (P = 0.047), maximum diameter (P = 0.048), and SII index (P = 0.022) all predicted AWE. The SII index (P = 0.038) was the only independent predictor of aneurysmal symptoms. The receiver operating characteristic curve analysis revealed that the SII index was able to accurately distinguish IFAs with AWE (area under the curve = 0.746) and aneurysmal symptoms (area under the curve = 0.739).

Discussion: An early elevation in the SII index can independently predict AWE in IFAs and is a potential new biomarker for predicting IFA instability.

Keywords: aneurysmal wall enhancement; immune; inflammation; intracranial aneurysm; magnetic resonance imaging.

Publication types

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

MeSH terms

Headache
Humans
Inflammation
Intracranial Aneurysm* / diagnostic imaging
Magnetic Resonance Imaging / methods
Retrospective Studies

Grants and funding

This current study was supported by the National Natural Science Foundation of China (No.82171290; 81771233), Natural Science Foundation of Beijing Municipality (No. 7222050, L192013), Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20190501), and Horizontal Project in Beijing Tiantan Hospital (HX-A-027 [2021]), and Research and Promotion Program of Appropriate Techniques for Intervention of Chinese High-risk Stroke People (GN-2020R0007), and BTH Coordinated Development—Beijing Science and Technology Planning Project (Z181100009618035), and Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20190501), and Beijing Natural Science Foundation (L192013; 22G10396).