title: Aneurysm wall enhancement on magnetic resonance imaging as a risk factor for progression of unruptured vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment.
abstract: OBJECTIVE The recurrence rate of vertebrobasilar dissecting aneurysms (VBDAs) after reconstructive endovascular treatment (EVT) is relatively high. The aneurysm wall enhancement on high-resolution MRI (HRMRI) reportedly predicts an unsteady state of an intracranial aneurysm. The authors used HRMRI to investigate the relationship between wall enhancement on HRMRI and progression of VBDAs after reconstructive EVT. METHODS From January 2012 to December 2015, patients with an unruptured VBDA who underwent reconstructive EVT were enrolled in this study. Preoperative enhanced HRMRI was performed to evaluate radiological characteristics. The relationships between aneurysm wall enhancement and various potential risk factors were statistically analyzed. Follow-up angiographic examination was performed with digital subtraction angiography and conventional HRMRI. Cox regression analysis was performed to identify predictors of VBDA progression after reconstructive EVT. RESULTS Eighty-two patients (12 women and 70 men, mean age 53.48 ± 9.23 years) with 83 VBDAs were evaluated in the current study. The average maximum diameter of the VBDAs was 11.30 ± 7.90 mm. Wall enhancement occurred in 43 VBDAs (51.81%). Among all 83 VBDAs, 62 (74.70%) were treated by stent-assisted coil embolization and 21 (25.30%) by stenting alone. The mean duration of imaging follow-up among all 82 patients was 10.55 months (range 6-45 months), and 15 aneurysms (18.07%) exhibited progression. The statistical analysis indicated no significant differences in age, sex, risk factors (high blood pressure, smoking, diabetes mellitus, and a high cholesterol level), VBDA stage, or VBDA size between enhanced and unenhanced VBDAs. Univariate Cox regression analysis showed that both the maximum diameter of the VBDAs and wall enhancement were associated with recurrence (p < 0.05). Multivariate Cox proportional hazard regression analysis showed that the maximum diameter of the VBDAs and wall enhancement on HRMRI were independent risk factors for aneurysm progression (p < 0.05). CONCLUSIONS Aneurysm size and wall enhancement on HRMRI can predict the progression of VBDAs after reconstructive EVT.
authors.affiliation: 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing.
authors.forename: Yisen
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: 2Department of Neuroimaging, Beijing Tiantan Hospital, Capital Medical University, Beijing; and.
authors.forename: Binbin
authors.initials: B
authors.lastname: Sui
authors.affiliation: 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing.
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.affiliation: 3Department of Neurosurgery, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province,China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing.
authors.forename: Zhongbin
authors.initials: Z
authors.lastname: Tian
authors.affiliation: 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing.
authors.forename: Junfan
authors.initials: J
authors.lastname: Chen
authors.affiliation: 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing.
authors.forename: Zhongxue
authors.initials: Z
authors.lastname: Wu
authors.affiliation: 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing.
authors.forename: Xinjian
authors.initials: X
authors.lastname: Yang
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D018450:Disease Progression; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: 3D-TOF = 3D time of flight; CI = confidence interval; DSA = digital subtraction angiography; EVT = endovascular treatment; FSE = fast spin-echo; HRMRI = high-resolution MRI; IMH = intramural hematoma; MRA = MR angiography; OR = odds ratio; TSE = turbo spin-echo; VBDA = vertebrobasilar dissecting aneurysm; endovascular treatment; high-resolution magnetic resonance imaging; intracranial dissecting aneurysm; progression; stent; vascular disorders; wall enhancement