title: Wall motion at 4D-CT angiography and surgical correlation in unruptured intracranial aneurysms: a pilot study.
abstract: BACKGROUND
  Unruptured intracranial aneurysms (UIAs) are reported more frequently nowadays but their management is not well established; it depends on different structural features of the aneurysms and on multiple patient's risk factors. With this prospective observational study we report our preliminary experience by using four-dimensional (4D) computed tomographic (CT) angiography with ECG-gated reconstructions in the evaluation of dynamic modifications of the aneurysm wall, as a potential predicting factor of growth or rupture. The novelty of this study consists in the correlation between Angio 4D-CT angiography images and surgical findings; only few scientific papers, in fact, have studied this issue.
  
  
  METHODS
  Thirty-one patients (1 male, 30 females; 59.0±12.7 years old) with 43 unruptured aneurysms (medium size: 5.2±3.0 mm) were studied. ECG-triggered 4D-CT angiography was performed with a 320-detector CT system (Aquilion ONE; Toshiba Medical Systems Corporation, Ōtawara, Japan); ECG-gated reconstruction was performed for visualizing local displacement of the aneurysmal wall over a heart cycle. In the aneurysms surgically treated in our institution we were able to compare the macroscopic features of the aneurysm wall with 4D-CTA findings. We performed long-term follow-up on untreated patients.
  
  
  RESULTS
  Pulsation was detected in 13 of 43 unruptured aneurysms. Eighteen aneurysms were treated: thirteen were surgically treated and five underwent embolization with detachable coil placement. In nine aneurysms surgically treated in our institution (5 with pulsation and 4 without) we observed a significant correlation between 4D-CTA findings and macroscopic features of the aneurysms wall, in particular the pulsations detected at 4D-CTA study have shown to correspond to dark-reddish thinner wall at surgery.
  
  
  CONCLUSIONS
  Our data confirm the previous reports concerning the reliability of 4D-CT angiography with ECG-gated reconstructions in defining the dynamic and structural features of the aneurysm wall. Moreover, optimal correlation rate between the findings provided by the 4D-CTA and the macroscopic surgical evaluation support a possible role of this technique to identify aneurysms with a higher risk of rupture.
authors.affiliation: Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ferrari
authors.affiliation: Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy - luigi.cirillo2@unibo.it.|Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cirillo
authors.affiliation: Department of Neurosurgery, Villalba Hospital, GVM, Care and Research, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Calbucci
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
authors.forename: Fiorina
authors.initials: F
authors.lastname: Bartiromo
authors.affiliation: Department of Diagnostic Imaging, Villalba Hospital, GVM, Care and Research, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ambrosetto
authors.affiliation: Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fioravanti
authors.affiliation: Department of Neuroradiology, University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Leonardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D055815:Young Adult