title: Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm.
abstract: BACKGROUND
  The aneurysm wall has been reported to play a critical role in the formation, development, and even rupture of an aneurysm. We used high-resolution magnetic resonance imaging (HRMRI) to investigate the aneurysm wall in an effort to identify evidence of inflammation invasion and define its relationship with aneurysm behavior.
  
  
  METHODS
  Patients with intracranial aneurysms who were prospectively evaluated using HRMRI between July 2013 and June 2014 were enrolled in this study. The aneurysm's wall enhancement and evidence of inflammation invasion were determined. In addition, the relationship between aneurysm wall enhancement and aneurysm size and symptoms, including ruptured aneurysms, giant unruputred intracranial aneurysms (UIAs) presenting as mass effect, progressively growing aneurysms, and aneurysms associated with neurological symptoms, was statistically analyzed.
  
  
  RESULTS
  Twenty-five patients with 30 aneurysms were available for the current study. Fourteen aneurysms showed wall enhancement, including 6 ruptured and 8 unruptured aneurysms. Evidence of inflammation was identified directly through histological studies and indirectly through intraoperative investigations and clinical courses. The statistical analysis indicated no significant correlation between aneurysm wall enhancement and aneurysm size. However, there was a strong correlation between wall enhancement and aneurysm symptoms, with a kappa value of 0.86 (95 % CI 0.68-1).
  
  
  CONCLUSIONS
  Aneurysm wall enhancement on HRMRI might be a sign of inflammatory change. Symptomatic aneurysms exhibited wall enhancement on HRMRI. Wall enhancement had a high consistent correlation of symptomatic aneurysms. Therefore, wall enhancement on HRMRI might predict an unsteady state of an intracranial saccular aneurysm.
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, Xicheng, Beijing, 100086, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Hu
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Clinical Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Dan-Dan
authors.initials: DD
authors.lastname: Wang
authors.affiliation: Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Shao-Chen
authors.initials: SC
authors.lastname: Guan
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Changchun Street 45#, Xicheng, Beijing, 100086, China. xwzhanghq@163.com.
authors.forename: Hong-Qi
authors.identifier: http://orcid.org/0000-0001-8740-6828
authors.initials: HQ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014657:Vasculitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Aneurysm wall; High-resolution magnetic resonance imaging; Inflammation; Intracranial aneurysms