Major clinical studies characterizing saccular aneurysm wall enhancement on VWI

StudyaAneurysm Categories (Type, Any Enhancement Present) (No.)Pattern of AWEDegree of AWEbAWE Association with Size (Range) (mm)Histopathologic Correlation
Matouk et al. Neurosurgery 2013;72:492–96Ruptured (5/5)cThickNot assessedNot assessedNo
Unruptured (0/3)(2–8)
Total = 8
Edjlali et al. Stroke 2014;45:3704–06Ruptured (16/17)CAWENot assessedNo correlation to size of entire cohortNo
Changing (5/5)(4–8)
Symptomatic (6/9)
Other (22/77)
Total = 108
Nagahata et al. Clin Neuroradiol 2014;26:277–83Ruptured (60/61)1) CAWE/PAWE grouped1) StrongNo correlation to size in the unruptured cohortNo
Unruptured (15/83)2) Focal2) Faint(1–18)
Total = 1443) Absent
Liu et al. Interv Neuroradiol 2016;22:501–05Unruptured (33/61)Present or absentNot assessedAWE likelihood increased with size (only 12% of those <7 mm)No
Total = 61(2.9–30.5)
Omodaka et al. AJNR Am J Neuroradiol 2016;37:1262–66Ruptured (28)1) Circumferential signal intensityAssessed as a signal intensity ratioNot reportedNo
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; 58:979–85Ruptured (6/6)Partial or CAWENot assessedNo relationship of AWE to size foundReported 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)CAWENot assessedAWE not correlated to size in entire cohortNo
Asymptomatic (6/22)Mean size = 7.8 ± 4.5 for symptomatic aneurysms
Total = 45
Wang. J Neurointerven Surg 2018;10:566–70Ruptured (19/19)1) CAWE(Quantitative signal intensity analysis)Not assessedNo
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;289:181–87Ruptured (23/26)1) Focal thickNot assessedCorrelation to size not assessedNo
Symptomatic or growing/2) Thin CAWEMedian 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 absentNot assessedPositive association with sizeNo
Total = 140(1.7–36.0)
Lv et al. World Neurosurg 2018;e338–43Unruptured (16/30)Present or absentNot assessedPositive association with sizeNo
Total = 30(2.5–15.9)
Omodaka et al. Neurosurgery 2018;82:638–44Ruptured (26)cCircumferential signal intensitySignal intensity ratio of ruptured to unruptured aneurysmsResults adjusted for size, but not formally assessedNo
Unruptured (36)Ruptured (2.7–11.8)
Total = 62Unruptured (2.0–11.4)
Backes et al. Neurosurgery 2018;83:719–25Unruptured (26/89)Present or absentNot assessedPositive association with sizeNo
Total = 89(≤7)
Wang et al. J Neuroradiol 2019;46:25–28Unruptured (65/88)Present or absentNot assessedPositive association with sizeNo
Total = 883.6–7.9
Larsen et al. AJNR Am J Neuroradiol 2018;39:1617–21Unruptured (6/13)None/faint vs strongNone/faint vs strongEnhancement present in 4/4 aneurysms ≥10 mm but absent in 7/9 <10 mmInflammatory mediators, neovascularization and vasa vasorum variably present in aneurysms with strong AWE; absent in those without AWE
Total = 13(4–17)
Shimonaga et al. Stroke 2018;49:2516–19Unruptured (5/6)Present or absentNot assessedNot assessedThickening 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
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.