• Daan Backes, Jeroen Hendrikse, Irene van der Schaaf, Ale Algra, Antti E Lindgren, Bon H Verweij, Rinkel Gabriel J E GJE Department of Neurology and Neuro-surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands., and Vergouwen Mervyn D I MDI Department of Neurology and Neuro-surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands..
• Department of Neurology and Neuro-surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
• Neurosurgery. 2018 Oct 1; 83 (4): 719-725.

BackgroundRecent studies suggest that gadolinium-enhancement of the aneurysm wall may reflect aneurysm wall inflammation, which might increase the risk of aneurysm growth or rupture.ObjectiveTo determine the prevalence of gadolinium-enhancement and its determinants in patients with predominantly small (<7 mm) unruptured intracranial aneurysms.MethodsWe performed 3 T MRI aneurysm wall imaging in patients with ≥1 unruptured aneurysm. With Poisson regression analysis, we calculated crude and adjusted risk ratios (RRs) with 95% confidence intervals (CI) to assess determinants of gadolinium-enhancement.ResultsGadolinium-enhancement was observed in 25/79 patients (32%; 95% CI: 21%-42%) and 26/89 aneurysms (29%; 95% CI: 20%-39%). With aneurysms 1.0-2.9 mm as reference, RRs were 4.6 (95% CI: 0.6-36.5) for 3.0 to 4.9 mm, 9.4 (95% CI: 1.3-67.2) for 5.0 to 6.9 mm, and 14.8 (95% CI: 2.1-104.6) for ≥7.0 mm. With internal carotid artery as reference, RRs adjusted for aneurysm size were 3.6 (95% CI: 1.1-11.4) for posterior communicating artery and 3.0 (95% CI: 1.0-8.6) for middle cerebral artery. RRs were 0.8 (95% CI: 0.4-1.8) for acetylsalicylic acid use, 0.9 (95% CI: 0.5-1.8) for statin use, 1.4 (95% CI: 0.7-2.8) for hypertension, 0.9 (95% CI: 0.4-1.8) for previous smoking, 0.9 (95% CI: 0.3-2.6) for never smoking, and 1.4 (95% CI: 0.7-2.7) for irregular aneurysm shape.ConclusionApproximately one-third of patients had gadolinium-enhancement. Because aneurysm size is the strongest determinant of gadolinium-enhancement and also an established predictor for aneurysm growth and rupture, prospective studies with serial imaging need to investigate if gadolinium-enhancement predicts aneurysm growth and rupture.

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