Associations between haemodynamics and wall enhancement of intracranial aneurysm

BACKGROUND AND PURPOSE: Previous studies have reported about inflammation processes (IPs) that play important roles in aneurysm formation and rupture, which could be driven by blood flow. IPs can be identified using aneurysmal wall enhancement (AWE) on high-resolution black-blood MRI (BB-MRI) and blood flow haemodynamics can be demonstrated by four-dimensional-flow MRI (4D-flow MRI). Thus, this study investigated the associations between AWE and haemodynamics in unruptured intracranial aneurysms (IA) by combining 4D-flow MRI and high-resolution BB-MRI. MATERIALS AND METHODS: Between April 2014 and October 2017, 48 patients with 49 unruptured IA who underwent both 4D-flow MRI and high-resolution BB-MRI were retrospectively included in this study. The haemodynamic parameters demonstrated using 4D-flow MRI were compared between different AWE patterns using the Kruskal-Wallis test and ordinal regression. RESULTS: The results of Kruskal-Wallis test showed that the average wall shear stress in the IA (WSS(avg-IA)), maximum through-plane velocity in the adjacent parent artery, inflow jet patterns and the average vorticity in IA (vorticity(avg-IA)) were significantly associated with the AWE patterns. Ordinal regression analysis identified WSS(avg-IA) (p=0.002) and vorticity(avg-IA) (p=0.033) as independent predictors of AWE patterns. CONCLUSION: A low WSS and low average vorticity were independently associated with a high AWE grade for IAs larger than 4 mm. Therefore, WSS and average vorticity could predict AWE and circumferential AWE.