Vessel Wall Imaging of Unruptured Intracranial Aneurysms: Ready for Prime Time? Not so Fast!

V.T. Lehman; W. Brinjikji

doi:10.3174/ajnr.A6048

Article Figures & Data

Tables

Major clinical studies characterizing saccular aneurysm wall enhancement on VWI

Study^a	Aneurysm Categories (Type, Any Enhancement Present) (No.)	Pattern of AWE	Degree of AWE^b	AWE Association with Size (Range) (mm)	Histopathologic Correlation
Matouk et al. Neurosurgery 2013;72:492–96	Ruptured (5/5)^c	Thick	Not assessed	Not assessed	No
	Unruptured (0/3)			(2–8)
	Total = 8
Edjlali et al. Stroke 2014;45:3704–06	Ruptured (16/17)	CAWE	Not assessed	No correlation to size of entire cohort	No
	Changing (5/5)			(4–8)
	Symptomatic (6/9)
	Other (22/77)
	Total = 108
Nagahata et al. Clin Neuroradiol 2014;26:277–83	Ruptured (60/61)	1) CAWE/PAWE grouped	1) Strong	No correlation to size in the unruptured cohort	No
	Unruptured (15/83)	2) Focal	2) Faint	(1–18)
	Total = 144		3) Absent
Liu et al. Interv Neuroradiol 2016;22:501–05	Unruptured (33/61)	Present or absent	Not assessed	AWE likelihood increased with size (only 12% of those <7 mm)	No
Liu et al. Interv Neuroradiol 2016;22:501–05	Total = 61			(2.9–30.5)
Omodaka et al. AJNR Am J Neuroradiol 2016;37:1262–66	Ruptured (28)	1) Circumferential signal intensity	Assessed as a signal intensity ratio	Not reported	No
	Unruptured (76)	2) Focal enhancement of bleb in some cases		>2 and <12
	Total = 104 (signal intensity cutoff values rather than absolute numbers determined)
Hu et al. Neuroradiology 2016; 58:979–85	Ruptured (6/6)	Partial or CAWE	Not assessed	No relationship of AWE to size found	Reported for 2 aneurysms (1 giant symptomatic and 1 ruptured) demonstrating inflammatory mediators
	Symptomatic (4/4)			Mean size = 11 ± 11.7
	Growing (1/1)
	Other (4/19)
	Total = 30
Fu et al. Clin Neuroradiol 2017 [Epub ahead of print]	Symptomatic (16/23)	CAWE	Not assessed	AWE not correlated to size in entire cohort	No
	Asymptomatic (6/22)			Mean size = 7.8 ± 4.5 for symptomatic aneurysms
	Total = 45
Wang. J Neurointerven Surg 2018;10:566–70	Ruptured (19/19)	1) CAWE	(Quantitative signal intensity analysis)	Not assessed	No
	Unruptured (64/87)	2) PAWE		(Unruptured 7.29 ± 6.60)
	Total = 106			(Ruptured mean size = 8.4 ± 4.8 for asymptomatic aneurysms)
Edjlali et al. Radiology 2018;289:181–87	Ruptured (23/26)	1) Focal thick	Not assessed	Correlation to size not assessed	No
	Symptomatic or growing/	2) Thin CAWE		Median size (5–6)
	changing (22/31)	3) Thick CAWE
	Other (106/276)
	Total = 333
Lv et al. Neurosurgery 2018 [Epub ahead of print]	Unruptured (82/140)	Present or absent	Not assessed	Positive association with size	No
Lv et al. Neurosurgery 2018 [Epub ahead of print]	Total = 140			(1.7–36.0)
Lv et al. World Neurosurg 2018;e338–43	Unruptured (16/30)	Present or absent	Not assessed	Positive association with size	No
Lv et al. World Neurosurg 2018;e338–43	Total = 30			(2.5–15.9)
Omodaka et al. Neurosurgery 2018;82:638–44	Ruptured (26)^c	Circumferential signal intensity	Signal intensity ratio of ruptured to unruptured aneurysms	Results adjusted for size, but not formally assessed	No
	Unruptured (36)			Ruptured (2.7–11.8)
	Total = 62			Unruptured (2.0–11.4)
Backes et al. Neurosurgery 2018;83:719–25	Unruptured (26/89)	Present or absent	Not assessed	Positive association with size	No
Backes et al. Neurosurgery 2018;83:719–25	Total = 89			(≤7)
Wang et al. J Neuroradiol 2019;46:25–28	Unruptured (65/88)	Present or absent	Not assessed	Positive association with size	No
Wang et al. J Neuroradiol 2019;46:25–28	Total = 88			3.6–7.9
Larsen et al. AJNR Am J Neuroradiol 2018;39:1617–21	Unruptured (6/13)	None/faint vs strong	None/faint vs strong	Enhancement present in 4/4 aneurysms ≥10 mm but absent in 7/9 <10 mm	Inflammatory mediators, neovascularization and vasa vasorum variably present in aneurysms with strong AWE; absent in those without AWE
Larsen et al. AJNR Am J Neuroradiol 2018;39:1617–21	Total = 13			(4–17)
Shimonaga et al. Stroke 2018;49:2516–19	Unruptured (5/6)	Present or absent	Not assessed	Not assessed	Thickening of the wall with vasa vasorum, inflammatory mediators (n = 5); thin vessel wall with a few macrophages with 3 others with walls not visible on 1.5T VWI
Shimonaga et al. Stroke 2018;49:2516–19	Total = 6 (additional aneurysms had walls not discernable on VWI)			(5.3–9.0)

Note:—CAWE indicates circumferential aneurysm wall enhancement; PAWE, partial aneurysm wall enhancement.
↵a Reports do not account for any aneurysm with duplicate reports in instances of 2 publications by the same institution/author.
↵b Not assessed beyond binary present/absent.
↵c All patients had at least 1 ruptured aneurysm.