Journal article
Analysis of symptomatic brain aneurysms with three-dimensional aneurysm wall enhancement
Neurosurgical review, Vol.49(1), 159
01/24/2026
DOI: 10.1007/s10143-025-04120-w
PMCID: PMC12831663
PMID: 41579209
Abstract
Objective
To determine whether three-dimensional quantitative assessment of aneurysm wall enhancement (AWE) improves the identification of high-risk intracranial aneurysms (IAs) compared to existing risk scoring systems. This cross-sectional, multicenter observational study included patients with saccular IAs who prospectively underwent 3T high-resolution MRI between 2018 and 2023 at the University of Iowa, Changhai Hospital, and Ren Ji Hospital. IAs were classified as symptomatic if associated with rupture, sentinel headache, cranial nerve palsy, or neurological symptoms due to mass effect. AWE was quantified using three-dimensional aneurysm wall mapping. The diagnostic performance of the PHASES score was compared to a multivariate logistic regression model developed using all-subsets regression, incorporating PHASES components along with sex, smoking status, aneurysm morphology, and AWE data. A total of 334 patients with 387 saccular IAs were analyzed; 73 aneurysms (19%) were symptomatic. In multivariate analysis, three-dimensional circumferential AWE (3D-CAWE) was independently associated with symptomatic presentation (OR 6.1, 95% CI 2.1–19.5; p < 0.001). The PHASES score achieved an area under the curve (AUC) of 0.64 (95% CI 0.56–0.71) for discriminating symptomatic IAs. A comprehensive model including age, smoking status, size ratio, and 3D-CAWE significantly outperformed PHASES, achieving an AUC of 0.80 (95% CI 0.74–0.85; ΔAUC = 0.16, 95% CI 0.09–0.23; p < 0.001). A comprehensive risk model that integrates clinical variables, aneurysm morphological features, and 3D-CAWE significantly improves the classification of symptomatic IAs compared to the PHASES score alone.
Details
- Title: Subtitle
- Analysis of symptomatic brain aneurysms with three-dimensional aneurysm wall enhancement
- Creators
- Chengcheng Zhu - University of WashingtonElena Sagues - University of IowaBing Tian - Changhai HospitalHuilin Zhao - Renji HospitalAndres Gudino - University of IowaNavami Shenoy - University of IowaDiego Ojeda - University of ConnecticutCarlos Dier - University of IowaArshaq Saleem - University of IowaLinder Wendt - University of IowaSebastian Sanchez - Yale UniversityJacob M Miller - University of IowaLuis Noboa - University of IowaKatherine Guijarro-Falcon - University of IowaMatthew T Jones - University of IowaRandall Krug - University of IowaSantiago Ortega-Gutierrez - University of IowaDavid Hasan - Duke UniversityEdgar A Samaniego - University of Iowa, Iowa Neuroscience Institute
- Resource Type
- Journal article
- Publication Details
- Neurosurgical review, Vol.49(1), 159
- DOI
- 10.1007/s10143-025-04120-w
- PMID
- 41579209
- PMCID
- PMC12831663
- NLM abbreviation
- Neurosurg Rev
- ISSN
- 0344-5607
- eISSN
- 1437-2320
- Publisher
- Springer; NEW YORK
- Grant note
- UM1TR004403 / NCATS NIH HHS
- Language
- English
- Date published
- 01/24/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Orthopedics and Rehabilitation; Neurosurgery
- Record Identifier
- 9985130054702771
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