Wall enhancement in unruptured posterior communicating aneurysms with oculomotor nerve palsy on magnetic resonance vessel wall imaging

Shunsuke Omodaka MD, PhD1,2, Hidenori Endo MD, PhD1,3, Kuniyasu Niizuma MD, PhD4,5, Toshiki Endo MD, PhD6, Kenichi Sato MD, PhD7, Atsushi Saito MD, PhD8, Hiroki Uchida MD, PhD1, Yasushi Matsumoto MD2, and Teiji Tominaga MD, PhD6
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  • 1 Departments of Neurosurgery and
  • | 2 Neuroendovascular Therapy, Kohnan Hospital, Sendai;
  • | 3 Division of Advanced Cerebrovascular Surgery and
  • | 4 Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University, Sendai;
  • | 5 Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai;
  • | 6 Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai;
  • | 7 Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai; and
  • | 8 Department of Neurosurgery, Sendai Medical Center, Sendai, Japan
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OBJECTIVE

Recent MR vessel wall imaging studies of unruptured intracranial aneurysms (UIAs) have revealed that aneurysm wall enhancement (AWE) can be an indicator for aneurysm evolution; however, the degree of AWE among different types of evolving UIAs has yet to be clarified. The authors assessed the degree of AWE in unruptured posterior communicating artery (PcomA) aneurysms with oculomotor nerve palsy (ONP), which may be a subgroup of evolving UIAs with rapid enlargement and high rupture risk.

METHODS

The degree of AWE was analyzed in 35 consecutive evolving PcomA aneurysms (19 with and 16 without ONP). UIAs were considered to be evolving when showing growth or ONP. A 3D T1-weighted fast spin echo sequence was obtained after contrast media injection, and the contrast ratio of the aneurysm wall against the pituitary stalk (CRstalk) was calculated as the indicator of AWE. The CRstalk in evolving UIAs with ONP was compared with that in UIAs without ONP.

RESULTS

The CRstalk was significantly higher in evolving UIAs with ONP than in those without ONP (0.85 vs 0.57; p = 0.006). In multivariable analysis, the CRstalk remained a significant indicator for ONP presentation in evolving UIAs (OR 6.13, 95% CI 1.21–31.06).

CONCLUSIONS

AWE was stronger in evolving PcomA aneurysms with ONP than in those without ONP, suggesting the potential utility of AWE for risk stratification in evolving UIAs. The degree of AWE can be a promising indicator of a rupture-prone UIA, which can be useful information for the decision-making process in the treatment of UIAs.

ABBREVIATIONS

AWE = aneurysm wall enhancement; CRstalk = contrast ratio of the aneurysm wall against the pituitary stalk; MR-VWI = MR vessel wall imaging; ONP = oculomotor nerve palsy; PcomA = posterior communicating artery; ROC = receiver operating characteristic; T1-FSE = T1-weighted fast spin echo; UIA = unruptured intracranial aneurysm.

Supplementary Materials

    • Supplemental Table 1 (PDF 394 KB)

Schematics of transseptal interforniceal resection of a superiorly recessed colloid cyst. ©Mark Souweidane, published with permission. See the article by Tosi et al. (pp 813–819).

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