Jorge A Roa1, Ryan P Sabotin2, Alberto Varon2, Ashrita Raghuram2, Devanshee Patel2, Timothy W Morris3, Daizo Ishii3, Yongjun Lu3, David M Hasan3, Edgar A Samaniego4. 1. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. 2. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. 3. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. 4. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Electronic address: edgarsama@gmail.com.
Abstract
OBJECTIVE: To correlate the presence of objectively measured wall enhancement on high-resolution vessel wall imaging (HR-VWI) with the clinical predictive scales PHASES, ELAPSS, and UIATS. METHODS: Patients with unruptured intracranial aneurysm (UIAs) prospectively underwent HR-VWI on a 3-T magnetic resonance imaging scanner at diagnosis. Aneurysmal wall enhancement was objectively quantified on T1 postcontrast magnetic resonance imaging using signal intensity values adjusted for the pituitary stalk to calculate a contrast ratio (CRstalk). UIAs with CRstalk ≥0.60 were considered "enhancing." Patients' demographics, comorbidities, and aneurysm morphology were reviewed to calculate PHASES, ELAPSS, and UIATS scores. Pearson coefficients were applied for statistical correlation. Univariable and multivariable logistic regressions were performed to assess for confounders. RESULTS: One-hundred and twenty-three patients harboring 178 UIAs underwent HR-VWI. A total of 101 patients with 135 UIAs were analyzed. Enhancing UIAs were larger (8.4 ± 5.5 mm vs. 5.5 ± 2.3 mm; P < 0.001), had higher aspect ratio (2.3 ± 1.5 vs. 1.8 ± 0.7; P = 0.008), higher size ratio (3.0 ± 1.8 vs. 2.4 ± 1.1; P = 0.016), scored higher on PHASES (5.6 ± 3.9 vs. 4.4 ± 2.6; P = 0.04) and ELAPSS (19.4 ± 8.9 vs. 15.4 ± 7.3; P = 0.006) compared with nonenhancing UIAs. Treatment allocation as defined by UIATS was measured independently to enhancement status. No significant differences were found for UIATS between enhancing and nonenhancing UIAs (P = 0.63). Multivariable regression showed that size was the only independent factor significantly associated with UIA enhancement (odds ratio, 1.76; P = 0.005). CONCLUSIONS: Enhancing UIAs score higher in PHASES and ELAPSS scales. This association is largely explained by aneurysm size, aspect, and size ratios. Morphologic UIA features should be accounted for in clinical predictive scales of aneurysm instability.
OBJECTIVE: To correlate the presence of objectively measured wall enhancement on high-resolution vessel wall imaging (HR-VWI) with the clinical predictive scales PHASES, ELAPSS, and UIATS. METHODS:Patients with unruptured intracranial aneurysm (UIAs) prospectively underwent HR-VWI on a 3-T magnetic resonance imaging scanner at diagnosis. Aneurysmal wall enhancement was objectively quantified on T1 postcontrast magnetic resonance imaging using signal intensity values adjusted for the pituitary stalk to calculate a contrast ratio (CRstalk). UIAs with CRstalk ≥0.60 were considered "enhancing." Patients' demographics, comorbidities, and aneurysm morphology were reviewed to calculate PHASES, ELAPSS, and UIATS scores. Pearson coefficients were applied for statistical correlation. Univariable and multivariable logistic regressions were performed to assess for confounders. RESULTS: One-hundred and twenty-three patients harboring 178 UIAs underwent HR-VWI. A total of 101 patients with 135 UIAs were analyzed. Enhancing UIAs were larger (8.4 ± 5.5 mm vs. 5.5 ± 2.3 mm; P < 0.001), had higher aspect ratio (2.3 ± 1.5 vs. 1.8 ± 0.7; P = 0.008), higher size ratio (3.0 ± 1.8 vs. 2.4 ± 1.1; P = 0.016), scored higher on PHASES (5.6 ± 3.9 vs. 4.4 ± 2.6; P = 0.04) and ELAPSS (19.4 ± 8.9 vs. 15.4 ± 7.3; P = 0.006) compared with nonenhancing UIAs. Treatment allocation as defined by UIATS was measured independently to enhancement status. No significant differences were found for UIATS between enhancing and nonenhancing UIAs (P = 0.63). Multivariable regression showed that size was the only independent factor significantly associated with UIA enhancement (odds ratio, 1.76; P = 0.005). CONCLUSIONS: Enhancing UIAs score higher in PHASES and ELAPSS scales. This association is largely explained by aneurysm size, aspect, and size ratios. Morphologic UIA features should be accounted for in clinical predictive scales of aneurysm instability.
Authors: James Feghali; Abhishek Gami; Risheng Xu; Christopher M Jackson; Rafael J Tamargo; Cameron G McDougall; Judy Huang; Justin M Caplan Journal: Neurosurg Rev Date: 2021-04-02 Impact factor: 3.042
Authors: Adam E Galloy; Ashrita Raghuram; Marco A Nino; Alberto Varon Miller; Ryan Sabotin; Carlos Osorno-Cruz; Edgar A Samaniego; Suresh M L Raghavan; David Hasan Journal: Front Neurol Date: 2021-12-10 Impact factor: 4.003
Authors: Ashrita Raghuram; Alberto Varon; Jorge A Roa; Daizo Ishii; Yongjun Lu; Madhavan L Raghavan; Chaorong Wu; Vincent A Magnotta; David M Hasan; Timothy R Koscik; Edgar A Samaniego Journal: Sci Rep Date: 2021-09-15 Impact factor: 4.379