• Shunsuke Omodaka, SugiyamaShin-IchiroSIDepartment of Neuroanesthesia, Kohnan Hospital, Sendai, Miyagi, Japan., Hiroyuki Sakata, Kenichi Funamoto, Takuhiro Yamaguchi, Kuniyasu Niizuma, and Hidenori Endo.
• Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
• Neurosurgery. 2024 Aug 8.

Background And ObjectivesRuptured aneurysms visualized by vessel wall MRI (VW-MRI) exhibit characteristic aneurysm wall enhancement (AWE). A secondary bulge of the aneurysmal wall, called a bleb, is often the site of rupture in ruptured aneurysms. We hypothesized that a higher degree of AWE would identify the rupture point in aneurysms with multiple blebs.MethodsAWE was quantitatively analyzed in consecutive ruptured intracranial aneurysms with multiple blebs (31 aneurysms with a total of 72 blebs) using VW-MRI. A 3-dimensional 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 AWE indicator. Bleb characteristics, including CRstalk and wall shear stress (WSS), were compared between ruptured and unruptured blebs. Odds ratios with 95% confidence intervals for ruptures were calculated by conditional logistic regression analysis.ResultsRuptured blebs had a higher CRstalk and lower WSS compared with unruptured blebs. CRstalk remained significantly associated with the bleb rupture status in the conditional logistic regression (adjusted odds ratio 3.9, 95% CIs 1.6-9.7).ConclusionAWE is associated with the bleb rupture status independent of WSS. Contrast-enhanced VW-MRI may be a useful noninvasive tool for identifying the rupture point and guiding the treatment strategy.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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