Artikel
Low wall shear stress is associated with presence of wall enhancement in vessel wall MRI of unruptured intracranial aneurysms
„Low wall shear stress“ ist assoziert mit Kontrastmittelaufnahme der Aneurysmawand in der MRT unrupturierter Aneurysmen – eine kombinierte Flussdynamik und „black blood“ MRT Analyse
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Veröffentlicht: | 8. Mai 2019 |
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Objective: Aneurysm wall enhancement (AWE) on Vessel wall MR imaging (VWMRI) has been suggested as an imaging biomarker for intracranial aneurysms (IAs) at higher risk of rupture. While retrospective computational fluid dynamic (CFD) studies have shown a link between hemodynamic forces and rupture status, the role of hemodynamic forces in unruptured aneurysm with AWE has not yet been investigated. We present our findings of AWE in VWMRI and associated hemodynamic forces in unruptured IAs.
Methods: Digital Subtraction Angiography (DSA) and VWMRI of N=25 consecutive patients were included from September 2016-2017, resulting in 22 patients with 25 aneurysms, 9 with and 16 without AWE. Patient-specific CFD models of hemodynamics were created from DSA. Univariate and multivariate analyses were performed to investigate the association between AWE and conventional morphological and hemodynamic factors.
Results: AWE group had low wall shear stress (p<0.001) and sac-averaged velocity (p<0.001), larger size (p<0.001), and higher size ratio (p=0.0116) and non-spherity index (p<0.01). From multivariate analysis of both hemodynamic and morphological factors, only low wall shear stress was found to be independently associated with AWE.
Conclusion: The presence of AWE was associated conventional rupture-risk morphological and hemodynamic factors. However, only low wall shear stress was found to be an independent predictor of AWE. Our findings suggest the hypothesis that low WSS may play an important role in aneurysm wall degradation, and VWMRI may be augmented with CFD-based hemodynamic factors.