Abstract
Abstract 77: Three Dimensional Aneurysm Wall Enhancement Improves the Prediction of Symptomatic Presentation: A Multicenter Study
Stroke (1970), Vol.56(Suppl_1)
02/2025
DOI: 10.1161/str.56.suppl_1.77
Abstract
Abstract only Background: Managing unruptured intracranial aneurysms (IAs) involves balancing procedural risks with the long-term risk of rupture. Aneurysm wall enhancement (AWE) has been associated with aneurysm instability and symptomatic presentation. However, assessing AWE typically relies on subjective two-dimensional visual inspection, which lack objectivity. This study aims to evaluate a predictive model for symptomatic status by integrating clinical, morphological, and three dimensional-AWE (3D-AWE) metrics from a large dataset of IAs. Methods: Patients from three large academic center from the US and China, with saccular unruptured IAs underwent 3T high-resolution magnetic resonance imaging. Morphological assessment was conducted through angiographic studies. The determination of AWE was performed using a 3D-mapping pipeline that quantifies the average signal intensity of the aneurysm wall after contrast administration producing an objective metric: 3D-AWE (figure). Symptomatic status was defined by rupture, sentinel headaches, cranial nerve palsy, and focal neurological symptoms due to mass effect by the aneurysm. The optimal multivariate model for predicting symptomatic presentation of IAs was determined using an all-subsets regression approach. Results: A total of 389 IAs were included, with 73 (19%) being symptomatic at presentation. The model using clinical and morphological aneurysm variables achieved an AUC of 0.78, with 60% sensitivity and 86% specificity in identifying symptomatic aneurysms. Adding 3D-AWE metrics improved the model's performance, increasing the AUC to 0.82, with 73% sensitivity and 78% specificity. High-risk locations (anterior communicating, posterior communicating, and basilar arteries; OR 1.87, p 0.04), size ratio (OR 1.52, p<0.001), smoking (OR 1.91, p 0.07), and positive 3D-AWE (OR 7.09, p<0.001) were identified as independent predictors of symptomatic presentation. Conclusions: Incorporating objective 3D-AWE data enhanced the predictive performance of clinical and morphological information for detecting symptomatic IAs.
Details
- Title: Subtitle
- Abstract 77: Three Dimensional Aneurysm Wall Enhancement Improves the Prediction of Symptomatic Presentation: A Multicenter Study
- Creators
- Chengcheng Zhu - University of WashingtonElena Sagues - University of IowaBing Tian - Shangri-la InstituteHuilin Zhao - Renji HospitalAndres Gudino - University of IowaCarlos Dier - University of IowaIvonne Salinas - University of Iowa, NeurologyMartin Cabarique - University of Iowa, Iowa City, Iowa, United StatesLuis Noboa - University of IowaDiego Ojeda - University of HartfordEdgar Samaniego - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.56(Suppl_1)
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- DOI
- 10.1161/str.56.suppl_1.77
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/2025
- Academic Unit
- Iowa Neuroscience Institute; Neurosurgery; Radiology; Neurology
- Record Identifier
- 9984786446702771
Metrics
9 Record Views