Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study

被引:39
作者
Vakil, P. [1 ,3 ]
Ansari, S. A. [1 ]
Cantrell, C. G. [3 ]
Eddleman, C. S. [4 ]
Dehkordi, F. H. [5 ]
Vranic, J. [1 ]
Hurley, M. C. [1 ]
Batjer, H. H. [4 ]
Bendok, B. R. [2 ]
Carroll, T. J. [1 ,3 ]
机构
[1] Northwestern Univ, Dept Radiol, Chicago, IL 60611 USA
[2] Northwestern Univ, Dept Neurosurg, Chicago, IL 60611 USA
[3] Northwestern Univ, Dept Biomed Engn, Chicago, IL 60611 USA
[4] Univ Texas Southwestern, Dept Neurol Surg, Dallas, TX USA
[5] Western Illinois Univ, Dept Econ & Decis Sci, Macomb, IL 61455 USA
基金
美国国家卫生研究院;
关键词
CEREBRAL ANEURYSMS; NATURAL-HISTORY; LOW-GRADE; HEMODYNAMICS; INFLAMMATION; RUPTURE; GLIOMAS; ARTERY; BRAIN; SIZE;
D O I
10.3174/ajnr.A4225
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND AND PURPOSE: Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability (K-trans, V-L) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K-trans would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors. MATERIALS AND METHODS: Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters K-trans, V) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K-trans and V-L were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics. RESULTS: Interobserver agreement was strong as shown in regression analysis (R-2 > 0.84) and intraclass correlation (intraclass correlation coefficient >0.92), indicating that the K-trans can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA (P < .001). Regression analysis demonstrated a significant trend toward an increased K-trans with increasing aneurysm size (P < .001). Logistic regression showed that K-trans also predicted risk in anatomic (P = .02) and combined anatomic/clinical (P = .03) groups independent of size. CONCLUSIONS: We report the first evidence of dynamic contrast-enhanced MR imaging modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K-trans was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms.
引用
收藏
页码:953 / 959
页数:7
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